Academic Pharmacy
The News Magazine of the American Association of Colleges of Pharmacy
NOW
Volume 11 2018 Issue 1
Tipping
the
Scales
Working with patients battling obesity, pharmacists and pharmacy schools are uniquely positioned to prompt change through prevention and treatment efforts. 14
Also in this issue: Calling Attention to Chemical Attacks 6 Promoting the Profession 8
who we are @AACPharmacy
Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy
American Association of Colleges of Pharmacy 1727 King Street, Floor 2 Alexandria, VA 22314 p: 703-739-2330 P f: 703-836-8982
www.aacp.org
Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.
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About Academic Pharmacy Now Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.
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NOW
CEO & Publisher
Lucinda L. Maine
Editorial Director
Lynette R. Bradley-Baker
Editor
Maureen Thielemans
mthielemans@aacp.org
Editorial Assistant
Kyle R. Bagin
kbagin@aacp.org
Art Director
Tricia Gordon
tgordon@aacp.org
Design Assistant
Sean Clark
sclark@aacp.org
Senior Advisor, Outreach and Communications
Stephanie Saunders Fouch sfouch@aacp.org
Freelance Writer
Athena Ponushis
reprinted without prior written permission.
Freelance Writer
Jane E. Rooney
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Academic Pharmacy NOW  2018 Issue 1
Volume 11 2018 Issue 1
@AACPharmacy a look inside
community impact
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Hiding in Plain Sight UCSF School of Pharmacy scientists engineer drug delivery device that treats glaucoma directly inside the eye.
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Using Science to Aid Human Rights A Mercer University professor shares her expertise with key groups to help prevent chemical weapons attacks.
campus connection
8
Up Close and Personal with Pharmacy
14 Tipping the Scales Working with patients battling obesity, pharmacists and pharmacy schools are uniquely positioned to prompt change through prevention and treatment efforts.
Programs at Western University of Health Sciences and Duquesne University are showing young students what the pharmacist can do—and powering the pipeline in the process.
@AACPharmacy
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Charging Up INspiration in Long Beach
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Leadership Development Begins Here
Bringing together insightful speakers, dynamic leadership development and illuminating peer discussions, the AACP INterim Meeting aims to INspire at every turn.
Academic Pharmacy NOW  2018 Issue 1
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community note publisher’s impact
Dear Colleagues: This is the first issue of Academic Pharmacy Now in 2018 so it is still appropriate to open with a Happy New Year salutation! In yearend conversations as we approached the December holidays, everyone I spoke with noted that the pace of 2017 had eclipsed any previous year. Fortunately, many looked forward to relatively quiet, family and funfilled days to end the year. As conversations continued into 2018 it seems this year’s pace may outrun last year’s; at least that is what these first weeks suggest. When time goes by so quickly it requires that we make choices to selectively work on that which can make a significant difference. The earliest meeting on the calendar for AACP each year is a small one for an organization called the National Conference of Pharmaceutical Organizations (NCPO). I am certain that few readers have ever heard of it though it was established more than 100 years ago. Every January the chief executive officers and their top elected leaders of 11 pharmaceutical sector associations meet for two days of highly relevant discussions on issues that cut across manufacturing, distribution, practice, education and regulation. We share what our top policy priorities are for the year ahead and often invite a speaker to describe the current political landscape. This year speakers discussed “the Amazon way” and the report of the President’s Commission on Opioids. Every organization and their members were currently directing significant attention to the opioid crisis, but Dr. Madras from Harvard University and a member of the Commission urged us to use our collective influence to stimulate action on the Commission recommendations. In response, NCPO issued a joint statement in late January expressing our commitment to address the crisis. It stated that we aim to meet with President Trump and the staff responsible for directing the Administration’s efforts on
opioid misuse to learn how they were prioritizing the recommendations and how our efforts could individually and collectively add value to reduce the harm from misuse while effectively addressing legitimate pain. We aim to make a significant contribution as pharmacy is absolutely front-and-center on the opioid misuse issue. This issue of Academic Pharmacy Now addresses an issue that may have an even more significant impact on the health and well-being of our citizens than opioid misuse and abuse—obesity. According to the Centers for Disease Control and Prevention, more than a third of adults in the U.S. are obese, costing an estimated $150 billion per year and contributing to heart disease, stroke, diabetes and even cancer. It is the leading preventable cause of disease. A cardiologist and former president of the American Heart Association who worked with the AACP Argus Commission in the last year noted that obesity will be among the most important targets for health improvement for decades to come. The basis for his projection was that the science of obesity is still quite immature. A great deal of work is needed on the full spectrum of obesity prevention and treatment efforts. So as AACP members consider how we individually and collectively prioritize our work in the fast-paced time in which we live, it is good to realize that there are many significant issues where our education, research and practice efforts aim to address compelling unmet needs in our society. My thanks for all that you do. Sincerely,
Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher
Share Your News with the Academy: Academic Pharmacy Now is seeking content for its Campus Connection and Community Impact sections. Articles in Campus Connection highlight professional best practices, innovative research teaching techniques and curriculum tools, or news that’s happening on campus.
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Articles in Community Impact illustrate how the work of faculty or researchers is affecting the larger community and showcase what pharmacy faculty are doing outside the classroom.
For submissions, questions or to learn more about broader themes for upcoming issues, contact Maureen Thielemans, associate director of communications, at mthielemans@aacp.org.
community impact
Hiding in Plain Sight UCSF School of Pharmacy scientists engineer drug delivery device that treats glaucoma directly inside the eye. By Levi Gadye, Ph.D. Glaucoma, which affects over 60 million people worldwide, can seem easy to treat: medicated eye drops can be used to ease the buildup of fluid in the eye that underlies the condition. If glaucoma is caught early, eye drops can prevent irreversible blindness. But prescription eye drops aren’t the perfect solution for glaucoma. Many elderly patients who suffer from glaucoma struggle to take their eye drops on time, which is required up to three times a day. And even when patients comply with this intensive eye drop schedule, much of the medication drains into the patient’s blood, missing its target inside the eye. Those problems could be part of the past, thanks to a device developed in the lab of Dr. Tejal Desai. The tiny implant promises to simplify how glaucoma drugs are administered, making life easier for aging patients.
The small device is implanted in the eye, delivering drugs over the course of six months before dissolving.
Image credit: Jean Kim/Desai Lab
Image credit: Alexageev, via Wikimedia Commons
Desai, who is chair of the Department of Bioengineering and Therapeutic Sciences, a joint department of the UCSF Schools of Pharmacy and Medicine, recently reported her lab’s success using the implant to reduce eye pressure in animals in the Journal of Controlled Release. The paper’s first author, Jean Kim, is a Ph.D. student in the Desai Lab.
Drug implant dissolves to treat glaucoma Recognizing the need for a drug delivery method that removes the fuss for patients, the researchers toyed with degradable materials that would slowly release the medication while dissolving in the eye. They settled on a “sandwich” of biodegradable films surrounding an anti-glaucoma drug. Using this design, “we can load enough drug in the tiny device to last over six months,” says Desai.
Image credit: Cindy Chew
The researchers implanted the drugreleasing devices and measured eye pressure on a weekly basis for 24 weeks. Beyond some rare and minor complications, the device successfully reduced eye pressure in the animals for the duration of the study. Dr. Tejal Desai, UCSF School of Pharmacy, is hopeful her lab’s device will soon improve outcomes for glaucoma patients.
“While there have been important advances in eye drop formulations, our
device substantially reduces the burden of patient compliance in a safe and effective way,” Desai says. Desai is hopeful that her lab’s device will soon improve outcomes for patients. “Next steps will involve scaling up, developing device fabrication procedures that comply with current good manufacturing practices, and testing the device in larger animals, before moving on to clinical trials,” she says. P This article was reprinted and adapted with permission from the School of Pharmacy, University of California, San Francisco. Levi Gadye, Ph.D., is a health and science writer at the UCSF School of Pharmacy.
Journal Citation Kim J, Kudisch M, da Silva NRK, Asada H, Aya-Shibuya E, Bloomer MM, Mudumba S, Bhisitkul RB, Desai TA (2018), “Long-term intraocular pressure reduction with intracameral polycaprolactone glaucoma devices that deliver a novel anti-glaucoma agent,” Journal of Controlled Release, 269: 45-51(published online Nov. 7, 2017), doi: 10.1016/j.jconrel.2017.11.008.
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Using Science to Aid Human Rights A Mercer University professor shares her expertise with key groups to help prevent chemical weapons attacks. By Kay Torrance
In a remote, mountainous region in western Sudan known as Jebel Marra in 2016, the rocket attacks came often and without warning. Homes were decimated. People and livestock were killed. Others, especially children, suffered horrible burns to their body. More than 30 rocket attacks occurred that year in Jebel Marra, believed to be a rebel stronghold by the Sudanese government. The Sudanese military forces, which have been implicated in similar attacks, are believed to be behind these too, according to Amnesty International (AI), which collected evidence and eyewitness accounts from survivors. Amnesty went public in September 2016 with a 100-page report and a press conference to publicly name the
government of Sudan as a perpetrator of chemical warfare.
weapon was sulfur mustard, a gas that can form large blisters on exposed skin and in the lungs.
Amnesty put together its report with the help of Dr. Jennifer Knaack, asKnaack and Ward’s analysis was sistant professor in Mercer University’s included in the report, which also was College of Pharmacy. Knaack lends her submitted to the United Nations. The time to the American Association for report contained many grisly photos the Advancement of Science’s On-call of injured children, women and men. Scientists program, which connects Amnesty believes that more than 200 scientists, engineers, and health profes- people were killed in the 2016 attacks; sionals to human rights organizations there is little to no health care in the seeking expertise. She and another area so many people went untreated. scientist who lends time to On-call, “I’d like to see that nobody gets away Keith Ward, formerly with the Departwith chemical weapons attacks, and ment of Defense, reviewed Amnesty’s that the people who are being attacked photos and survivors’ accounts. They are getting some supportive therapy determined the wounds were consisor aid,” she said. “I’m really passionate tent with those previously seen from about this, and this is a priority for me, chemical weapons and that the likely because if I’m not able to go into these areas to directly help people, then I can do this.”
Increasing Awareness Knaack and Ward attended the press conference at the U.N. General Assembly meeting in New York. There, Knaack fielded questions from journalists and was interviewed on-camera by the French news agency Agence FrancePresse. She also was quoted by CNN.
Dr. Jennifer Knaack, assistant professor at Mercer University College of Pharmacy, conducts a press interview at the UN.
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Knaack lends her time to the American Association for the Advancement of Science’s On-call Scientists program, which connects scientists, engineers, and health professionals to human rights organizations seeking expertise.
Knaack also worked with Amnesty on the use of alleged nerve agents in Syria
Kay Torrance is director of communications and marketing at Mercer University College of Pharmacy in Atlanta.
Image credit: John Amis for Mercer University
“I can’t stop people from releasing these agents and people being exposed to them, but I can at least help call attention to the problem and hopefully contribute to stopping it,” she said.
in 2013 and 2017 and has counseled staffers on how best to collect samples in the field. Before joining Mercer’s faculty, Dr. Knaack worked for the Centers for Disease Control and Prevention as a chemical warfare expert where she developed and studied tests to determine if a person has been exposed to chemical warfare agents. At Mercer, she oversees a lab where she and her team of graduate students develop diagnostic methods for measuring exposure to synthetic or natural toxins. P
Last October, Knaack participated in a conference call with the Organisation for the Prohibition of Chemical Weapons (OPCW) in The Hague. The OPCW and U.N. meetings took place an in effort to increase awareness of the attacks and to persuade the U.N. to investigate the Sudanese government.
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campus connection
Up Close and Personal with Pharmacy Programs at Western University of Health Sciences and Duquesne University are showing young students what the pharmacist can do—and powering the pipeline in the process. By Athena Ponushis and Maureen Thielemans
Member schools are continuing to amp up efforts to recruit young adults to pursue pharmacy as a career and strengthen the pharmacy pipeline. Dr. Mario Jimenez knows such efforts work. As a senior in high school, Jimenez never considered pharmacy as a career, until a student pharmacist came to speak to his class. Now, after working more than 25 years as a pharmacy owner, Jimenez is the one going to speak at high schools and
junior colleges, in his role as Director of Diversity Initiatives at the Western University of Health Sciences College of Pharmacy.
Jimenez tries to draw the curiosity of students by talking about what pharmacists today can do—give immunizations, talk about travel medications, help with smoking cessation and prescribe birth control pills.
Jimenez wants to break the myth that all a pharmacist does is count and pour, and show students what a career in “Hopefully, I can reach one student out pharmacy could really look like—give of each group of 80 or so, and then we immunizations, provide travel mediwill see future diverse pharmacists cine consultations, participate in smok- who can address the needs of our curing cessation and furnish prescription rent population,” Jimenez said. hormonal contraceptives.
During the Summer Health Professions Education Program, undergraduate students from various ethnic and socioeconomic backgrounds across the United States visit WesternU and are exposed to different fields such as cardiology, dentistry, veterinary medicine and pharmacy, and discuss topics ranging from diabetes to blood pressure to narcotics.
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campus connection
Pharmacy pipeline programs at WesternU are hoping to change young adults’ perceptions of what a pharmacist can do—counsel patients, use science and chemistry to compound a medication, give immunizations and much more. Palomares Day brings students from Palomares Academy, a health sciences junior high school, to WesternU to learn how to take blood pressure readings and measure blood glucose with a glucometer, as a way of experiencing what pharmacists do. During PharmDay local high school students visited WesternU’s College of Pharmacy compounding lab where they created lip balm.
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“Hopefully, I can reach one student out of each group of 80 or so, and then we will see future diverse pharmacists who can address the needs of our current population.” — Dr. Mario Jimenez
AACP has made a commitment to enhance the pharmacy pipeline and to make its applicant pool more diverse to • better reflect the population it serves. Recruiting students, changing public understanding of pharmacists and changing pharmacy students’ understanding of the public, are top priorities. Pipeline programs at WesternU are doing just that: •
Duquesne University School of Pharmacy attracts young adults into a pharmacy career using multiple avenues and programs, including the Carnegie Science Center Tour Your Future event. This half-day workshop provided the opportunity for girls to explore STEM careers in-depth. Participants were able to witness the role a pharmacist plays in a mock emergency room situation, watch a SIM man experience an asthma attack and compound an ointment.
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•
The Summer Health Professions Education Program will bring 80 undergraduate students from various ethnic and socioeconomic backgrounds across the United States to WesternU in June. Over the course of six weeks, students are exposed to different fields such as cardiology, dentistry, veterinary medicine and pharmacy, and discuss topics ranging from diabetes to blood pressure to narcotics. Jimenez said the program intentionally does not target the students’ specific field of interest, but exposes the student to a number of fields he or she may have never been exposed to otherwise. Palomares Day has been bringing students from Palomares Academy, a health sciences junior high school, to WesternU for several years now. Hosting the pharmacy program this year, Jimenez has a game plan for the students to take blood pressure readings and measure blood glucose
•
with a glucometer, as a way of experiencing what pharmacists do. PharmDay launched last year, hosting students from nine local high schools at WesternU’s College of Pharmacy compounding lab, where they created lip balm. Many of the students had not been exposed to a scale or weighed ingredients before, Jimenez noted, so they were interested to learn about pharmacy where they could pursue a compounding profession. The Pomona Health Career Ladder, a partnership among the Pomona Unified School District, Cal Poly Pomona and WesternU, aims to engage local youth in health professions. Starting out with 50 attendees in the 6th grade in 2007, the program has grown to work with an average of 300 students from 6th to 12th grade on a monthly basis. PHCL also created the youth academy, working with children and families from preschool through the 5th grade. WesternU has also engaged the American Indian communities from Riverside and Los Angeles counties, establishing the American Indian Health Career Ladder to create a specialized curriculum for native youth, coupling their traditional and cultural practices with the teaching of western medicine.
campus connection
At the Carnegie Science Center Williams’ Girls Rock Science Weekend in September, girls from local elementary, middle, and high schools who are interested in STEM careers stopped by the Duquesne University School of Pharmacy table to solve math problems and listen to their own heartbeats using a stethoscope.
Dr. Daniel Robinson, dean of the College of Pharmacy at WesternU, expects to see the rewards of their pipeline programs in the next three to five years. “We have students who enter our program each year who represent as many as 20 countries of birth. Even with this tremendous diversity, we still suffer from underrepresentation of Hispanic, African American and Native American students. Our pipeline programs are important because they reach into our highly diverse communities and expose youth to future opportunities in the health professions so that future graduates will be more representative
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campus connection
“Our pipeline programs are important because they reach into our highly diverse communities and expose youth to future opportunities in the health professions so that future graduates will be more representative of the local populations they will serve.” — Dean Daniel Robinson
of the local populations they will serve,” he said. Jimenez likes to tell students how actively his college supports diversity and he encourages faculty at other member schools to do the same. “I like to make that known to the students because a lot of times they might get intimidated and say, ‘Well, I don’t know if that school is really for me,’” he said. “They need to know that they are supported, that they can do this.”
Making STEM a Success At Duquesne University School of Pharmacy, efforts are in place to attract young students with an interest in science and math to the pharmacy profession, said Dr. Janet K. Astle, assistant dean for student services. Three programs offer these young students the opportunity to help shape the future of the profession: the Carnegie Science Center Williams’ Girls Rock Science Weekend, the Carnegie Science Center Tour Your Future event, and engagement with the Phi Lambda Sigma professional honorary pharmacy leadership society. For two days in September, the School of Pharmacy hosted a table sponsored
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by Giant Eagle Pharmacy at the Williams’ Girls Rock Science Weekend, which is sponsored by the Carnegie Science Center. Girls from local elementary, middle, and high schools who are interested in STEM careers—everything from pharmacy to meteorology to robotics—visited with organizations to learn more about the various fields. Duquesne’s P3 students helped the girls complete some of the tasks a pharmacist would perform, such as compounding an ointment and calculating math problems based on a patient’s scenario. For example, the girls were presented with a case of an 8 year-old boy who was stung by a bee. Minutes later he has trouble breathing. They’re given the option of selecting an EpiPen® or EpiPen Jr®, with corresponding weight ranges in kilograms. Knowing that the patient weighs 63 lbs., they had to convert the weight to kgs and determine which product is best to use. For the younger girls, trying on white coats and listening to their own heartbeat using stethoscopes were popular activities, said Astle. The Girls Rock weekend was such a success that the School of Pharmacy was asked to participate in the Carnegie Science Center Tour Your Future event.
This half-day workshop provided the opportunity for girls to explore STEM careers in-depth. Fifteen participants, ages 12–17, signed up to spend a halfday on the Duquesne University campus where faculty walked the student visitors through the role a pharmacist plays in a mock emergency room situation. Faculty further demonstrated a SIM man experiencing an asthma attack and how his response changed once the appropriate medication was administered. Some of the girls were overheard saying, ‘Wow, I didn’t know pharmacists could do all this,’ Astle noted. “It really did open their eyes and they left excited about the possibilities,” she said. Astle added that the feedback from Carnegie was also very positive, and she is eager to participate again next year. Meeting young students in their current classrooms is also important to the recruitment efforts. The School of Pharmacy has engaged its Phi Lambda Sigma honorary leadership society members to visit local middle and high schools to deliver interactive presentations about pharmacy as a career. P Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida. Maureen Thielemans is Associate Director of Communications at AACP and editor of Academic Pharmacy Now.
@AACPharmacy
New Models | New Paths New Initiatives in Community Healthcare We fund evidence-based research and educational initiatives designed to improve patient outcomes and advance public health. Visit us at NACDSFoundation.org
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Tipping
the
Scales The obesity crisis is one of the nation’s biggest health concerns. Pharmacists are on the front lines when it comes to helping patients shed and keep off extra pounds. By Jane E. Rooney
As obesity becomes more prevalent among the U.S. population—more than a third of adults and one in five children are now considered to be obese—the effects on society are harder to ignore. Health conditions that can be tied to obesity include heart disease, stroke, type 2 diabetes, respiratory problems and certain cancers, according to the Centers for Disease Control and Prevention.
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Children who are obese are more likely to become obese adults, and obesity and disease risk factors in adulthood are likely to be more severe. The estimated annual medical cost of obesity in this country is more than $200 billion. Medical costs for people who have obesity are approximately $1,429 higher than those of normal weight. In 2013, the American Medical Association began recognizing obesity—defined as a body mass index (BMI) of 30 or above—as a disease. The Office of Disease Prevention and Health Promotion, part of the U.S. Department of Health and Human Services, establishes national health objectives with 10-year targets. One of its Healthy People 2010 goals was to reduce the proportion of adults who were obese to 15 percent. No state met that objective; in fact, the proportion of adults age 20 and over who were obese rose from 23 percent to 34 percent, according to data from 2012. To put the dangers of obesity in perspective, consider the numbers in relation to the opioid epidemic. The New York Times reported that overdoses from opioids were the leading cause of death last year for Americans under 50 years old, killing approximately 64,000 people. The CDC estimates 112,000 deaths per year that are associated with obesity. The Obesity Society, which refers to obesity as one of the greatest public health challenges of our time, notes that it is a condition “that has often been stigmatized because of the perception that it is caused mostly by the modifiable behavioral factors of diet and physical inactivity. Nevertheless, a rich body of research demonstrates that obesity is a complex disease condition mediated through the interplay of multiple genetic, biologic, metabolic, behavioral, social, economic and cultural determinants.” The organization suggests that reducing the burden of this disease requires a team of multidisciplinary healthcare providers. Healthcare professionals play a key role in working with patients battling obesity, and pharmacists and pharmacy schools are uniquely positioned to prompt change through prevention and treatment efforts.
Communication Is Key Dr. Jan Kavookjian, associate professor, Auburn University Harrison School of Pharmacy, said pharmacists can play a significant role in providing continuity of care for patients, particularly those that they see regularly for chronic conditions for monitoring in between physician visits. “When talking to patients about other conditions, pharmacists are really in a position to listen to patients about the role that
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obesity plays in their overall health, and particularly the management of whatever condition they might be discussing, whether it be diabetes, hypertension, etc. Weight loss is an important part of controlling those conditions,” she said. “Some community pharmacies and pharmacy-based clinics across the country are engaging in advanced care services that incorporate weight loss for purposes of health and chronic disease management.” With recent changes to accreditation standards for pharmacy education, engaging in patient-centered communication skills is one area that is getting attention and is especially relevant in discussions about obesity. “Pharmacists working in teams with other healthcare providers is something we’re seeing really becoming an important focus area,” Kavookjian added. “The topic of health management and weight loss is well suited across health professions.” She represented AACP and pharmacy education on an interdisciplinary panel at a National Academy of Medicine/Institute of Medicine initiative in 2017, which brought together 20 leading health organizations in an attempt to come to consensus on a core set of competencies for preventing and managing obesity that are applicable across health professions. She said she is pleased with the report, “Provider Competencies for the Prevention and Management of Obesity,” which resulted after several brainstorming sessions that involved a diverse group of providers and support professions. The report highlighted the fact that fewer than 25 percent of physicians feel they received adequate training to be able to counsel patients in making lifestyle changes. “The competencies that emerged for behavior change interventions and patient-centered communication really are applicable across health professions and are very relevant even for people who are not clinically trained,” she noted. “A big part of my specific role was bringing in the experiences I have with communication best practices that demonstrate an evidence base in applications with patients. It’s part of the language used and knowing how to have these conversations with patients in a way that is not perpetuating the stigma of being overweight, and in a way that is being supportive and encouraging. Providers need to help the patient find his or her own internal motivation to make changes.” Dr. Jacqueise Unonu, assistant professor at the Howard University College of Pharmacy, agrees that getting patients to open up and be honest about their struggles with weight is crucial. “Oftentimes patients do not receive education in neither the appropriate language with regards to reading level nor the appropriate delivery method. Due to time con-
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“When talking to patients about other conditions, pharmacists are really in a position to listen to patients about the role that obesity plays in their overall health, and particularly the management of whatever condition they might be discussing, whether it be diabetes, hypertension, etc. … Some community pharmacies and pharmacy-based clinics across the country are engaging in advanced care services that incorporate weight loss for purposes of health and chronic disease management.” — Dr. Jan Kavookjian
straints they are handed a booklet of information addressing their condition, especially in the environment of the emergency department. That information may touch on obesity as it relates to the main conditions being attended to and merely provided instructions on what to do.” Motivational interviewing is an important part of what pharmacists do, Unonu added. “We want patients to know that it’s a team effort and they can do it,” she said. “We never want to seem like a parent telling them what to do. We want them to feel like part of a team and let them make decisions about what they’re going to do.” Pharmacists are in a great position to offer education and make sure that patients understand information that they have received” she noted. “We utilize guidelines and best practices from organizations such as the American Heart Association and American Diabetes Association to see what the recommendation needs to be for the patient. Pharmacists can assess the risk factor and look at what percent weight loss the patient needs to have, and then let them know that even the smallest amount can increase life expectancy. From there we go to medication and talking about any kinds of changes the patient needs to make in terms of behavior.”
An Ounce of Prevention Auburn launched a new integrated curriculum last fall, which includes obesity as a specific condition to be addressed. “There is significant coverage of how to communicate with patients who are at risk or who are obese and talking about treatment and prevention,” Kavookjian explained. “Auburn has a pharmaceutical care clinic that engages in services including healthy lifestyles—things that are important to maintaining a healthy weight,” she continued. “The pro-
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gram is run in the pharmacy-based clinic at the school and addresses goal setting and monitoring of lifestyle factors that impact weight and obesity. Fourth-year students rotate through this setting and have an opportunity to get engaged with employee patients and also people in the community. This is about rounding out opportunities to provide direct patient care experiences that will spill over in this realm of working with people whose health is affected by obesity.” At Howard University College of Pharmacy, discussions about obesity are part of the curriculum and the institution offers a Healthy Rewards program that provides a health coach and incentives as employees meet healthy diet and exercise goals. “Institutions are being proactive in making sure faculty and staff are knowledgeable about obesity and focusing on preventive measures,” said Unonu, who has a background in exercise and nutrition. She echoed Kavookjian’s sentiment that pharmacists are on the front lines for offering prevention and treatment assistance to patients struggling with obesity. “The initial step is the non-pharmacological aspect of therapy,” she said. “Our role is not only to be knowledgeable about medication interventions but what to initially recommend to providers and educate patients on regarding lifestyle modifications including diet and exercise before we move to medication. The educational part should come first with the patient weighing in on what they feel they can gradually do. That being said, it should be recognized that medication is an option as obesity is not only a risk factor for other conditions but is a disease in and of itself. Once that concept is accepted patients will feel more comfortable seeking help and healthcare professionals will be on the same page so that the disease can be addressed properly.”
campus connection
An Interprofessional Look at “Inflammaging” Complications from obesity can compound with age. But a group of University of Florida Health researchers has found a new role for protein in significantly reducing the chronic, lowgrade inflammation that may contribute to aging and agingrelated diseases. Using human cell and fruit fly models, the researchers showed the liver-produced protein, known as human alpha-1 antitrypsin, has anti-inflammatory and cell-protecting properties. That makes it particularly effective at stopping so-called “inflammaging,” chronic inflammation that has been implicated in a host of aging-related disorders such as cardiovascular disease, Type 2 diabetes and osteoporosis. The findings by 13 scientists in the UF department of molecular genetics, the College of Pharmacy, the UF Genetics Institute and the UF Health Cancer Center were published in the journal, Aging Cell. While much research remains to be done, understanding how the protein works to suppress the genes that promote inflammation is a crucial step, said Dr. Sihong Song, an associate professor of pharmaceutics in the UF College of Pharmacy, part of UF Health. “Although this protein may contribute to extending the lifespan of humans, we’re more interested in improving quality of life for the elderly,” Song said.
A Tough Target Inflammation is an obvious but challenging target for preventing aging-related diseases, Song said. In both fruit flies and human cells, the protein was shown to significantly inhibit inflammation-related genes and molecular pathways, the researchers found.
Lei Zhou, Ph.D., (left) is an associate professor in the UF College of Medicine’s department of molecular genetics and microbiology. Sihong Song, Ph.D., is an associate professor of pharmaceutics in the UF College of Pharmacy.
By Doug Bennett
The protein is appealing as a potential treatment because it is naturally produced and can be harvested from blood plasma, Song said. It already has federal approval to treat a genetic disorder known as alpha-1 antitrypsin deficiency, which can cause lung disorders such as emphysema and chronic obstructive pulmonary disease. Fruit flies that had the human protein-producing gene inserted lived significantly longer and survived in greater numbers than those that were untreated, the researchers found. More than 50 percent of the transgenic flies that were given the medication RU486 to induce expression of the human proteinproducing gene survived at least 100 days. The fly’s normal lifespan is 40 to 60 days, Song noted. During testing on human connective tissue cells, the researchers studied the protein’s effectiveness at inhibiting gene activity in cells that are no longer capable of dividing — essentially a laboratory model of what happens during inflammaging. They found that the activity of 42 genes was significantly affected by the introduction of the protein when compared with a control group. While the researchers say they don’t fully understand the molecular mechanisms of anti-inflammaging, some of the data suggest the human protein has an effect on the NF-kappaB protein, which controls certain DNA activity. One limitation for any potential human therapy involves a supply issue: For the protein to be effective against inflammaging, the proper dose has to be delivered at the right time and place. However, the supply of protein is potentially limited because it is harvested from blood plasma. To address that, Song said he sees potential in a gene therapy technique known as AAV, which uses a small, harmless virus to deliver new genes to a patient’s cells. That targeted technique would require less of the protein and provide longer-lasting treatment, he said. Considering its status as a Food and Drug Administrationapproved therapy and its newly discovered anti-inflammaging properties, researchers said the protein is a promising candidate to fight aging and aging-related diseases. Adapted and edited with permission from UF Health. Doug Bennett is a science writer and editor with UF Health.
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campus connection
Competencies for Obesity Prevention and Management These are the top-line competencies designed for health professionals that emerged from the NAM/ IOM summit. They are intended to set the bar for what schools and training programs should be teaching future healthcare providers.
1. Demonstrate a working knowledge of obesity as a disease. 2. Demonstrate a working knowledge of the epidemiology of the obesity epidemic. 3. Describe the disparate burden of obesity and approaches to mitigate it. 4. Describe the benefits of working interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional. 5. Apply the skills necessary for effective interprofessional collaboration and integration of clinical and community care for obesity. 6. Use patient-centered communication when working with individuals with obesity and others. 7. Employ strategies to minimize bias towards and discrimination against people with obesity, including weight, body habitus, and the causes of obesity. 8. Implement a range of accommodations and safety measures specific to people with obesity. 9. Utilize evidence-based care/services for persons with obesity or at risk for obesity. 10. Provide evidence-based care/services for persons with obesity co-morbidities.
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Unonu further explained that pharmacists are an integral part in patients’ access to medication, particularly those for obesity. Pharmacists know how to navigate around the red tape to help providers obtain medications that seem inaccessible due to insurance processes or out of pocket costs. Unonu recently represented AACP this past November at The Obesity Society (TOS) Roundtable titled “Obesity is a Disease—Progress and Gaps” where multidisciplinary stakeholders worked together with the goal of updating the official TOS position statement. Unonu stated that she was able to contribute the perspective of a pharmacist and how pharmacists can assist in closing the gap and addressing treatment. “Again, helping patients is a joint effort. The patient is at the center and is a part of the decision-making process. The ultimate goal is to improve their health and improve quality of life at the end of the day. As pharmacists that’s what we’re here to do. Kavookjian said that early intervention at the community level is a good place for pharmacists to start. Focusing efforts at the family level on youth and trying to break unhealthy patterns is a promising strategy being addressed by outcomes researchers across professions. Within academia, Unonu emphasized that schools need to be integrating discussions about obesity into the curriculum. “We see it in different disease states as a risk factor, but we really need to be looking at it as a disease on its own,” she said. “We try to have a comprehensive approach to the patient and the weight loss journey.”
Removing the Stigma Kavookjian said that getting providers adequately trained in communicating with patients can have a positive impact in building a relationship as well as the trust that is required to help patients feel supported. “They’ve got to feel that support to find their own internal motivation,” she emphasized. “To be really impactful, behavior changes need to be sustained through continued positive reinforcement for what patients are thinking and doing for healthy behaviors. We’re going to see this emphasized more and more as we have these future healthcare providers trained in the evidence-based motivational interviewing skills set and way of being. When we’re talking about treatment decisions, we’re really engaging patients in goal setting and change decisions. Pharmacists will be better equipped with these tools in hand to have these conversations specifically about these difficult topics related
campus connection
to being obese. Being able to have a caring, nonjudgemental conversation with someone is very important.” Our society has stigmatized persons with obesity in negative ways, she continued, to the point that there’s a weight bias and patients won’t even reach out to their provider to talk about weight loss. Issues such as access to care, literacy, economic barriers, transportation and other inequalities also come into play that make the burden of obesity harder on some populations. Providers need to think about obese patients in the same way they would think about someone with depression or cancer. “Pharmacists who are willing to educate themselves and become aware of their own biases is one of the first steps in having that empathic encounter with someone who is overweight,” Kavookjian explained. “We need to think about even the language we use. The word obese is negative. We
need to be direct and assertive, but there’s a way to do that in a caring way. Using ‘people-first’ language (people with obesity vs. obese people, or talking about healthier weight vs. morbid obesity). Such a sensitive topic is often brought up in a shaming or blaming way. The first step is being aware and then educating oneself about constructive strategies and skills.” Said Unonu: “The next step is really addressing obesity as a disease and recognizing it as such. Many don’t think about obesity as being something you have to address. There’s this idea that the person got there because they aren’t exercising or they are just watching TV and eating. The fact is that there are so many things compounding it—depression, genetics….Instead of an ‘I told you’ attitude, clinicians need to help address obesity just as much as the other issues.” P Jane E. Rooney is a freelance writer based in Oakton, Virginia.
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@AACPharmacy
Charging Up INspiration in Long Beach Bringing together insightful speakers, dynamic leadership development and illuminating peer discussions, the AACP INterim Meeting aims to INspire at every turn. New conference highlights such as rapid-fire microsessions, in which speakers tackle a pressing topic in just ten minutes, lead a packed agenda that promises to deliver the best strategies and tools for leaders at all levels to create positive change at their institutions.
Attending the meeting in Long Beach? You won’t want to miss the sessions that address: • How to leverage personal strengths to be the leader your institution needs;
• How to effectively persuade different audiences during a crisis;
February 24–27, 2018 Long Beach, California AACP greatly appreciates the support from our meeting sponsors, whose contributions made this event possible. Educational Day Sponsor
The NACDS Foundation utilizes education, research and philanthropy to help improve patient outcomes and advance public health. Through its collaboration with academic institutions and public health entities, the Foundation seeks to uncover innovative care delivery models that can be replicated and scaled into real-world solutions.
Bronze Sponsors
• How to successfully navigate conflict using peertested case studies;
• How data from the NAPLEX and PCOA are being utilized to improve pharmacy education.
As the next few years present challenges and opportunities in healthcare and higher education, effective leadership at all levels is essential. We hope you join us at INspire 2018, and future INterim Meetings, where we aim to Inspire, Innovate and Invigorate.
http://bit.ly/INspire2018
AACP Annual Meeting The premier professional development meeting for pharmacy educators heads to Boston, July 21–25. Registration for Pharmacy Education 2018 opens in April.
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ExamSoft enables educators to efficiently and effectively create, administer, grade, and analyze assessments with the goal of improving student performance, curricular design, and accreditation compliance.
Kaplan is the world leader in test preparation and is excited to showcase their NAPLEX preparation options, including question practice, on-demand videos, and live reviews.
RxPrep provides complete and current board review programs that optimize preparation for the NAPLEX, MPJE, and CPJE exams.
Shadow Health® is an educational software developer of web-based Digital Clinical Experiences™ designed to augment courses for nursing students and allied health education programs.
@AACPharmacy
Leadership Development Begins Here It’s Time to Take the Lead: Apply to join the Academic Leadership Fellows Program This prestigious leadership development program has helped to create top leaders in academic pharmacy and higher education by providing the knowledge, skills and network to foster personal and professional growth. Make the commitment to enhance your leadership skills in the New Year and beyond. Visit https://www. aacp.org/academic-leadership-fellows-program to learn more and submit an application by March 19.
AACP Catalyst helps mid-career researchers expand their individual and institutional research capacity by building networks, identifying new opportunities and developing key skills in order to reach their full research and leadership potential. Visit https://www.aacp.org/resource/aacp-catalyst to apply or nominate an individual at your school who is poised to breakthrough to the next level of research and leadership. Submissions must be received by 11:59 p.m. EDT on April 17, 2018.
Mark Your Calendars Interested in presenting a school poster at Pharmacy Education 2018 or volunteering for a committee? Below are some important deadlines to add to your calendar. More information can be found on the AACP website, www.aacp.org.
March
Pharmacy Education 2018 Roundtable Topics Deadline: March 7 The AACP Program Committee invites AACP members to submit pressing, current topics important to the Academy for roundtable discussions at the 2018 Annual Meeting, July 21–25, in Boston. http://bit.ly/AM18SubmissionInfo Scholarship of Teaching and Learning Grant Deadline for Letters of Intent: March 15 AACP’s new Scholarship of Teaching and Learning grants provide up to $4,000 in research funding for active members engaging in educational research. Proposals must address an issue of Strategic Plan Priority #3. http://bit.ly/SOTLGrant Pharmacy Education 2018 School Posters Deadline: March 28 The AACP Program Committee invites each AACP member institution to submit one poster addressing the 2018 school poster theme “Complementary Approaches with a Common Mission: Connecting the Pharmaceutical Sciences and Pharmacy Practice.” http://bit.ly/AM18SubmissionInfo Election Nominations Deadline: March 30 Guide the future of AACP! We are seeking nominations for President-elect, Treasurer, Speaker of the House, and Council level positions. Join the conversation by submitting your nomination materials. http://bit.ly/AACPElections
April
Committee Volunteers Deadline: April 4 AACP President-elect David D. Allen is seeking volunteers to serve on AACP standing, awards selection and other committees to take academic pharmacy’s successes in faculty leadership and development, in conjunction with overall faculty wellness, to new heights. http://bit.ly/AACPCommittees
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Registration Opens Soon AACP Spring Institute:
Reaching New Heights in Experiential Education May 7–9, 2018
P
Hyatt Regency Dulles, Herndon, VA (Washington D.C. area)
The 2018 Spring Institute focuses on four areas related to Experiential Education: Assessment strategies to include the integration of EPA’s into the student’s experience; Identifying needs for preceptor development with a focus on clear guidance for meeting program expectations; Remediation strategies which reflect early identification, root cause analyses and the elements for a remediation plan; and A focus on practical approaches to scholarly activities in experiential education.
Who Should Attend: • Experiential Education administration and staff • Individuals influencing curriculum • Individuals influencing assessment • Preceptors
https://www.aacp.org/event/2018-spring-institute-experiential-education