Getting started writing a personal diversity statement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Morphology of the Occipital Bones and Foramen Magnum Resulting From Premature Minor Suture Fusion in Crouzon Syndrome.

To identify skull-base growth patterns in Crouzon syndrome, we hypothesized premature minor suture fusion restricts occipital bone development, secondarily limiting foramen magnum expansion.Skull-base suture closure degree and cephalometric measurements were retrospectively studied using preoperative computed tomography (CT) scans and multiple linear regression analysis.Evaluation of multi-institutional CT images and 3D reconstructions from Wake Forest's Craniofacial Imaging Database (WFCID).Sixty preoperative patients with Crouzon syndrome under 12 years-old were selected from WFCID. The control group included 60 age- and sex-matched patients without craniosynostosis or prior craniofacial surgery.None.2D and 3D cephalometric measurements.3D volumetric evaluation of the basioccipital, exo-occipital, and supraoccipital bones revealed decreased growth in Crouzon syndrome, attributed solely to premature minor suture fusion. Spheno-occipital (ß = -398.75; P < .05) and petrous-occipital (ß = -727.5; P < .001) suture fusion reduced growth of the basioccipital bone; lambdoid suture (ß = -14 723.1; P < .001) and occipitomastoid synchondrosis (ß = -16 419.3; P < .001) fusion reduced growth of the supraoccipital bone; and petrous-occipital suture (ß = -673.3; P < .001), anterior intraoccipital synchondrosis (ß = -368.47; P < .05), and posterior intraoccipital synchondrosis (ß = -6261.42; P < .01) fusion reduced growth of the exo-occipital bone. Foramen magnum morphology is restricted in Crouzon syndrome but not directly caused by early suture fusion.Premature minor suture fusion restricts the volume of developing occipital bones providing a plausible mechanism for observed foramen magnum anomalies.

PreHevbrio: A New 3-Antigen Hepatitis B Vaccine for Adults.

OBJECTIVE: The main objective of this article is to review the immunogenicity and safety of the 3-antigen recombinant hepatitis B vaccine (3A-HepB) in adults. DATA SOURCES: A literature search was performed using PubMed and Google Scholar (2000 to June 2022) with the search terms hepatitis B vaccine and 3-antigen. Other resources included the Centers for Disease Control and Prevention, conference abstracts of liver meetings, the prescribing information, and the manufacturer's website. STUDY SELECTION AND DATA EXTRACTION: All English-language articles of studies assessing the immunogenicity and safety of 3A-HepB in humans were included. DATA SYNTHESIS: The 3A-HepB is licensed to prevent infection caused by all known subtypes of the hepatitis B virus in adults. It contains 3 hepatitis B surface antigens. The 3A-HepB has been shown to be noninferior to a single-antigen hepatitis B vaccine (1A-HepB). It is administered intramuscularly as a 3-dose series at 0, 1, and 6 months. The most commonly reported local reactions were injection site pain and tenderness, and the most commonly reported systemic reactions were headache, fatigue, and myalgia. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: The introduction of 3A-HepB represents another step toward reducing the rates of new hepatitis B infections. However, clinical trials are needed to assess the immunogenicity of 3A-HepB in individuals at high-risk of nonresponse or low response to 1A-HepB, such as those with renal or hepatic impairment and those with altered immunocompetence. CONCLUSIONS: The 3A-HepB represents another vaccine to prevent hepatitis B in adults. It is safe and immunogenic but is associated with more adverse reactions than 1A-HepB.

Improving advanced pharmacy practice experiences with an intention/reflection practice.

BACKGROUND AND PURPOSE: Experiential learning in pharmacy has the potential to offer transformative experiences for students. Advanced pharmacy practice experiences (APPEs) can be improved if students are encouraged and able to (1) identify and track individual learning gains and interests, and (2) develop self-awareness and intrinsic motivation. EDUCATIONAL ACTIVITY AND SETTING: The intention/reflection (I/R) practice was developed to address these educational concepts and help facilitate meaningful experiences during APPEs. The I/R tool is a simple, nontechnical, resource-light activity consisting of a set of three to five questions at the beginning, midpoint, and end of an APPE. The questions were designed to help students identify how they can attain meaningful gains from each APPE. Preceptors across three universities designed, implemented, and evaluated the impact of an I/R practice within the context of a variety of APPEs. The APPEs varied between 4, 5, 6, and 10 weeks and were focused on patient care and academia. FINDINGS: Three of the I/R questions were selected for thematic analysis, one at each point of the rotation. These questions were strategically selected because they demonstrate the value resulting from the progressive nature of the I/R tool. The answers to the three questions were descriptively coded to capture the main thought(s) of each student's response. A quarter of students indicated I/R helped them achieve their goals. SUMMARY: A retrospective pre-post survey demonstrated statistically significant improvements in all survey items, including (1) ability to identify learning outcomes, (2) focus and motivation, and (3) self-awareness and metacognition.

Assessing Emotionally Intelligent Leadership in Pharmacy Students.

Objective. To determine the frequency distribution of pharmacy students across Emotionally Intelligent Leadership Inventory (EILI) measures. Methods. The EILI was administered to 235 pharmacy students at two schools. The instrument was systematically compared to the 2013 CAPE Outcomes and analyzed by confirmatory factor analysis. Results. The EILI has primary connections with pharmacy competencies related to interprofessional communication and leadership. The three facets of the EILI were verified for internal consistency (Context, α=.78; Self, α=.74; Others, α=.79). Student scores were the highest for the consciousness of self facet, with a mean score of 31.4 out of 40. Conclusion. The EILI shows promise as an instrument for use in assessing pharmacy students' emotional intelligence and leadership skills.

Health-related quality of life associated with systemic corticosteroids.

BACKGROUND: Systemic corticosteroids (SCS) are commonly used but are associated with adverse effects. Given their prevalent use, the potential impact of SCS use on health-related quality of life (HRQoL) is important to characterize. OBJECTIVE: To assess the HRQoL of patients taking SCS. METHODS: The 2000-2003 Medical Expenditure Panel Survey was used to examine EQ-5D and SF-6D scores associated with SCS use in adults. The study sample was restricted to those with a condition for which SCS are prescribed. SCS use was categorized into three levels: none; 1-3; and ≥4 prescriptions per year. HRQoL scores were regressed on SCS use (1-3 or ≥4 annual prescriptions) controlling for age, gender, race, ethnicity, education, income category, geographic region, number of ER visits, number of outpatient visits, total number of chronic conditions (for which SCS are not used) and conditions for which SCS are clinically indicated. RESULTS: There were 54,856 individuals with no SCS exposure, 2245 with 1-3 and 624 with ≥4 annual SCS prescriptions. In adjusted analyses, use of ≥4 annual SCS prescriptions appeared to be associated with significantly lower EQ-5D (US), EQ-5D (UK), SF-6D and EQ-5D VAS scores compared to no exposure: -0.032, -0.047, -0.036, and -7.58. CONCLUSION: While SCS are efficacious and widely used for numerous conditions, results suggest that their use may be associated with a substantial deleterious impact on HRQoL. This potential negative effect should be considered in balance with the cost and efficacy of comparable treatments.

Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes.

The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI experts for structuring and planning EI development. Finally, we make 9 recommendations' to inform the process of including EI in pharmacy curricula.

Orientating nonpharmacist faculty members to pharmacy practice.

OBJECTIVE: To design, implement, and evaluate a faculty development program intended to orient nonpharmacist faculty members to pharmacy practice. DESIGN: A multifaceted program was implemented in 2012 that included 4 shadowing experiences in which faculty members visited acute care, ambulatory care, hospital, and community pharmacy settings under the guidance of licensed preceptors. Itineraries for each visit were based on objective lists of anticipated practice experiences that define the role of the pharmacist in each setting. ASSESSMENT: The 4 shadowing experiences culminated with reflection and completion of a survey to assess the impact of the program. All of the faculty participants agreed that the experience improved their conceptual understanding of contemporary pharmacy practice and the role of the pharmacist in the healthcare setting. The experience also improved faculty comfort with creating practice-relevant classroom activities. CONCLUSIONS: A shadowing experience is an effective way of orienting nonpharmacist faculty members to the practice of pharmacy. This program inspired the creation of an experience to introduce pharmacy practice faculty to pharmaceutical science faculty research initiatives.

The relationship between asthma, asthma control and economic outcomes in the United States.

OBJECTIVE: Asthma, a serious chronic lung disease affecting approximately 26 million Americans, remains clinical and economic burdens on the healthcare system. Although associations between uncontrolled asthma and poor health outcomes is known, the extent of this impact of uncontrolled asthma on economic outcomes in the United States (US) is unknown. We sought to determine the relationship between asthma, asthma control and economic outcomes in the US. METHODS: The 2008-2010 Medical Expenditure Panel Surveys were used to estimate the impact of uncontrolled asthma (asthma-related emergency department [ED] visit, use of >3 canisters of quick-relief inhaler in past 3 months or asthma attack in past 12 months) on medical expenditures, utilization and productivity. Estimates were generated using multivariate regression controlling for sociodemographics and comorbidity. RESULTS: Medical expenditures attributable to asthma were up to $4423 greater for those with markers of uncontrolled asthma compared with those who did not have asthma. Frequency of hospital discharges were up to 4.6-fold greater for those with uncontrolled asthma than those without asthma (p < 0.01), while all others with asthma did not have significantly more discharges. ED visits were up to 1.8-fold greater for those with uncontrolled asthma compared with those without asthma (p < 0.01). Productivity was significantly (p < 0.01) decreased (more likely to be unemployed, more days absent from work and more activity limitations) for those with uncontrolled asthma. CONCLUSIONS: In recent national data, individuals with asthma and markers of uncontrolled asthma had higher medical expenditures, greater utilization and decreased productivity.

Asthma control in the United States, 2008-2010: indicators of poor asthma control.

BACKGROUND: An estimated 23 million Americans have asthma, of whom at least 12 million experience an asthma exacerbation every year. Clinical practice guidelines focus on asthma control, with an emphasis on reducing both impairment and risk. OBJECTIVE: We sought to explore broad patterns of asthma prevalence, self-reported medication use, and indicators of control in a nationally representative sample. METHODS: The 2008, 2009, and 2010 Medical Expenditure Panel Surveys were used to examine the national prevalence of self-reported asthma, trends in medication use, and demographic characteristics of asthmatic patients. History of lifetime asthma and current diagnosis were ascertained based on self-report. Asthma management and control were examined by using patient-reported medication use. RESULTS: Of the 102,544 subjects asked about an asthma diagnosis, 9,782 reported lifetime asthma, and 8,837 reported current asthma. Five thousand five subjects (4.8% of the population) reported experiencing an asthma exacerbation in the previous year. Four thousand five hundred twenty-one subjects used a quick-relief inhaler for asthma symptoms, and 14.6% used more than 3 canisters of this type of medication in the past 3 months. Of this group, 60% were using daily long-term control medication but still required significant use of quick-relief inhalers, whereas 28% had never used long-term control medication. Of those who had a recent exacerbation, 29% were using daily preventive medication, whereas 54% had never used long-term control medication. CONCLUSIONS: Improvement of asthma control continues to be a US public health concern. Results suggest suboptimal asthma control with underuse of long-term control medications, overuse of quick-relief inhalers, and a significant number of self-reported asthma exacerbations.

An elective course in leader development.

OBJECTIVE: To describe the design, implementation, and evaluation of a leader-development elective course. DESIGN: Students discovered, reflected on, and enhanced their leadership skills by participating in leadership quality presentations, selecting and facilitating team-building activities for pharmacy-based scenarios, creating a personal mission statement, maintaining a journal, creating pharmacy performance matrices, facilitating leadership discussions and activities, and completing a variety of leader-development inventories to identify their strengths and opportunities for growth. ASSESSMENT: Students successfully completed 98% of the assignments. The most valued topics and assignments involved validated instruments, which promoted self-discovery and development. End-of-course survey results revealed all students agreed the course achieved all learning outcomes except preventing conflict from escalating (9% disagreed) and applying knowledge of core values to achieve greater effectiveness in interpersonal communication (4% disagreed). CONCLUSIONS: Students perceived this leader-development elective course was effective in achieving learning outcomes. Assignments guided the creation of personalized leader-development tracks, ultimately promoting lifelong learning.

Prevnar 13, the new 13-valent pneumococcal conjugate vaccine.

OBJECTIVE: To review the immunogenicity, efficacy, and safety of the 13-valent pneumococcal conjugate vaccine (PCV13) for use in pediatric patients. DATA SOURCES: A MEDLINE search (2000-September 2011) was conducted using the key words Streptococcus pneumoniae and pneumococcal conjugate vaccine for clinical trials, limited to studies conducted in humans and published in English. STUDY SELECTION AND DATA EXTRACTION: Randomized, controlled, multicenter trials were reviewed and included to evaluate the safety and efficacy of PCV13. Literature on the epidemiology and pathology of pneumococcal infections and recommendations from the Advisory Committee on Immunization Practices (ACIP) were also reviewed. DATA SYNTHESIS: PCV13 is approved for routine vaccination of all infants as a 4-dose series at age 2, 4, 6, and 12-15 months for children who previously received 1 or more doses of the 7-valent pneumococcal conjugate vaccine (PCV7), and for children with underlying medical conditions that increase their risk for pneumococcal disease or its complications. PCV13 has comparable immunogenicity to the serotypes common with PCV7 and also provides protection against 6 additional pneumococcal serotypes. PCV13 has also been shown to have a comparable adverse reaction profile to PCV7. CONCLUSIONS: Based on published immunogenicity and safety data, as well as the recent recommendations by the ACIP for routine use in infants and indications for high-risk pediatric patients, PCV13 is a revised formulation of pneumococcal vaccine that should be included on pharmacy formularies.

Update on prevention of meningococcal disease: focus on tetravalent meningococcal conjugate vaccine.

OBJECTIVE: To review the immunogenicity, efficacy, safety, and new recommendations for routine use of the tetravalent meningococcal conjugate vaccine (MCV4). DATA SOURCES: A MEDLINE search (1966-June 2005) was conducted using the key words Neisseria meningitidis and meningococcal vaccines for clinical trials limited to human research published in the English language. STUDY SELECTION AND DATA EXTRACTION: Randomized, controlled, multicenter trials were reviewed and included to evaluate the safety and efficacy of MCV4. Additional open-label trials on the use of MCV4 in children less than 24 months of age are included since these studies may be used to support the approval of the vaccine for use in children. Literature on epidemiology and pathology of meningococcal meningitis and the Advisory Committee on Immunization Practices (ACIP) recommendations were also reviewed. DATA SYNTHESIS: MCV4 is approved for active immunization of adolescents and adults between the ages of 11 and 55 years for the prevention of disease caused by N. meningitidis serogroups A, C, Y, and W-135. MCV4 has been shown to have comparable immunogenicity and a similar adverse reaction profile to the tetravalent meningococcal polysaccharide vaccine (MPSV4). It is expected that MCV4 will provide a longer duration of protection from meningococcal disease than MPSV4. CONCLUSIONS: Based on lished immunogenicity, efficacy, and safety data, as well as the recent recommendations by the ACIP for its routine use, MCV4 is the preferred meningococcal vaccine for persons between 11 and 55 years of age and should be included on pharmacy formularies.