Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region

Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region Chloe Nguyen, PharmD, Judy Wong, PharmD, BCACP, and Karen White, PharmD, BCACP Background: Currently, there is a gap in meeting the statin metric at Providence Medical Group in Southern Oregon Region. The purpose of this project is to identify intervention strategies to improve statin metric for secondary prevention among patients with clinical atherosclerotic cardiovascular disease (ASCVD). Methods: This quality improvement project was approved by the system’s Institutional Review Board. Patients at least 18 years of age with diagnosis of clinical ASCVD not prescribed statin therapy or prescribed sub-optimal statin therapy were included. Different strategies were implemented at Central Point Family Medicine Clinic. A presentation was delivered to the providers in late December to address barriers with statin prescribing. Pre- and post-surveys were collected to assess the effectiveness of the presentation and knowledge of providers regarding statin prescribing in patients with clinical ASCVD. Chart reviews were performed in January on identified patients to provide recommendation to providers. The primary outcomes were to assess impact of academic detailing intervention on perceived barriers on statin initiation or optimization via pre- and post-surveys and to calculate the percentage of approved recommendation from providers. The secondary outcome was the percentage of statins prescribed per each intervention strategy: refer to clinical pharmacist for management, discuss statin therapy during the next appointment with provider, or update problem list and medication list. Results: Prior to the intervention, a majority of providers believed that statins caused myopathy, liver injury, and rhabdomyolysis which can influence their decision when prescribing statin therapies and discussing statin treatment with patients. Post-survey results showed a slight decrease in belief that statins cause myopathy, liver injury, incidental diabetes, cognitive impairment and rhabdomyolysis. In addition, providers were more likely to retry a different statin or at a lower dose if patient had a documented intolerance to previous statin therapy following education. In a sample of 35 chart reviews, 5 patients were receiving sub-optimal statin therapies, 7 had documented reason for statin intolerance, and 3 were not candidates to receive high intensity statin. A majority of recommendations were approved by providers. The most common intervention chosen by providers (51.4%) was to discuss statin options with patient in next office visit. However, no changes were observed from this intervention. Out of the 10 patients who were referred to clinical pharmacy services for management, 5 declined statin and 4 were unable to reach. Only one patient was successfully started on high intensity statin. Conclusions: Beliefs and approaches to statin discussions are varied among PCPs and can be contributing factors for statin initiation or optimization. These results highlight the complexity of finding interventions that would be most successful for improving statin metric for secondary prevention among patients with clinical ASCVD. Nonetheless, we can be vigilant about working with providers to provide recommendations for the remaining patients with clinical ASCVD and create appropriate follow-up plans for those who were unable to be reached and those who do not have upcoming appointment with providers.https://digitalcommons.psjhealth.org/pharmacy_PGY2/1003/thumbnail.jp

PIP/DIP Joint Capsule Stiffness: Current Evidence For Effective Interventions

This research aimed to identify and analyze intervention approaches to remediate Proximal and Distal Interphalangeal (PIP/DIP) joint capsule stiffness and was performed to inform practice of hand therapists in an outpatient occupational therapy (OT) clinic. The treatment protocols were analyzed according to practicality for the practice and overall efficacy. Ten databases were searched to collect appropriate data based on a specific predetermined list of search terms. Articles were examined against specific inclusion and exclusion criteria, and sixteen were eventually selected for analysis. Six different intervention strategies emerged from the research including occupation-based practice, electromagnetotherapy, technology-assisted therapy, orthoses, and preparatory methods/modalities. No evidence was found to support one specific intervention strongly over another, rather each had a set of circumstances such as the type of hand condition and/or diagnosis that would warrant the use of that protocol. This suggests that it is important for practitioners who treat PIP/DIP joint capsule stiffness to be aware that there are a multitude of different treatment options available. Selecting one to use with a client will require clinical consideration of their client factors, disease/diagnosis factors, as well as clinic factors such as resources or therapist qualifications

Effectiveness of music interventions to reduce test anxiety in pharmacy students

Background: The main objective of this pilot study was to evaluate the impact of a classroom activity involving music on anxiety associated with preparing for and taking an assessment. Methods: Two hundred and two (202) pharmacy students were randomly assigned to one of two conditions of the experimental study: active music playing (n = 103) versus passive music listening (n = 99). All students completed a pre-test, a mid-test, and a post-test including: an “Attitudes and Perceptions” survey, State-Trait Anxiety Inventory for Adults (STAI Survey), and a knowledge assessment. Data were analyzed to determine the impact each of the music interventions had on students’ test anxiety. Results: Both types of musical interventions produced similar results in terms of anxiety reduction. Faced with an upcoming test prior to the musical intervention, average state-trait anxiety scores increased; after the musical intervention, state-trait anxiety scores decreased. Conclusions: The use of music helped to reduce test anxiety, even after one brief musical intervention, regardless of whether students passively listened to music or actively played music

IgG light chain-independent secretion of heavy chain dimers: consequence for therapeutic antibody production and design

Rodent monoclonal antibodies with specificity towards important biological targets are developed for therapeutic use by a process of humanisation. This process involves the creation of molecules, which retain the specificity of the rodent antibody but contain predominantly human coding sequence. Here we show that some humanised heavy chains can fold, form dimers and be secreted even in the absence of light chain. Quality control of recombinant antibody assembly in vivo is thought to rely upon folding of the heavy chain CH1 domain. This domain acts as a switch for secretion, only folding upon interaction with the light chain CL domain. We show that the secreted heavy-chain dimers contain folded CH1 domains and contribute to the heterogeneity of antibody species secreted during the expression of therapeutic antibodies. This subversion of the normal quality control process is dependent upon the heavy chain variable domain, is prevalent with engineered antibodies and can occur when only the Fab fragments are expressed. This discovery will impact on the efficient production of both humanised antibodies as well as the design of novel antibody formats

CCR5AS lncRNA variation differentially regulates CCR5, influencing HIV disease outcome.

Multiple genome-wide studies have identified associations between outcome of human immunodeficiency virus (HIV) infection and polymorphisms in and around the gene encoding the HIV co-receptor CCR5, but the functional basis for the strongest of these associations, rs1015164A/G, is unknown. We found that rs1015164 marks variation in an activating transcription factor 1 binding site that controls expression of the antisense long noncoding RNA (lncRNA) CCR5AS. Knockdown or enhancement of CCR5AS expression resulted in a corresponding change in CCR5 expression on CD4+ T cells. CCR5AS interfered with interactions between the RNA-binding protein Raly and the CCR5 3' untranslated region, protecting CCR5 messenger RNA from Raly-mediated degradation. Reduction in CCR5 expression through inhibition of CCR5AS diminished infection of CD4+ T cells with CCR5-tropic HIV in vitro. These data represent a rare determination of the functional importance of a genome-wide disease association where expression of a lncRNA affects HIV infection and disease progression

Global variations in pubertal growth spurts in adolescents living with perinatal HIV

Objective: To describe pubertal growth spurts among adolescents living with perinatally-acquired HIV (ALWPHIV) on antiretroviral therapy (ART)./ Design: Observational data collected from 1994–2015 in the CIPHER global cohort collaboration./ Methods: ALWPHIV who initiated ART age <10 years with ≥4 height measurements age ≥8 were included. Super Imposition by Translation And Rotation (SITAR) models, with parameters representing timing and intensity of the growth spurt, were used to describe growth, separately by sex. Associations between region, ART regimen, age, height-for-age (HAZ), and BMI-for-age z-scores (BMIz) at ART initiation (baseline) and age 10 years and SITAR parameters were explored./ Results: 4,723 ALWPHIV were included: 51% from East and Southern Africa (excluding Botswana and South Africa), 17% Botswana and South Africa, 6% West and Central Africa, 11% Europe and North America, 11% Asia-Pacific, and 4% Central, South America, and Caribbean. Growth spurts were later and least intense in sub-Saharan regions. In females, older baseline age and lower BMIz at baseline were associated with later and more intense growth spurts; lower HAZ was associated with later growth spurts. In males, older baseline age and lower HAZ were associated with later and less intense growth spurts; however, associations between baseline HAZ and timing varied by age. Lower HAZ and BMIz at 10 years were associated with later and less intense growth spurts in both sexes./ Conclusions: ALWPHIV who started ART at older ages or already stunted were more likely to have delayed pubertal growth spurts. Longer-term follow-up is important to understand the impact of delayed growth.

Connecting the dots between breast cancer, obesity and alcohol consumption in middle-aged women: ecological and case control studies

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Abstract Background Breast cancer (BC) incidence in Australian women aged 45 to 64 years (‘middle-aged’) has tripled in the past 50 years, along with increasing alcohol consumption and obesity in middle-age women. Alcohol and obesity have been individually associated with BC but little is known about how these factors might interact. Chronic psychological stress has been associated with, but not causally linked to, BC. Here, alcohol could represent the ‘missing link’ – reflecting self-medication. Using an exploratory cross-sectional design, we investigated inter-correlations of alcohol intake and overweight/obesity and their association with BC incidence in middle-aged women. We also explored the role of stress and various lifestyle factors in these relationships. Methods We analysed population data on BC incidence, alcohol consumption, overweight/obesity, and psychological stress. A case control study was conducted using an online survey. Cases (n = 80) were diagnosed with BC and controls (n = 235) were women in the same age range with no BC history. Participants reported lifestyle data (including alcohol consumption, weight history) over consecutive 10-year life periods. Data were analysed using a range of bivariate and multivariate techniques including correlation matrices, multivariate binomial regressions and multilevel logistic regression. Results Ecological inter-correlations were found between BC and alcohol consumption and between BC and obesity but not between other variables in the matrix. Strong pairwise correlations were found between stress and alcohol and between stress and obesity. BMI tended to be higher in cases relative to controls across reported life history. Alcohol consumption was not associated with case-control status. Few correlations were found between lifestyle factors and stress, although smoking and alcohol consumption were correlated in some periods. Obesity occurring during the ages of 31 to 40 years emerged as an independent predictor of BC (OR 3.5 95% CI: 1.3–9.4). Conclusions This study provides ecological evidence correlating obesity and alcohol consumption with BC incidence. Case-control findings suggest lifetime BMI may be important with particular risk associated with obesity prior to 40 years of age. Stress was ecologically linked to alcohol and obesity but not to BC incidence and was differentially correlated with alcohol and smoking among cases and controls. Our findings support prevention efforts targeting weight in women below 40 years of age and, potentially, lifelong alcohol consumption to reduce BC risk in middle-aged women

24th Annual Richard A. Harrison Symposium: A Celebration of Student Research and Achievement in the Humanities and Social Sciences

The Harrison Symposium celebrates independent and collaborative student research in the Social Sciences and Humanities. The Harrison is usually held as an annual conference in May, but this year’s shift to remote teaching and the new coronavirus pandemic eliminated the opportunity for in-person presentations. Instead of cancelling the event, students nominated by faculty members were invited either to participate in next year’s Harrison, or to contribute to the volume you are now reading. Reimagining the Harrison as a written artifact was inspired by the 1997 Harrison Symposium. In the early years of the conference, the Dean of Faculty Richard A. Harrison (1991-1997) published the proceedings of the symposium – formerly known as the Humanities and Social Sciences Symposium though the event was later renamed in Harrison’s honor – as a collection of papers. Margaret E. Madden, then Associate Dean of the Faculty, notes in the introduction to the 1998 proceedings that “Faculty members and departments on campus who received the first symposium collection were pleased to have some visible record of the high level of accomplishments of humanities and social science students, whose products are often not as visible as those students of the performing arts or sciences.” I hope that this version of the Harrison will also serve as a way to publicly and communally celebrate the wide-ranging and incisive research undertaken by students at Lawrence

Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Importance: Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation. Objective: To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people. Design, setting, and participants: This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility. Exposures: Self-identified gender identity and sexual orientation group. Main outcomes and measures: Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group. Results: The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups. Conclusions and relevance: In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.</p