Evaluation of the effect of voxelotor and darbepoetin alfa on hemoglobin levels in patients with sickle cell disease.

BACKGROUND: To date, there is limited evidence on patients utilizing both voxelotor and darbepoetin alfa and its impact on hemoglobin levels. The objective is to evaluate the effect of voxelotor and darbepoetin alfa on hemoglobin levels in patients with SCD. RESEARCH DESIGN AND METHODS: This was a retrospective chart review study that assessed the primary independent variable as the utilization of either voxelotor alone, darbepoetin alfa alone, or the concurrent administration of voxelotor and darbepoetin alfa. Descriptive statistics were utilized to obtain the mean standard deviation for numerical variables and proportions for categorical variables. RESULTS: A total of 23 participants were included in this study. When comparing baseline to 2 months and 3 months, participants on voxelotor alone experienced a 3% decrease and a 6.6% increase in hemoglobin, darbepoetin alfa alone group a 4.3% decrease and a 0.6% increase in hemoglobin and voxelotor and darbepoetin group a 4.4% decrease and a 0.5% decrease in hemoglobin levels. Fifty percent of the participants in the voxelotor group and 6 (66.7%) participants in the voxelotor plus darbepoetin alfa group experienced adverse drug events. CONCLUSIONS: Voxelotor resulted in a clinically significant difference in the percent change of hemoglobin from baseline to 3 months.

Minority Student Perceptions of the Impact of Financial Cost of Pharmacy School and Career Choice at a Historically Black College and University (HBCU).

OBJECTIVE: One of the barriers that might prevent an underrepresented minority (URM) individual from pursuing a professional career in the United States is finances. The high disproportionate burden of student debt among URM students further perpetuates the racial wealth gap. Therefore, this study sought to evaluate the extent to which URM students' personal finance perceptions, and current and projected student loan indebtedness affect postgraduation career intentions. METHODS: A cross-sectional analysis was conducted using data from four cohorts of pharmacy students using a survey from November 2, 2022, to February 1, 2023. The financial perception survey included subscales namely personal finance self-efficacy, debt influence and pressure, and risk mitigation and retirement. Descriptive statistics, simple logistic regression, and multivariate logistic regression analyses were conducted. RESULTS: In total, 93 students completed the survey and had a mean age of 28.1 ± 5.3 years. Seventy-one percent of the respondents were female, and 67.7 % had completed a 4-year bachelor's degree. There was a significant association between age and the intention to pursue postgraduate training as well as a significant association between risk mitigation and retirement perceptions and intention to pursue postgraduate training after adjusting for other factors. CONCLUSION: Among students from largely minority backgrounds, age, and confidence in their ability to make wise investment decisions for retirement are associated with a greater likelihood of pursuing postgraduate training opportunities.

Roles of Pharmacists in the Management of Sickle Cell Disease in Adults: A Narrative Review.

Background: Sickle cell disease (SCD) is an autosomal, recessive, genetic condition of the sickle cell genes. It affects about 100 000 people in the United States where an estimated 1 out of every 365 black children and 1 out of every 13 black children will be born with SCD and sickle cell trait, respectively. Severe and unpredictable pain crisis are the leading cause of emergency department visit for adult patients with SCD and account for 90% of inpatient hospitalizations and 85% of all acute medical care, as well as high usage of medical resources. The care of patients with SCD is complex and requires a multidisciplinary approach. With a few pharmacotherapeutic options to reduce SCD complications and pain episodes, the role of pharmacists in the medication management is unclear. This article aims to outline the potential role of pharmacists in SCD management. Data sources: The authors searched Medline, PubMed, EMBASE, and Scopus from January 1, 1990 to August 31, 2022, for primary literature that assessed the role of pharmacists in managing patients with SCD. Results: The authors identified relevant studies and summarized the role of pharmacists in SCD management. Conclusions: Access to comprehensive health care is essential to ensure that patients with SCD have decreased hospitalizations and good health-related quality of life. Pharmacists are an integral part of the multidisciplinary health-care team and can help patients with SCD navigate the complexities of health care. Pharmacists are medication experts who are positioned to ensure comprehensive care in the acute and chronic SCD management.

Extravasation of Non-Cytotoxic Drugs in Older People.

Objective To describe the risk factors of extravasation, its impact on the pharmacokinetics of non-cytotoxic drugs, and management of extravasation in older individuals. Extravasation occurs when vesicants leak from blood vessels into surrounding tissue causing severe injury such as tissue necrosis while infiltration is caused by leakage of an irritant that causes injury but does not lead to tissue necrosis. Extravasation occurs in approximately 0.01% to 6% of patients, particularly with cytotoxic agents. However, there is limited documentation about extravasation of non-cytotoxic agents, particularly in older people. Data Sources A literature search of Pubmed and Medline was performed using the following search items: "extravasation," "infiltration," "elderly," and "non-cytotoxic drugs," as well as a combination of these terms. Conclusion It is important to recognize, identify, and manage extravasation early since it can have deleterious consequences for older people. It is more important to prevent extravasation than manage it using standardized evidence-based protocols, and this can be implemented in the nursing facility and acute care setting.

Contemporary Management and Prevention of Vaso-Occlusive Crises (VOCs) in Adults With Sickle Cell Disease.

Sickle cell disease (SCD) is a hematological disorder that primarily affects individuals of African descent from sub-Saharan Africa and along the mediterranean. The main complications leading to hospitalizations include vaso-occlusive crises (VOCs) and acute chest syndrome (ACS). Therefore, the main objective of this paper was to identify and evaluate evidence-based management and prevention of VOCs in patients with SCD. A literature search of PubMed, Medline Cochrane and Google Scholar database (January 1985 to April 2020) was performed using the following search terms "vaso-occlusive crises", "sickle cell disease", "hydroxyurea", "L-glutamine", "voxelotor", "crizanlizumab", "treatment" and "prevention" as well as a combination of these terms. All English-language interventional studies assessing the efficacy and safety of VOC outcomes were evaluated. Literature was excluded if published in a language other than English or if it was a review article. A total of 69 articles were identified and there were 7 articles that met the search criteria. Majority of the studies focused on mean and median annual rates of VOCs as primary outcomes while median time to first sickle cell crises, median rates of hospitalizations etc were evaluated as secondary outcomes. After reviewing the literature, many patients with VOCs will still benefit from hydroxyurea therapy since long term efficacy data and cost is still a concern for the newer agents including L-glutamine, voxelotor and crizanlizumab. Other factors such as cost or compliance may also be taken into consideration when making recommendations for therapy.

Rates of Opioid Misuse Amongst Patients Receiving Pain Management for Sickle Cell Disease in An Urban Setting.

Background and Objective: Sickle Cell Disease (SCD) is known to cause acute severe pain episodes known as vaso-occlusive crisis (VOC) mainly treated with opioid analgesics. Since the opioid epidemic there is an interest in determining the opioid misuse potential in these patients. Therefore, the primary objective of this study is to determine the rates of opioid misuse among patients with SCD by assessing the rate of unexpected drug screening results in a sickle cell disease clinic. Methods: This was a retrospective chart review study conducted at the outpatient sickle cell disease clinic. The primary independent variables were the prescribed opioid medications while the primary dependent variable was the collected opioid metabolite. Descriptive statistics, linear regression and multivariate logistic regression analysis were conducted using SPSS version 24. Results: A total of 100 participants were recruited from July 1, 2018, to June 30, 2020 with 71 included in the analysis. The total mean of morphine milligram equivalents (MME) for all participants was 71.1±104.9 with 71% of participants having a daily calculated MME of <90MME. The odds of misusing an opioid were 6.72 times higher (P<.02) if a participant used marijuana compared to a participant who didn't. In addition, the odds of misusing an opioid were 2.47 times higher (P<.04) if the patient was prescribed an opioid daily dose greater than 90 MME as opposed to a daily dose less than 90 MME. Conclusion: Participants who consumed greater than 90 MME's per day and utilized marijuana were more likely to misuse opioids.

A Pre-matriculation Success Program to Improve Pharmacy Students' Academic Performance at a Historically Black University.

Objective. The Pharmacy Biomedical Preview program is a five-week summer academic reinforcement program held for students entering the Howard University College of Pharmacy. The objective of this study was to evaluate the impact of the program and preadmission factors on pharmacy students' first semester academic performance.Methods. A retrospective cohort study was conducted of students entering the preview program from 2012 to 2015. The primary outcome assessed was first semester grade point average (GPA). Descriptive statistics of all study variables were conducted. Bivariable analyses were used to compare students by program status. Pearson correlations and point biserial R were conducted to evaluate which factors were associated with the first semester GPA. Multiple linear regression analysis was used to evaluate whether participation in the preview program predicted GPA during the first semester in pharmacy school after adjusting for other factors. All analyses were conducted using SPSS, version 23, at an alpha of .05.Results. Incoming overall undergraduate GPA was the strongest predictor of students' first semester GPA in pharmacy school, followed by participation in the Pharmacy Biomedical Preview Program. After adjusting for other factors, mandatory participation in the program was associated with a higher first semester GPA, and voluntary participation in the program was also associated with a first semester GPA that was higher.Conclusion. Findings from this study indicated that implementation of a pre-matriculation success program at a college of pharmacy in a historically Black institution is a viable strategy to improve students' academic success in the first year.

Determination of predictors impacting performance on the third-year pharmacy curriculum outcomes assessment at a historically Black college of pharmacy.

INTRODUCTION: The Pharmacy Curriculum Outcomes Assessment (PCOA) is a standardized exam developed by the National Association of Boards of Pharmacy (NABP) in 2008 to measure the curriculum in relation to student progress. The purpose of the study was to determine the impact of pre-admissions and pharmacy school variables on third-year student PCOA performance at a Historically Black College or University (HBCU) College of Pharmacy. METHODS: A retrospective analysis was conducted using data from three cohorts of students who took the PCOA in their third professional year from 2015 to 2017. An independent samples t-test, correlation analysis, and multivariate linear regression were conducted to determine the relationship between student characteristics and the PCOA score. RESULTS: The mean PCOA scaled score for the third-year pharmacy students was 349.6 ± 46.20 while the mean Pharmacy College Admission Test (PCAT) percentile was 62.7 ± 14.5. Most students (67%) self-identified as Black and the majority (54.9%) were female. The PCOA scores were correlated with the PCAT percentile (P < .001) and the cumulative grade point average (GPA) through the fall semester of the third professional year (P < .001). After adjusting for other factors, the cumulative GPA through the fall semester of the third professional year (P < .001) and PCAT percentiles (P < .001) remained predictive of students PCOA scores. CONCLUSIONS: The cumulative GPA through the third-year fall semester and PCAT percentiles are important factors in helping to predict PCOA scores among third year pharmacy students at a HBCU.

Factors Associated With Health Literacy and Medication Adherence in an Urban Community.

OBJECTIVE: The primary objective of this study is to determine factors associated with health literacy and medication adherence in an urban community. DESIGN: A cross-sectional study was conducted to assess factors associated with health literacy and medication adherence. Participants were recruited from October 2012 to April 2013. SETTING: Ambulatory care clinic and senior wellness center. PARTICIPANTS: Participants were eligible if they were older than 18 years of age and had received care at the ambulatory clinic or obtained services at the senior wellness center. INTERVENTIONS: REALM survey and the Morisky 8-Item Medication Adherence Questionnaire. MAIN OUTCOME MEASURES: The two outcomes evaluated in this study were health literacy and medication adherence. RESULTS: A total of 51 participants were enrolled in the study. Twenty-seven (53%) of the participants were noted to be nonadherent to their medications. Twenty (74%) of these participants read below the high school level, and the remaining 7 (26%) read above a high school level. Study findings showed that both education level and comorbidities status were associated with health literacy. Participants who had a below high school education level had greater odds of having a below high school health literacy level (odds ratio [OR] = 7.500, 95% confidence interval [CI] 1.482-37.949). Participants who had two or more comorbidities had greater odds of having a below high school health literacy level (OR = 24.889, 95% CI 2.698-229.610). CONCLUSION: Our study results found associations between both comorbidities and education with health literacy.

Cultural Sensitivity and Global Pharmacy Engagement in Africa.

Global engagement between schools and colleges of pharmacy in the United States and Africa is increasing. For a balanced and fruitful engagement, sensitivity towards the cultural and clinical needs of the people and professionals of the African region is critical. In this paper, we have divided the discussion into Southern, East, Central, and West Africa. General information about Africa, with unique aspects for individual subregions and countries, will be introduced. Stereotypes and misconceptions about the region and the people will also be discussed, along with recommendations for culturally sensitive engagement for pharmacy and other health care practitioners when hosting members from, or visiting this region. The paper is a resource for schools and colleges of pharmacy who are currently engaged or considering future outreach opportunities in Africa.

An assessment of the relationship between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status.

INTRODUCTION: A study was conducted to assess if there is an association between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status. METHODS: A cross-sectional analysis was conducted using data from a student perception survey completed by third-year pharmacy students. The survey collected demographic information on age, gender, level of education, ethnicity, and pharmacy-related work experience. A series of Likert scale items were used to assess students' perceptions regarding their competency in specific skills areas essential for participation in emergency responses. An independent samples t-test was used to compare mean scores for Likert scale items between working and nonworking students. Multivariate linear regression models were developed to determine if work status was an independent predictor of students' self-reported competencies after adjusting for covariates. RESULTS: Sixty-six of 69 (95.7%) students completed the student perception survey. Students currently working in a pharmacy reported higher mean scores on several of the measured competencies. After covariates adjustment, current work status was associated with higher scores on self-reported competencies related to proficiency in evaluating information from patient assessment and collaborating with other individuals to develop processes related to the optimizing flow of care. CONCLUSIONS: These results suggest that students who are working tend to have more confidence in their ability to contribute to emergency responses as well as work better in a team setting. Incorporating cases related to emergency response readiness in pharmacy curriculum may be needed to enhance skills and confidence of non-working pharmacy students.