Background: The COVID-19 pandemic caused dramatic disruptions in the education of pharmacy students who graduated in 2022. As an additional active learning opportunity at a New York City hospital site with multiple preceptors and faculty, a monthly studentled virtual educational conference was implemented. The objective of this study was to assess student perspectives on the implementation of a virtual peer education conference. Methods: Between May 2021 and May 2022, a total of twenty-eight students participated as presenters or attendees. All students completed a 13-item survey to evaluate the impact their participation in the virtual conference had on their overall learning and how similar opportunities could impact their future learning experiences. Results: When asked to rate on a scale from 1 (did NOT improve at all) to 5 (greatly improved my learning), 93% (26/28) of students rated their change in learning after attending the student-led conference as a four or five. Students identified that participation enhanced their drug/disease state knowledge, improved their presentation skills and/or improved their critical thinking and clinical application skills. Conclusion: In the future, advanced pharmacy practice experiences (APPE) can consider the inclusion of peer education through an online platform as a strategy to facilitate learning in pharmacy programmes.

Background: Chat Generative Pre-trained Transformer (ChatGPT) use in higher education has been controversial. The purpose of this study was to evaluate the impact of ChatGPT on pharmacy student achievement of educational outcomes and entrustable professional activities, as outlined by the American Association of Colleges of Pharmacy (AACP), during Advanced Pharmacy Practice Experiences (APPEs). Methods: A 20-question electronic survey was distributed to pharmacy students in the Class of 2023 and 2024. The survey evaluated the impact of ChatGPT on educational outcomes and student perceptions of the technology. Results were analysed using descriptive statistics. Results: A total of 69 students participated in the survey. Among them, 44% (17/39) used ChatGPT during their APPE rotations. Of those, 82% (14/17) of students agreed or strongly agreed that ChatGPT helped them find, analyse, and integrate foundational knowledge of medications. Similarly, 82% (14/17) agreed or strongly agreed that ChatGPT positively impacted their approach to work and research habits. Additionally, 89% (15/17) agreed or strongly agreed that they will use ChatGPT on future APPEs and in professional practice. Conclusion: The use of ChatGPT by pharmacy students during their APPE rotations demonstrates a potential benefit in student achievement of educational outcomes across all three domains during APPEs.

The number of fatal and nonfatal drug overdoses continues to increase in the United States. Disparities in drug overdose deaths across racial and ethnic groups and income inequality continue to widen. Pharmacists play a critical role in addressing the nation's growing challenges related to substance use disorder by acting to lessen the stigma surrounding substance use, serving as allies in harm reduction, and advocating for patients. Harm reduction tools in pharmacy practice include naloxone, sterile syringe access, and preexposure prophylaxis for HIV prevention. Harm reduction organizations are an effective community-based resource that pharmacists should keep in mind when assisting patients. All of these tools and resources can help pharmacists combat health disparities related to the opioid epidemic and advance health equity.

Infective endocarditis (IE) is a lifethreatening bacterial infection in the heart due to bacteria such as streptococci , staphylococci , and enterococci. Both adults and children can be at risk for developing IE. Risk factors include heart defects, dental procedures, and IV drug use. Most patients will present with nonspecific symptoms of infection and require a workup to rule out potential sources of infection. The Duke Criteria were established to assist clinicians with the diagnosis of IE. As changes in microbiology, diagnostics, and treatment arise, the Duke Criteria have also been modified to reflect updates in practice. Pharmacists play an important role in the management of IE, including optimizing antibiotic regimens and dosing, recognizing and managing adverse effects and drug interactions, assisting with the transition to oral regimens, and identifying patients who may be candidates for IE prophylaxis.

Lyme disease is a common vector-borne illness most often caused by Borrelia burgdorferi in infected ticks. Ticks are small and difficult to see. They may go unnoticed for extended periods of time, allowing for the transmission of Lyme disease to its host. A hallmark of Lyme disease is the presentation with erythema migrans, or the "bull's-eye" rash at the site of a tick bite. If left untreated, Lyme disease can progress to impact the heart (Lyme carditis), joints (Lyme arthritis), and the peripheral and central nervous systems (neurologic Lyme disease). In patients who present with neurologic Lyme disease, first-line treatment options include IV ceftriaxone, cefotaxime, penicillin G, or oral doxycycline. Pharmacists can recommend appropriate drug therapy for patients and provide patient education to prevent Lyme disease.

Vancomycin is a widely available antibiotic with gram-positive activity against Staphylococcus aureus, including methicillin-resistant S aureus (MRSA). In 2020, updated practice guidelines recommended a change in vancomycin therapeutic drug monitoring (TDM) from trough-based to AUC to minimum inhibitory concentration (AUC/MIC) ratio-based to optimize vancomycin efficacy and reduce nephrotoxicity. The goal AUC/MIC ratio recommended is 400 to 600 mg*hr/L. Bayesian software programs are the preferred method of vancomycin AUC monitoring by the guidelines; however, first-order pharmacokinetic equations can be used as an alternative. As healthcare institutions transition to AUC/MIC-based monitoring, pharmacists play a vital role in providing education on the guideline updates, implementation, and TDM.

In 2020, the Infectious Diseases Society of America (IDSA) recommended a change in vancomycin therapeutic drug monitoring from trough-based to AUC/MIC-based to optimize vancomycin’s efficacy and reduce nephrotoxicity. Many hospitals have not implemented this change due to barriers such as the cost of AUC/MIC software and lack of provider familiarity. The purpose of this study was to determine the rate of AUC/MIC ratio target attainment using current trough-based vancomycin dosing practices at a city hospital. The rates of acute kidney injury (AKI) were also evaluated. Vancomycin orders were reviewed retrospectively to determine the expected AUC/MIC ratios using first-order pharmacokinetic equations over a 7-month period. Orders were excluded if they were written for a one-time dose, for individuals less than 18 years of age, or for those on hemodialysis. A total of 305 vancomycin orders were included in this review. Overall, 27.9% (85/305) of vancomycin orders attained the AUC/MIC ratio target of 400–600 mg·h/L as recommended by the guidelines. Nearly 35% (106/305) achieved AUC/MIC ratios below 400 mg·h/L and 37.4% (114/305) achieved AUC/MIC ratios above 600 mg·h/L. Orders for obese patients were significantly more likely to have below the target AUC/MIC ratios (68% vs. 23.9%, X2 48.48, p < 0.00001) and non-obese patients were significantly more likely to have above the target AUC/MIC ratios (45.7% vs. 12%, X2 27.36, p < 0.00001). The overall rate of acute kidney injury observed was 2.6%. Most vancomycin orders did not attain therapeutic drug monitoring targets, reflecting the ongoing clinical challenge of optimizing vancomycin doses and implementing new guideline recommendations.

INTRODUCTION:The purpose of this study was to assess pharmacy student perceptions of remote learning experiences and personal well-being during the COVID-19 pandemic in a metropolitan commuter city.METHODS:A survey was developed and sent to pharmacy students from the three pharmacy colleges in New York City in January 2021. The survey domains consisted of demographics, personal well-being, classroom experiences, and pandemic and post-pandemic preferred learning modalities and reasons.RESULTS:From a total of 1354 students from professional years one, two, and three across the three colleges, completed responses were received from 268 students (20% response rate). More than half of the respondents (55.6%) reported a negative impact of the pandemic on their well-being. More than half of the respondents (58.6%) reported more time to study. When students were asked their preferred mode of pharmacy education delivery during the pandemic and post-pandemic, a quarter (24.5%) preferred remote learning for all courses during the pandemic, and only a quarter (26.8%) preferred traditional classrooms for all courses post-pandemic. Approximately 60% of the respondents preferred some type of remote learning post-pandemic.CONCLUSIONS:Pharmacy student learning has been and continues to be impacted by the COVID-19 pandemic, especially for pharmacy students in New York City. This study sheds light on the remote learning experiences and preferences of pharmacy students in a commuter city. Future studies could assess pharmacy student learning experiences and preferences after return to campus.

The objective of this study was to examine the distribution of prestigious speaking roles by gender at gambling studies conferences to better understand the state of gender representation within the field. Keyword searches were conducted in the fall of 2019. A total of 16 conferences that occurred between 2010-2019 and comprising 882 prestigious speaking opportunities were included. Quantitative analysis (i.e., t-tests, chi-squared posthoc tests) was undertaken to evaluate the representation of women speakers and if proportions were the same across genders for speakers. There were significantly less women than men within prestigious speaking roles at gambling studies conferences with only 30.2% of speakers being women (p < .001). This underrepresentation of women was consistent across conference location, speaker continent, speaker role, time, and across the majority of conferences. Women held prestigious speaking roles less frequently than men (M = 1.48 vs. 1.76; p < .001). A 9 to 1 (p < .001) ratio of men to women was found among top 10 most frequent prestigious speakers. While there was a higher proportion of women than men among student speakers and there was no significant gender disparity among early career researchers, there was a significantly lower proportion of women than men among speakers who hold more senior academic positions. There is an issue of gender disparity in prestigious speaking roles at conferences within the gambling studies field. This study highlights the need to counteract gender disparities and make room for diversity within the field.

Euglycemic diabetic ketoacidosis (EDKA) is a rare, acute, life-threatening emergency that is characterized by euglycemia, metabolic acidosis, and ketoacidosis. Unlike DKA, the diagnosis of EDKA is often overlooked because of the absence of hyperglycemia. The mechanism behind EDKA involves a general state of starvation that results in ketosis while normoglycemia is maintained. EDKA may be associated with precipitating factors, including sodium-glucose cotransporter 2 inhibitors, starvation, pregnancy, alcohol use, surgery, and drug-induced intoxication. A stepwise approach is used in the management of EDKA. Pharmacists can assist the medical team in preventing EDKA and can play a role in the management of EDKA.

The objective of this study was to determine the utility of a structured method of antimicrobial stewardship by Advanced Pharmacy Practice Experience students and assess student perceptions of the tool. Pharmacy students on rotation were trained to utilize a structured team antibiotic review form (TARF) as a tool to participate in antimicrobial stewardship. Students completed anonymous evaluations regarding their confidence in performing stewardship after completing their rotation, and preceptors quantified total student interventions. Data analysis was conducted using descriptive statistics. The Fisher’s Exact Test was used to compare students’ confidence before and after using TARFs. Twenty-six students participated in antimicrobial stewardship using TARFs, resulting in 889 interventions. Nearly 96% of students reported that TARFs helped them evaluate patient antibiotics in a way that was easy to follow and that TARFs provided them with an organized and structured way to systematically evaluate antibiotics. All students felt that the TARFs increased their knowledge on how to evaluate antibiotics. Significantly more students were confident in participating in antimicrobial stewardship after using the TARF. TARF use allowed students to substantially contribute to stewardship, and provided them with a structured guide allowing for improved student knowledge and confidence.

Candida auris (C auris) is an emerging multidrug-resistant yeast that presents a global health threat. Hospitalized patients and residents in long-term care facilities from several countries have fallen ill with Cauris, with infections reported in over 30 countries. Thirty percent of reported cases were resistant to at least two antifungals.This pathogen can persist on surfaces and spread between patients in healthcare facilities. Primary infection-control measures should be followed to prevent transmission. Infections are diagnosed through either a blood culture or culture from other bodily fluids. Echinocandins are currently recommended as first-line therapy for the treatment of C auris infections in individuals aged 2 months and older. A novel antifungal agent currently in phase Ill development has demonstrated potent fungicidal activity against C auris. Pharmacists can be involved in practicing antifungal stewardship and participating in the development of institutional guidelines and procedures for the management of C auris.

Depression affects 16 million Americans each year, with half of patients experiencing inadequate response to monotherapy with antidepressants. Up to 20% of people may suffer from chronic depression despite treatment. Treatment-resistant depression (TRD) can negatively impact an individual's activities of daily living. Pharmacologic approaches for the management of TRD include optimizing current treatment with correct dosage and agent selection, switching therapy, and augmentation.

Clostridium difficile is a pathogen known to cause diarrhea and colitis. If not properly treated, it can recur as well as progress to life-threatening conditions such as toxic megacolon and multiorgan failure. Guideline updates released in 2018 reflect notable changes in treatment of C difficile infection (CDI). Metronidazole is no longer recommended as first-line therapy for adults; oral vancomycin and fidaxomicin are now recommended. Current guidelines recommend fecal microbiota transplantation for patients with multiple recurrences of CDI in whom antibiotic treatment has failed. Pharmacist involvement in antibiotic stewardship programs has been shown to significantly reduce hospital rates of CDI.

Opioid-related overdose deaths have quadrupled since 1999. To combat this epidemic, pharmaceutical companies are developing various reformulations of commonly used opioid pain medications with abuse-deterring properties. The increase in opioid-overdose deaths has also led to widespread use of prescription drug monitoring programs to identify over-prescribing, diversion, and dispensing of naloxone to reverse opioid overdoses without a prescription in pharmacies, thereby outlining a crucial role for the pharmacist in this epidemic.

Melanoma—the deadliest form of skin cancer—leads to thousands of deaths each year. Although melanoma is less common than basal cell and squamous cell skin cancers, melanoma is more dangerous because it is more likely to spread to other parts of the body, such as lymph nodes, if not diagnosed and treated early. Data from the National Cancer Institute indicate a steady rise in new cases of melanoma and, unfortunately, a steady rate in the number of deaths through 2013. Ninety percent of melanomas are linked to inadequate sun protection from ultraviolet rays or the tanning habits of young adults. Over the past 5 years, however, there have been a variety of new pharmacologic treatments for advanced melanoma including immunotherapy, targeted agents (BRAF and MEK inhibitors), and oncolytic viral therapy. In this article, we review the current literature on the treatment of melanoma, with a focus on emerging therapies.

Abstract Glioblastoma is one of the most devastating of human cancers, with near-uniform fatality within two years of diagnosis. Therapeutic failure is thought to be related to small subpopulation of cells that exhibit the properties of self-renewal and tumorigenicity. Understanding how such subpopulations attain and retain these properties remains a central question in oncology. One fundamental issue is whether tumorigenicity exists within a static population of elite cells or whether the capacity is stochastically acquired. To test these models, we assayed the tumorigenicity of single-cell subclones derived from long-terms passaged and primary patient-derived xenograft (PDX) glioblastoma lines. Our findings were best described by a hybrid model that is largely deterministic (elite) but with opportunities for dynamic (stochastic) interchange between non-tumorigenic and tumorigenic states. To identify molecular determinants of tumorigenicity, we performed gene expression profiling of the subclones. Analysis of the data suggested that tumorigenicity in glioblastoma is a dynamic property driven by variation in MYC expression, which in turn regulates Olig2 expression, a neural stem cell marker. Ectopic expression of MYC conferred tumorigenicty and MYC silencing abolished tumorigenicity in vitro and in vivo for multiple PDX and GEMM models. Transition between tumorigenic and non-tumorigenic cell states was associated with changes in histone modification at the MYC locus mediated by expression of lysine-specific demethylase 1 (LSD1). The model suggests a critical LSD1-MYC-OLIG2 axis that regulates the dynamic transition between glioblastoma cell states of differing tumorigenicity and unveils a novel framework for glioblastoma therapeutic development. Citation Format: Clark Chen, David Kozono, Jie Li, Masayuki Nitta, Oltea Sampetrean, Kimberly Ng, David Gonda, Deepa S. Kushwaha, Dmitry Merzon, Valya Ramakrishnan, Shan Zhu, Kaya Zhu, Hiroko Matsui, Olivier Harismendy, Wei Hua, Ying Mao, Chang-Hyuk Kwon, Keith L. Ligon, Hideyuki Saya, Bob S. Carter, Donald P. Pizzo, Scott R. VandenBerg, Frank Furnari, Webster Cavenee. Dynamic epigenetic regulation of glioblastoma tumorigenicity through a LSD1-MYC-OLIG2 axis. [abstract]. In: Proceedings of the AACR Special Conference on Myc: From Biology to Therapy; Jan 7-10, 2015; La Jolla, CA. Philadelphia (PA): AACR; Mol Cancer Res 2015;13(10 Suppl):Abstract nr PR02.

Glioblastoma is the most common form of brain cancer and remains a devastating disease. Recent studies revealed significant intra-tumoral heterogeneity in the genetic and epigenetic make-up of glioblastomas. One level of heterogeneity involves subpopulations of cells capable of tumor initiation (TI). Here we provide data suggesting that the transition between TI- and non-TI is a dynamic process governed by spontaneous fluctuation in the level of MYC. In vitro culturing of sub-clones derived from long-term passaged and primary glioblastoma lines revealed that only a subset of the sub-clones possess TI capacity. The property of TI for each individual sub-clone appeared stable through serial passages. However, a small fraction of the non-TI clones will spontaneously acquire the TI ability. This phenomenon was observed both in vitro and in vivo. Transcriptome profiling of the sub-clones with varied TI capacity revealed a gene signature enriched for genes regulated by MYC. Among various sub-clones, MYC expression levels correlated with TI capacity tightly. More direct evidence was provided by MYC overexpression which augmented TI capacity in both xenograft and genetic murine models. Reversely, MYC silencing abolished glioblastoma capacity for TI. Importantly, the sub-clones that spontaneously acquired capacity exhibited enhanced MYC expression. In freshly resected glioblastoma specimens, overall MYC expression levels of the specimens correlated with their xenograft-forming ability. When these specimens were sub-fractionated by A2B5, a cell surface marker enriched in TI glioblastoma populations, the MYC level was significantly elevated in the A2B5+ fraction relative to the A2B5- fraction. In The Cancer Genome Atlas (TCGA) glioblastoma specimens, the expression level of a MYC signature directly correlated with mRNA signatures associated with the Cancer Stem Cell states. In dual immunofluorescence staining of clinical glioblastoma specimens, C-MYC co-stained with MIB1, suggesting that MYC expression support in vivo tumor proliferation. Since the various sub-clones were genetically identical based on SNP array profiling, we hypothesized that fluctuations in MYC expression was regulated through epigenetic regulation. Supporting our hypothesis, the primary glioblastoma tumor lines that demonstrated high MYC levels showed higher ratios of H3K4me3 to H3K27me3 at the MYC locus. Culturing conditions that enhanced TI capacity of glioblastoma cell lines also increased the ratio of H3K4me3 to H3K27me3 and induced MYC expression. In sum, our results suggest a threshold model in which TI capacity is driven by epigenetic regulation of MYC. MYC inhibition constitutes an attractive therapeutic target since this inhibition reduces dynamic cell state transition and reduce the complexity of the tumor heterogeneity. This abstract is also presented as Poster B75. Citation Format: David Kozono, Jie Li, Masayuki Nitta, Oltea Sampetrean, Kimberly Ng, David Gonda, Deepa Kushwaha, Matsui Hiroko, Olivier Harismendy, Oren Becher, Chang-Hyuk Kwon, Keith L. Ligon, Hideyuki Saya, Bob S. Carter, Donald Pizzo, Scott Vandenberg, Clark C. Chen. Epigenetic regulation of MYC drives dynamic transition between tumor initiating states in glioblastoma. [abstract]. In: Abstracts: AACR Special Conference on Cellular Heterogeneity in the Tumor Microenvironment; 2014 Feb 26-Mar 1; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2015;75(1 Suppl):Abstract nr PR13. doi:10.1158/1538-7445.CHTME14-PR13