Effect of a Community Health Worker-Led Intervention Among Low-Income and Minoritized Patients With Cancer: A Randomized Clinical Trial.

PURPOSE: To determine whether a community health worker (CHW)-led intervention could improve health-related quality of life (HRQoL; primary outcome) more than usual care among low-income and racial and ethnic minoritized populations newly diagnosed with cancer. METHODS: This randomized clinical trial was conducted from November 1, 2018, until August 31, 2021, in outpatient cancer clinics in Atlantic City, NJ, and Chicago, IL. Hourly low-wage worker members of an employer union health fund age 18 years or older with newly diagnosed solid tumor and hematologic malignancies were randomly assigned 1:1 to usual care (control group) or usual care augmented with a trained CHW for 12 months (intervention group). The CHW assisted participants with advance care planning (ACP), proactively screened symptoms, and referred participants to community-based resources for identified health-related social needs. Usual care comprised nurse case management and benefits redesign (waived copayments and free transportation for any cancer care received at preferred oncology clinics in each city). The primary outcome was HRQoL. Secondary outcomes included patient activation, satisfaction with decision, ACP documentation, health care use, total health care costs, and overall survival. RESULTS: A total of 160 participants were enrolled. Intervention group participants had a greater increase in mean HRQoL scores at 4-month and 12-month follow-up as compared with baseline than control group participants (expected mean difference, 11.25 [95% CI, 7.28 to 15.22]; 11.29 [95% CI, 6.96 to 15.62], respectively). CONCLUSION: In this randomized trial, a CHW-led intervention significantly improved HRQoL for low-income and racial and ethnic minoritized patients with cancer more than usual care alone.

Global pen pal education intervention among student pharmacists: A pilot project.

INTRODUCTION: Global health, a practice that prioritizes improving health and achieving health equity for all people worldwide, is a priority for pharmacists, schools, and pharmacy colleges. Several initiatives aim to enhance faculty and student exchanges while promoting projects and initiatives among thriving universities and under-resourced countries and institutions. While many organizations recognize the benefit of global collaboration, as demonstrated by the adoption of the 2012 American Association of Colleges of Pharmacy Strategic Plan, which calls for increased global experiences for faculty and students, the COVID-19 pandemic created a demand for international engagement within pharmacy practice. The objective of this study was to evaluate students' perceptions and attitudes toward incorporating a global pharmacy pen pal (PPP) exchange within the pharmacy curricula at two schools/colleges of pharmacy. METHODS: This mixed-method study included assigned engagement within a required or elective didactic course, followed by a post-experience survey. Each student was pre-assigned a pen pal from a cohort of pharmacy students residing in 11 countries for the assignment. RESULTS: In total, 184 students completed the learning experience, and across both sites, 63 students completed the post-experience survey. The students' impressions of the PPP varied by site, yet most participants reported an improved awareness of pharmacy practice in other countries.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum.

Objective. To identify and review strategies reported in the literature for strengthening instruction about both health disparities and cultural competency (HDCC) within various portions of the Doctor of Pharmacy curriculum and co-curriculum.Findings. The classroom strategies reported in the literature for incorporating HDCC into the PharmD curriculum involved teaching a single course or series of courses in HDCC. Activities found to be effective in teaching HDCC were those that involved case-based and community engagement exercises. Recommendations for incorporating HDCC into the experiential education included preceptor development in areas of HDCC to assess student understanding of health disparities concepts, increasing student engagement with diverse patient populations, and implementation of cross-cultural communication models at clinical sites. Co-curricular and interprofessional (IPE) portions of pharmacy training were found to permit greater methodological flexibility for incorporating training in HDCC, as they often confronted fewer time or space constraints than classroom endeavors. Documented methods for teaching HDCC within co-curricular and IPE experiences included service learning, study abroad, symposia, and forums.Summary. There is a paucity of literature describing processes for incorporation of health disparities and cultural competency education and training into the PharmD program. Findings suggest that conceptual frameworks for HDCC should be used throughout the pharmacy curriculum, with learning activities mapped to relevant pharmacy education standards to ensure coverage of important practice competencies. Best practices also involve the use of contemporary tools, strategies, and resources from a cross-section of disciplines that provide opportunities for learners to correct misconceptions and biases through active situational problem-solving.

Conceptualizing Social Ecological Model in Pharmacy to Address Racism as a Social Determinant of Health.

Racism has been declared a public health crisis. The COVID-19 pandemic has highlighted inequities in the US health care system and presents unique opportunities for the pharmacy Academy to evaluate the training of student pharmacists to address social determinants of health among racial and ethnic minorities. The social ecological model, consisting of five levels of intervention (individual, interpersonal, organizational, community, and public policy) has been effectively utilized in public health practice to influence behavior change that positively impacts health outcomes. This paper adapted the social ecological model and proposed a framework with five intervention levels for integrating racism as a social determinant of health into pharmacy curricula. The proposed corresponding levels of intervention for pharmacy education are the curricular, interprofessional, institutional, community, and accreditation levels. Other health professions such as dentistry, medicine, and nursing can easily adopt this framework for teaching racism and social determinants of health within their respective curricula.

Socialized and traumatized: Pharmacists, underserved patients, and the COVID-19 vaccine.

The coronavirus disease 2019 (COVID-19) pandemic has brought attention and awareness to existing health disparities in underrepresented minority communities. Not only were minoritized populations disproportionately and negatively affected by COVID-19, but a history of mistrust and other systemic barriers prevented access to treatment and testing and even affected access and acceptance of the current vaccines. Pharmacists are essential to the provision of care for the general population, particularly during global crises. Minoritized pharmacists play an even greater role as partners with public health officials to translate science and build trust in minoritized community members who are hesitant about vaccine development, safety, and efficacy. Dedicated to representing the views and ideals of minority pharmacists on critical issues affecting health care, the National Pharmaceutical Association (NPhA) has been at the forefront of the pandemic. Throughout the pandemic, NPhA has prioritized the role of underrepresented practitioners, striving to improve awareness and access to underrepresented communities. While delivering education and information about the COVID-19 vaccine, clinical trials, population prioritization, and federal funding to our service areas and target populations, NPhA continues to challenge health care myths and address historical conflicts and systemic racism that often dictate the access to treatment and quality health care.

Experiential education accommodations for students with disabilities in United States pharmacy schools: An exploratory study.

INTRODUCTION: We sought to identify challenges and possible outcomes for pharmacy schools providing accommodations on experiential rotations for students with disabilities. METHODS: A survey was developed and sent to the experiential education departments of pharmacy schools across the nation and anonymous responses were collected. Quantitative survey results were assessed using descriptive statistics, and qualitative results were assessed using thematic analysis. RESULTS: A total of 43 individuals who self-identified as current members of the experiential education department of their school responded to the survey. Student, preceptor, and institutional challenges and barriers were identified, and various approaches to providing accommodations for students with disabilities during experiential rotations were described. CONCLUSIONS: Providing accommodations for students on experiential rotations remains a challenge for pharmacy programs. However, guidance for pharmacy schools on proper support of students with disabilities on experiential rotations remains limited.

Assessment of a multi-institution integration of cultural competency activities.

INTRODUCTION: To meet educational standards and provide effective patient care, student pharmacists must be well-prepared to interact with a diverse patient population. Thus, the objective was to assess the effectiveness of four different active learning strategies in enhancing the cultural competency (CC) of student pharmacists at multiple institutions. METHODS: Across two years, eight colleges/schools of pharmacy integrated two sets of CC activities with different student cohorts (first-third professional year) that were designed to address different aspects of CC. Pre- and post-activity, a modified electronic version of the Clinical Cultural Competency Questionnaire (CCCQ) that included the addition of activity-specific questions was distributed to students. RESULTS: A total of 1009 students participated in these activities across eight colleges of pharmacy. The integration of activities resulted in significant increases in most items on three of the four subscales of the CCCQ (knowledge, skills, and encounters/situations). Items on the attitude subscale remained the same. Students also felt the activities were beneficial in addressing their intent. CONCLUSIONS: Faculty were able to incorporate these activities throughout their respective curricula with minimal time commitment and resources. The activities improved student perceptions of their CC knowledge, skills, and ability to handle encounters and situations. These activities may be useful for other institutions as they determine the best approach to improve student CC and prepare them for practice.

Euphorbia bicolor (Euphorbiaceae) Latex Phytochemicals Induce Long-Lasting Non-Opioid Peripheral Analgesia in a Rat Model of Inflammatory Pain.

The negative side effects of opioid-based narcotics underscore the search for alternative non-opioid bioactive compounds that act on the peripheral nervous system to avoid central nervous system-mediated side effects. The transient receptor potential V1 ion channel (TRPV1) is a peripheral pain generator activated and sensitized by heat, capsaicin, and a variety of endogenous ligands. TRPV1 contributes to peripheral sensitization and hyperalgesia, in part, via triggering the release of proinflammatory peptides, such as calcitonin gene-related peptide (CGRP), both locally and at the dorsal horn of the spinal cord. Ultrapotent exogenous TRPV1 agonists, such as resiniferatoxin identified in the latex of the exotic Euphorbia resinifera, trigger hyperalgesia followed by long lasting, peripheral analgesia. The present study reports on the analgesic properties of Euphorbia bicolor, a relative of E. resinifera, native to the Southern United States. The study hypothesized that E. bicolor latex extract induces long-lasting, non-opioid peripheral analgesia in a rat model of inflammatory pain. Both inflamed and non-inflamed adult male and female rats were injected with the methanolic extract of E. bicolor latex into the hindpaw and changes in pain behaviors were reassessed at various time points up to 4 weeks. Primary sensory neuron cultures also were treated with the latex extract or vehicle for 15 min followed by stimulation with the TRPV1 agonist capsaicin. Results showed that E. bicolor latex extract evoked significant pain behaviors in both male and female rats at 20 min post-injection and lasting around 1-2 h. At 6 h post-injection, analgesia was observed in male rats that lasted up to 4 weeks, whereas in females the onset of analgesia was delayed to 72 h post-injection. In sensory neurons, latex extract significantly reduced capsaicin-evoked CGRP release. Blocking TRPV1, but not opioid receptors, attenuated the onset of analgesia and capsaicin-induced CGRP release. Latex was analyzed by mass spectrometry and eleven candidate compounds were identified and reported here. These findings indicate that phytochemicals in the E. bicolor latex induce hyperalgesia followed by peripheral, non-opioid analgesia in both male and female rats, which occurs in part via TRPV1 and may provide novel, non-opioid peripheral analgesics that warrant further examination.

Brigatinib: Novel ALK Inhibitor for Non-Small-Cell Lung Cancer.

OBJECTIVE: We review here the pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, potential drug-drug interactions and place in therapy of brigatinib for abnormal anaplastic lymphoma kinase (ALK) specific non-small-cell lung cancer (NSCLC). DATA SOURCES: A literature search using PubMed was conducted using the terms brigatinib and ALK positive NSCLC from January 2013 to November 2018. STUDY SELECTION AND DATA EXTRACTION: All English-language articles evaluating brigatinib were analyzed for this review. DATA SYNTHESIS: Brigatinib was granted approval for the treatment of patients with metastatic ALK+ NSCLC who have progressed on or are intolerant to crizotinib. It is administered at a dose of 90 mg orally once daily for the first 7 days then, if tolerated, increased to a dose of 180 mg orally once daily. Common adverse effects include nausea, fatigue, diarrhea, increased creatine phosphokinase levels, headache, dyspnea, and hypertension. Serious treatment-emergent adverse effects were pulmonary related. Relevance to Patient Care and Clinical Practice: This article discusses the clinical trials that led to the accelerated approval of brigatinib for its ability to overcome crizotinib-resistant mutations and for its increased central nervous system penetration properties. CONCLUSION: Brigatinib was granted accelerated approval for the treatment of patients with metastatic ALK+ NSCLC who have progressed on or are intolerant to crizotinib. In a subset of NSCLC patients, brigatinib increases survival for approximately 1 year; however, side effects were detected.

Oxygen supply did not affect how lizards responded to thermal stress.

Zoologists rely on mechanistic niche models of behavioral thermoregulation to understand how animals respond to climate change. These models predict that species will need to disperse to higher altitudes to persist in a warmer world. However, thermal stress and, thus, thermoregulatory behavior may depend on atmospheric oxygen as well as environmental temperatures. Severe hypoxia causes animals to prefer lower body temperatures, which could be interpreted as evidence that oxygen supply limits heat tolerance. Such a constraint could prevent animals from successfully dispersing to high elevations during climate change. Still, an effect of oxygen supply on preferred body temperature has only been observed when oxygen concentrations fall far below levels experienced in nature. To see whether animals perceive greater thermal stress at an ecologically relevant level of hypoxia, we studied the thermoregulatory behavior of lizards (Sceloporus tristichus) exposed to oxygen concentrations of 13% and 21% (equivalent to PO2 at 4000 m and 0 m, respectively). In addition, we exposed lizards to 29% oxygen to see whether they would accept a higher body temperature at hyperoxia than at normoxia. At each oxygen level, we measured a behavioral response to heat stress known as the voluntary thermal maximum: the temperature at which a warming animal sought a cool refuge. Oxygen concentration had no discernable effect on the voluntary thermal maximum, suggesting that lizards experience thermal stress similarly at all 3 levels of oxygen (13%, 12% and 29%). Future research should focus on thermoregulatory behaviors under ecologically relevant levels of hypoxia.

Jazzin' Healthy: Interdisciplinary Health Outreach Events Focused on Disease Prevention and Health Promotion.

OBJECTIVES: Health-related disparities are a significant public health concern. In conjunction with a university concert series, healthcare professionals and students provided education, clinical services, and preventive care using an interdisciplinary approach to a primarily African American cohort. The objective was to assess cardiovascular risk factors and readiness to change health-related behaviors. METHODS: Six outreach events were conducted over 3 years by an interdisciplinary team including pharmacy, medicine, nursing, nutrition, occupational therapy, public health, optometry, and health information technology. Clinical services, such as health screenings for glucose, blood pressure, cholesterol, and body fat along with counseling on the results and smoking cessation behavioral counseling, were provided. Education initiatives addressed bone health, heart disease, HIV risk, nutrition, and access to physician care. Preventative care included vaccinations and eye exams. RESULTS: There were 285 participants that were predominantly African American (95.8 %), female (71.5 %), and age within 55-64 years (45.1 %). Hypertension (50.8 %) and obesity (65.1 %) were the most common cardiovascular risk factors. Of those advised to make health behavior changes, 76.4 % reported they planned to make changes within 1 month. CONCLUSION: These interdisciplinary outreach events provided health information and access to care in a novel setting and led to a high rate of planned health behavior changes.

Lizards fail to plastically adjust nesting behavior or thermal tolerance as needed to buffer populations from climate warming.

Although observations suggest the potential for phenotypic plasticity to allow adaptive responses to climate change, few experiments have assessed that potential. Modeling suggests that Sceloporus tristichus lizards will need increased nest depth, shade cover, or embryonic thermal tolerance to avoid reproductive failure resulting from climate change. To test for such plasticity, we experimentally examined how maternal temperatures affect nesting behavior and embryonic thermal sensitivity. The temperature regime that females experienced while gravid did not affect nesting behavior, but warmer temperatures at the time of nesting reduced nest depth. Additionally, embryos from heat-stressed mothers displayed increased sensitivity to high-temperature exposure. Simulations suggest that critically low temperatures, rather than high temperatures, historically limit development of our study population. Thus, the plasticity needed to buffer this population has not been under selection. Plasticity will likely fail to compensate for ongoing climate change when such change results in novel stressors.

Understanding of Medication Directions: Assessment of Native Korean Older Adults.

OBJECTIVE: Investigate the knowledge and understanding of older adult Korean immigrants concerning prescription and over-the-counter medication directions. DESIGN: A pre- postsurvey study. SETTING: Four Korean churches located in the suburbs of Chicago, Illinois. PARTICIPANTS: Korean-born, community-dwelling older adults older than 50 years of age. INTERVENTION: A presurvey in English was administered to older Korean immigrants residing in the Northwest Chicago suburbs, who completed it independently. Two student pharmacists then conducted a short medication seminar in Korean, and a postsurvey was given to determine if the information improved their overall understanding about the medications. MAIN OUTCOME MEASURES: The primary goal of this study was to determine if Korean older adults' understanding of medication directions improved when explained in their native language. RESULTS: After two student pharmacists delivered the seminar, there was an improvement in both the participants' understanding of medication directions and their perceived trust in pharmacists. CONCLUSIONS: There is a lack of understanding of medication directions by Korean immigrant older adults, even when information is communicated in their native tongue. This research demonstrates that educating the Korean older adult population, while also building a relationship of trust with pharmacists, will improve their understanding of the medication directions and possibly reduce the rate of medication errors.

Role of a percutaneous ventricular assist device in decision making for a cardiac transplant program.

BACKGROUND: The role of a percutaneous ventricular assist device (VAD) for left heart support in the management of patients in cardiogenic shock is not well defined. METHODS: All patients who received LV support using the percutaneous TandemHeart (percTH) ventricular support device (Cardiac Assist, Pittsburgh, PA) were retrospectively reviewed. Indications for insertion included bridge to decision (BTD) or "salvage" and bridge to transplant (BTT). RESULTS: Between April 2005 and December 2008, 22 percTH devices were successfully implanted in patients (13 men) with isolated left heart failure. Mean duration of support was 6.8 +/- 9.4 days (median, 4; maximum, 45 days). Of patients requiring percTH support for at least 3 days, mean pump flows were 3.77 +/- 1.10, 4.22 +/- 0.69, and 4.04 +/- 0.41 L/min on at days 1, 2, and 3. Mean serum aspartate aminotransferase levels were 455 +/- 994 mg/dL before percTH, 551 +/- 1046 mg/dL at day 1, and 231 +/- 225 mg/dL at day 3 after percTH. No mechanical device failure, device-related infections, or cerebrovascular accidents occurred. Ten of 11 BTT patients were successfully bridged. Support was withdrawn in 7 of 11 BTD patients. The percTHs were successfully explanted in 4 BTD patients: 1 as recovery, 1 direct to transplant, and 2 to VAD. CONCLUSIONS: The percTH was reliable, with no mechanical device failures and minimal associated adverse events. We support the use of the percTH in the BTD mode, allowing time for a more complete evaluation of neurologic and end-organ status without the added expense and morbidity of a long-term VAD.

Favorable outcome after aggressive treatment of infection in a diabetic patient with MRSA-related IgA nephropathy.

IgA immune complex deposition is not commonly seen with acute postinfectious glomerulonephritis secondary to staphylococcal infections. Its deposition is usually indicative of IgA nephropathy or Henoch-Schonlein purpura nephritis. We describe a patient with a history of diabetes mellitus who was admitted with methicillin resistant Staphylococcus aureus bacteremia and subsequent demonstration on renal biopsy of crescentic glomerulonephritis associated with codominant IgA and C3 immune deposits and early changes of diabetic nephropathy. After aggressive treatment of infection, which included bilateral metatarsal amputation and subsequent left below-the-knee amputation as well as antibiotic administration for persistent osteomyelitis, the patient's renal function progressively improved with a reduction in serum creatinine concentration from 6.1 mg/dL (539 micromol/L) to 2.7 mg/dL (239 micromol/L). On a 3-year follow-up evaluation, his serum creatinine concentration was 1.7 mg/dL (150 micromol/L) and urine was negative for protein and blood.

The analysis of an intracerebral hematoma for drugs of abuse.

Toxicological investigations were performed on an intracerebral hematoma, antemortem blood, and postmortem blood of an individual who was found unresponsive in his home. The hematoma was found to have ethanol at a concentration of 0.05% (w/v), and benzoylecgonine (a cocaine metabolite) was also confirmed at a concentration of 0.43 mg/L by specific analysis using gas chromatography/mass spectrometry (GC/MS). These results enabled the pathologist to record the cause of death as intracerebral hemorrhage due to acute cocaine intoxication.