White coats, Black lives-racial trauma in Black pharmacists.

BACKGROUND: Race-based traumatic stress, or racial trauma, can negatively impact the health and wellbeing of Black health professionals. However, the effects of racial trauma among Black pharmacists have not been thoroughly explored. OBJECTIVE: The purpose of this study is to explore Black pharmacist experiences of race-based traumatic stress and its effects in the workplace. METHODS: This qualitative study utilized focus groups among a convenience sample of Black pharmacist attendees of a national convention for an organization dedicated to serving underserved communities and minoritized pharmacy professionals. The data were analyzed with inductive coding and thematic analysis as proposed by Braun and Clark. RESULTS: Three focus groups were conducted with a total of 22 participants. The majority of participants were female (77%), and the average age of the participants was 48.3 years old. Three themes related to racial trauma were identified. The participants described racial trauma as an ever-present phenomenon, tension with coworkers and institutions, and internal and external structures of support. The Black pharmacists in this study provided context and recommendations for employers to support their wellbeing. CONCLUSIONS: An awareness of the hidden wounds that Black pharmacists carry with them to work every day is an important factor in creating diverse and inclusive workplaces. The results of this study give Black pharmacists a voice and a chance to share with colleagues their distinct realities. Employers and institutions should assess individual needs and implement strategies to support Black pharmacists in creating more inclusive work and professional environments.

Baseline Assessment of Systemic Racism Education in Pharmacy Curricula.

Objective. To determine, by survey, the inclusion of systemic racism education in US Doctor of Pharmacy (PharmD) curricula and identify barriers and facilitators to addressing this content.Methods. A survey was developed and distributed to curricular representatives at US colleges and schools of pharmacy. The survey assessed inclusion of systemic racism education in curricula, faculty involvement in teaching systemic racism content, barriers to adding systemic racism content in curricula, and future curricular plans. Data were analyzed using descriptive statistics for institutional background information, curricular content, and barriers to inclusion. Relationships between the inclusion of systemic racism content at public versus private programs were examined, and associations between traditional and accelerated programs were assessed.Results. Fifty-eight colleges and schools of pharmacy provided usable responses. Of the respondents, 84% indicated that teaching systemic racism content and its impact on health and health care was a low priority. For 24% of respondents, systemic racism content was not currently included in their curriculum, while 34% indicated that systemic racism content was included in one or more courses or modules but was not a focus. Despite systemic racism content being offered in any didactic year, it was rarely included in experiential curricula. Top barriers to inclusion were lack of faculty knowledge and comfort with content and limited curricular space. No significant differences were found between program types.Conclusion. Based on the current level of systemic racism education and barriers to inclusion, faculty need training and resources to teach systemic racism concepts within pharmacy curricula. The inclusion of systemic racism concepts and guidance in the Accreditation Council for Pharmacy Education's Accreditation Standards could help to drive meaningful change and promote health equity.

Transition-Related Psychosocial Factors and Mental Health Outcomes in Former National Football League Players: An NFL-LONG Study.

Transition from professional sport to nonsport endeavors has implications for postcareer health and well-being of athletes. The purpose of the current study was to examine associations among transition-related psychosocial factors and current mental health outcomes in former National Football League (NFL) players. Participants were former NFL players (n = 1,784; mean age = 52.3 ± 16.3 years) who responded to a questionnaire assessing the nature of their discontinuation from professional football (i.e., any degree of voluntary choice vs. forced discontinuation), prediscontinuation transition planning (yes vs. no), and current symptoms of depression and anxiety. After adjusting for relevant covariates, having an involuntary discontinuation and no transition plan prior to discontinuation were associated with greater depressive and anxiety symptom severity. Autonomy in discontinuation and pretransition planning are important to former NFL football players' mental health. Increasing autonomy in the discontinuation decision and pretransition planning represent psychoeducational intervention targets for this population.

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.

Addressing the Need for Ethnic and Racial Diversity in the Pipeline for Pharmacy Faculty.

Objective To analyze the ethnic and racial diversity of faculty in pharmacy, medicine, and dentistry in the United States and suggest how the pipeline for pharmacy academe can be diversified.Methods A retrospective analysis of the representativeness of faculty at schools and colleges of pharmacy was compared to that in schools and colleges of medicine and dentistry. The range of ethnic and racial diversity across top schools of pharmacy, historically black colleges and universities (HBCUs), and newer schools of pharmacy was evaluated for both faculty and students for the year 2019-2020. The ethnic and racial diversity in residency and fellowship programs along with graduation rates provided insight into the available pipeline for future pharmacy faculty.Results Faculty in pharmacy, medicine, and dentistry demonstrated similarly low representation of underrepresented minorities (URMs) compared to their composition within the US population. Dentistry had the largest percentage of URMs (13.9%), compared with 8.5% in pharmacy and 7.1% in medicine. Five HBCUs contributed 32.8% of all Black faculty, yet their graduates had comparatively low residency match rates. The ratio of URM students to non-URM students in post-PharmD and graduate training programs is lower than the ratio of URM students to non-URM students in pharmacy programs.Conclusion Lack of access to postgraduate residency or fellowship training programs is a major barrier to progression to pharmacy academe and impacts URMs more significantly. Barriers to advanced training must be removed or decreased to create the needed diverse faculty candidates for pharmacy academe. Without intervention, students in pharmacy programs will be primarily trained by non-URM faculty, which may impact how graduates provide care in an increasingly diverse patient population.

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.

The (Contrasted) Ethics of Covid-19 and HIV: Will the Favor be Returned?

With 118,000 cases in 114 countries and 4291 global mortalities, the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. The origins were believed to be from Wuhan, China, and SARS CoV-2, a coronavirus, was quickly identified as the causative organism. Researchers at the National Institute of Health Vaccine Research Center identified the spike protein as the critical portion of the virus that allows for attachment to human cells. In just 66 days after identifying the genetic sequence, the first COVID-19 vaccine candidate began the enrollment of human subjects into a Phase I clinical trial. This accelerated effort was due to a collective and collaborative global response. Currently, one COVID-19 vaccine has been approved and two others have received an emergency use authorization (EUA) from the United States Food and Drug Administration (FDA). Thus, there has been a clear comparison of the COVID-19 response efforts and that which was utilized in addressing the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. For over four decades, the HIV/AIDS epidemic has been historically defined by a disproportionate number of infections and related mortalities amongst racially and ethnically minoritized individuals, including those that identify as homosexual. While novel drug therapies have been developed for the treatment of HIV/AIDS; there have been key components employed amid the global health response to COVID-19, that have been absent from the management of the HIV/AIDS epidemic. Majorly, the development and availability of vaccine against HIV/AIDS. Many of the ideas and initiatives that have resulted in a positive COVID-19 response and the eventual successful vaccination development; have been those learned from the trial and error of mitigating increasing global rates of HIV/AIDS infections. Hence, the question remains as to whether the lessons and approaches learned during the COVID-19 pandemic, namely vaccination development, will be applied to managing the HIV/AIDS epidemic. Herein, we aim to compare the HIV/AIDS epidemic and COVID-19 pandemic, by describing how the fight against HIV/AIDs equipped global scientific leaders with effective strategies to overcome future public health crises (COVID-19), discuss the ethical considerations associated with the differences in the global health responses to the HIV/ AIDS epidemic versus the COVID-19 pandemic, and finally, identify lessons learned from the COVID-19 pandemic that can be applied to the quest for an HIV/AIDS vaccine..

Racial disproportionality of students in United States colleges of pharmacy.

OBJECTIVE: To describe the disproportionality of racial and ethnic people of color (i.e., minorities) among the student body in schools and colleges of pharmacy (COPs) compared to county-specific United States Census Bureau data. METHODS: Data were obtained from national databases and published reports from the American Association of Colleges of Pharmacy. In addition, demographic information for enrollees of minority-serving institutions and predominantly white institutions was obtained and racial disproportionality was assessed to determine the degree of concordance between enrollees and the demographics of people within the county that the school was located. Data were evaluated using descriptive statistics. RESULTS: Compared to the general population in counties where COPs are located, Asians are over-represented while all other students of color are underrepresented. The top schools that have a negative disproportionality rate for Black students included Thomas Jefferson University (-40.49), Wayne State University (-40.13), Philadelphia College of Pharmacy (-39.90), and the University of Tennessee (-39.74).The top five schools that have a negative disproportionality rate of Hispanic students included Loma Linda University (-45.67), California Health Sciences (-45.64), the University of Southern California (-43.79), the University of the Pacific California (-37.95), and Texas Southern University (-36.65). The enrollments within most COPs do not reflect the racial and ethnic diversity of the counties in which they are located. CONCLUSIONS: To meet the healthcare needs of an increasingly diverse population, each institution should establish a strategic plan for increasing diversity and evaluating and adopting best practices.

The Racial and Ethnic Representation of Faculty in US Pharmacy Schools and Colleges.

Objective. To describe the representation of racial and ethnic minorities among faculty members (faculty) in schools and colleges of pharmacy (COP) compared to US Census Bureau data; to evaluate the representation of racial and ethnic minorities in historically black colleges and universities (HBCUs), newer doctor of pharmacy (PharmD) programs, and PharmD programs with a religious affiliation compared with all pharmacy programs; and to compare racial and ethnic pharmacy faculty data to trends in medical and dental schools, and all higher education. Methods. Information was obtained from national databases and published reports; data was comparatively evaluated. Results. Compared to the general population, Asians are overrepresented in pharmacy, while all other minority groups are underrepresented. The HBCUs, newer schools, and religious-affiliated institutions have greater numbers of African American/Black faculty. Newer schools also have better representation of Hispanic faculty. Pharmacy has been more successful than medicine and dentistry in recruiting African American/Black faculty, but lag behind dental schools in their representation of Hispanic faculty. Conclusion. To meet the health care needs of the population, we recommend the implementation of short-term and long-term diversity and inclusion strategies that address minority representation in COP.

Panobinostat: A histone deacetylase inhibitor for the treatment of relapsed or refractory multiple myeloma.

PURPOSE: The mechanism of action, pharmacodynamics, pharmacokinetics, clinical efficacy, interaction potential, adverse effects, and place in therapy of panobinostat are reviewed. SUMMARY: Panobinostat (Farydak, Novartis) is a novel pan-deacetylase inhibitor approved for use in combination with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma (RRMM) who have received at least two regimens containing an immunomodulatory drug and bortezomib. National Comprehensive Cancer Network (NCCN) guidelines recommend the use of panobinostat plus bortezomib and dexamethasone as a preferred regimen for previously treated multiple myeloma (MM). A Phase III trial comparing panobinostat or placebo use in combination with bortezomib and dexamethasone demonstrated improved median progression-free survival in the panobinostat group (11.99 months [95% CI, 10.33-12.94 months] versus 8.08 months [95% CI, 7.56-9.23 months]; hazard ratio, 0.63 [95% CI, 0.52-0.76]; p < 0.0001), as well as a significantly higher rate of complete or near complete response (27.6% [95% CI, 23.2-32.4%] versus 15.7% [95% CI, 12.2-19.8%]; p = 0.00006). Common grade 3 or 4 laboratory abnormalities and adverse events associated with panobinostat include thrombocytopenia, lymphopenia, diarrhea, asthenia, fatigue, and peripheral neuropathy. CONCLUSION: Panobinostat is a promising alternative to well-studied, NCCN-recommended regimens for the treatment of RRMM. It has demonstrated efficacy when used in combination with bortezomib and dexamethasone for the treatment of patients with MM who have received at least two prior regimens including bortezomib and an immunomodulatory agent. Despite the observed benefits, concern regarding toxicity may limit panobinostat use in practice.

Death with Dignity: The Developing Debate Among Health Care Professionals.

The right-to-die movement-known variously as death with dignity, physician-assisted suicide, or aid in dying-remains controversial. The recently publicized death of 29-year-old Brittany Maynard, who chose to end her life through physician-assisted suicide, forced many health care professionals to evaluate or re-evaluate their stance on the issue. Currently, only five states have aid-in-dying laws, but many others have bills under consideration. The legalized process for physician-assisted suicide has a strict set of procedures that physicians and patients must follow to ensure the competency and safety of all parties involved. Opposition against legalizing physician-assisted suicide encompasses more than simply moral, religious, or ethical differences. While some individuals believe that physician-assisted suicide gives patients autonomy in their end-of-life care, health care professionals also may have reservations about the liability of the situation. Pharmacists, in particular, play a pertinent role in the dispensing of, and counseling about, the medications used to assist patients in hastening their death. It is imperative that pharmacists be aware of the intended use of the particular medication so that they can make informed decisions about their participation and ensure that they perform all the necessary steps required to remain compliant with the laws or statutes in their jurisdiction. This practice places an increased burden on pharmacists to evaluate their opinion on the concept of death with dignity and whether or not they want to participate.

Opioid-induced pruritus.

Opioid analgesics are commonly used medications for the treatment of acute and chronic pain syndromes associated with multiple disease states. However, their use is often limited by adverse effects. Opioid-induced pruritus (OIP) is one of the most common adverse effects, affecting patients on oral and neuraxial opioids. Although not life-threatening, pruritus is an unpleasant side effect potentially contributing to patient discomfort, decreased quality of life, and noncompliance. The occurrence of pruritus varies with the type of opioid, dose, and method of administration. Pharmacists can make interventions that will optimize control of, or reduce the incidence of, OIP. An understanding of the receptors, mechanisms, incidence, and pharmacological therapies available to manage OIP is required knowledge for practitioners caring for patients who use opioids.

The type of responder T-cell has a significant impact in a human in vitro suppression assay.

BACKGROUND: In type 1 diabetes (T1D), a prototypic autoimmune disease, effector T cells destroy beta cells. Normally, CD4(+)CD25(+high), or natural regulatory T cells (Tregs), counter this assault. In autoimmunity, the failure to suppress CD4(+)CD25(low) T cells is important for disease development. However, both Treg dysfunction and hyperactive responder T-cell proliferation contribute to disease. METHODS/PRINCIPAL FINDINGS: We investigated human CD4(+)CD25(low) T cells and compared them to CD4(+)CD25(-) T cells in otherwise equivalent in vitro proliferative conditions. We then asked whether these differences in suppression are exacerbated in T1D. In both single and co-culture with Tregs, the CD4(+)CD25(low) T cells divided more rapidly than CD4(+)CD25(-) T cells, which manifests as increased proliferation/reduced suppression. Time-course experiments showed that this difference could be explained by higher IL-2 production from CD4+CD25(low) compared to CD4+CD25- T cells. There was also a significant increase in CD4+CD25(low) T-cell proliferation compared to CD4+CD25- T cells during suppression assays from RO T1D and at-risk subjects (n = 28, p = 0.015 and p = 0.024 respectively). CONCLUSIONS/SIGNIFICANCE: The in vitro dual suppression assays proposed here could highlight the impaired sensitivity of certain responder T cells to the suppressive effect of Tregs in human autoimmune diseases.

Purification of specific cell population by fluorescence activated cell sorting (FACS).

Experimental and clinical studies often require highly purified cell populations. FACS is a technique of choice to purify cell populations of known phenotype. Other bulk methods of purification include panning, complement depletion and magnetic bead separation. However, FACS has several advantages over other available methods. FACS is the preferred method when very high purity of the desired population is required, when the target cell population expresses a very low level of the identifying marker or when cell populations require separation based on differential marker density. In addition, FACS is the only available purification technique to isolate cells based on internal staining or intracellular protein expression, such as a genetically modified fluorescent protein marker. FACS allows the purification of individual cells based on size, granularity and fluorescence. In order to purify cells of interest, they are first stained with fluorescently-tagged monoclonal antibodies (mAb), which recognize specific surface markers on the desired cell population (1). Negative selection of unstained cells is also possible. FACS purification requires a flow cytometer with sorting capacity and the appropriate software. For FACS, cells in suspension are passed as a stream in droplets with each containing a single cell in front of a laser. The fluorescence detection system detects cells of interest based on predetermined fluorescent parameters of the cells. The instrument applies a charge to the droplet containing a cell of interest and an electrostatic deflection system facilitates collection of the charged droplets into appropriate collection tubes (2). The success of staining and thereby sorting depends largely on the selection of the identifying markers and the choice of mAb. Sorting parameters can be adjusted depending on the requirement of purity and yield. Although FACS requires specialized equipment and personnel training, it is the method of choice for isolation of highly purified cell populations.

Research in women and special populations.

The American College of Clinical Pharmacy charged a Task Force on Research in Special Populations to review, update, and broaden its 1993 White Paper on Women as Research Subjects. Participants of the task force included pharmacy clinicians and investigators in the field. This resulting White Paper, Research in Women and Special Populations, discusses the current concepts regarding the conduct of research in women, as well as in special populations such as children, elderly, minorities, cognitively impaired, and other vulnerable populations (e.g., prisoners and refugees). For each specific population, the barriers to research participation, current guidelines and regulations, and available recommendations to address these barriers are discussed. The participation in research by these populations requires addressing special social and ethical challenges. Clinical pharmacy researchers should be cognizant of these guidelines and be an advocate for the inclusion and the rights of women and special populations in research participation.

The "staircase test": a measure of independent forelimb reaching and grasping abilities in rats.

A novel reaching test for the rat has been developed to assess the independent use of forelimbs in skilled reaching and grasping tasks. The apparatus is a plexiglas box with a removable baited double staircase. Food pellets are placed on the staircase and presented bilaterally at 7 graded stages of reaching difficulty to provide objective measures of side bias, maximum forelimb extension and grasping skill. In the present experiment, the apparatus was used to assess the reaching performance of rats following unilateral lesions of the sensorimotor cortex, unilateral lesions of the posterior cortex or bilateral lesions of the olfactory bulbs. The task has the advantage of objective over rating measurement, and the simplicity of the apparatus permits many animals to be tested concurrently.