Search

Mehmet Asim Bilen,1 Ibrahim Khilfeh,2 Carmine Rossi,3 Erik Muser,2 Laura Morrison,3 Annalise Hilts,3 Lilian Diaz,3 Patrick Lefebvre,3 Dominic Pilon,3 Daniel J George4 1Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; 2Janssen Scientific Affairs, LLC, Horsham, PA, USA; 3Analysis Group, Inc., Montréal, QC, Canada; 4Department of Medicine, Duke University Cancer Center, Durham, NC, USACorrespondence: Carmine Rossi, Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada, Tel +1 514-871-4233, Email carmine.rossi@analysisgroup.comBackground: Alterations in DNA damage repair genes in advanced prostate cancer (PC) may impact responses to therapy and clinical outcomes. This study described homologous recombination repair (HRR) testing patterns and clinical outcomes among patients with metastatic castration-resistant prostate cancer (mCRPC) by HRR alteration status and race in the United States (US).Methods: Clinical data in the nationwide (US-based) Flatiron Health-Foundation Medicine, Inc. (FMI) Metastatic PC Clinico-Genomic Database were evaluated (01/01/2011– 12/31/2022). Patients initiating first-line (1L) mCRPC therapy on or after mCRPC diagnosis were included. Testing patterns, time-to-next treatment, overall survival (OS), and time-to-prostate specific antigen response were described.Results: Of the 1367 patients with mCRPC and at least one HRR panel test prior to or on the date of 1L mCRPC therapy initiation, 332 (24.3%) were HRR positive (White patients: n = 219 [66.0%]; Black patients: n = 37 [11.1%]) and 1035 (75.7%) were HRR negative (White patients: n = 702 [67.8%]; Black patients: n = 84 [8.1%]). The mean time between first positive test and 1L mCRPC therapy initiation date was 588 days (White patients: 589 days; Black patients: 639 days). Among HRR positive relative to negative patients, trends for faster progression (respective 12-month rate overall: 71.1% and 63.7%; White patients: 72.5% and 64.0%; Black patients: 65.4% and 56.4%), shorter OS (respective 24-month rate overall: 46.8% and 51.9%; White patients: 48.6% and 46.2%; Black patients: 52.8% and 54.1%), and decreased treatment response (respective 12-month rate overall: 24.3% and 37.9%; White patients: 24.5% and 35.2%; Black patients: 17.0% and 43.9%) were observed.Conclusion: Patients with mCRPC positive for HRR alterations tended to exhibit poorer treatment responses and clinical outcomes than those with a negative status. These findings highlight the importance of timely genetic testing in mCRPC, particularly among Black patients, and the need for improved 1L targeted therapies to address the unmet need in HRR positive mCRPC.Keywords: burden of illness, electronic health records, homologous recombination repair genes, metastatic castration-resistant prostate cancer, next-generation sequencing testing, precision therapy

According to the American School Counselor Association (ASCA), schools designated with Recognized American School Counselor Model Programs (RAMP) demonstrate alignment with the ASCA National Model, widely recognized as the standard for comprehensive school counseling programs (CSCPs). Empirical investigations of the barriers to achieving the RAMP-designation have primarily focused on the intra- and interpersonal characteristics of the schools' counselors, with little attention to macro-systemic factors. Grounded in McMahon et al.'s (2014) ecological school counseling framework, we investigated whether macro-systemic characteristics including region, institution type, community setting, and program funding significantly and uniquely predict RAMP-designation above and beyond school counselors' inter- and intra-personal characteristics. Using a national sample (n = 1,641) of practicing school counselors, our results revealed that school region, institution type, and community setting significantly and uniquely predicted RAMP-designation. Implications for future research, advocacy, and policy for CSCPs and RAMP are discussed.

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers’ Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

The authors examined whether school counselors' emotional intelligence predicted their comprehensive school counseling program (CSCP) implementation and whether engagement in transformational leadership practices mediated the relationship between emotional intelligence and CSCP implementation. The sample for the study consisted of 792 school counselors nationwide. The findings demonstrated the significant mediating role of transformational leadership on the relationship between emotional intelligence and CSCP implementation. Implications for the counseling profession are discussed.

To address gaps in care for individuals from under-resourced communities disproportionately affected by tobacco use, this pharmacist-led demonstration project evaluated the feasibility of implementing tobacco use screening and brief cessation interventions during mobile health access events. A brief tobacco use survey was administered verbally during events at two food pantries and one homeless shelter in Indiana to assess the interest and potential demand for tobacco cessation assistance. Individuals currently using tobacco were advised to quit, assessed for their readiness to quit, and, if interested, offered a tobacco quitline card. Data were logged prospectively, analyzed using descriptive statistics, and group differences were assessed by site type (pantry versus shelter). Across 11 events (7 at food pantries and 4 at the homeless shelter), 639 individuals were assessed for tobacco use (n = 552 at food pantries; n = 87 at the homeless shelter). Among these, 189 self-reported current use (29.6%); 23.7% at food pantries, and 66.7% at the homeless shelter (p < 0.0001). About half indicated readiness to quit within 2 months; of these, 9 out of 10 accepted a tobacco quitline card. The results suggest that pharmacist-led health events at sites serving populations that are under-resourced afford unique opportunities to interface with and provide brief interventions for people who use tobacco.

In this paper, we describe how school counselors can use Marcia's theory of psychosocial identity development to provide differentiated career advisement for adolescent students. Furthermore, we identify how school counselors can use Marcia's theory of psychosocial identity development when collaborating and consulting with teachers and parents to assist them in supporting the career development of students. We explain how school counselors can determine a student's identity status, and we provide highly specific strategies for career advisement for adolescent students in accordance with each of Marcia's identity statuses.

Since 1965, the American School Counselor Association (ASCA) has recommended a student-to-school-counselor ratio of 250:1; however, a large disparity exists in school counselor caseloads across the United States. To date, most of the literature highlights the positive impact that lower ratios have on student outcomes, yet literature exploring the potential relationships between school counselor caseload and ecological contextual factors is scant. This study examined the association between student-to-school-counselor ratios and school-level variables, school counselor demographics, perceived school climate, and leadership practices. The results, based on a national sample, revealed that school counselors' racial identity (i.e., identifying as White), school-level variables (i.e., percentages of students with disabilities, students who are bi/multilingual, White students, and White faculty members) were significantly associated with school counselors' odds of meeting a 250:1 student-to-school-counselor ratio. School counselors with a ratio of 250:1 or lower scored slightly lower in leadership practices. This article discusses implications for practice, policy, and future research.

BackgroundIn recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described.ObjectiveTo compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation.MethodsTwenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training.ResultsOver the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p

To characterize state laws in the United States regarding the expansion of pharmacists prescriptive authority for tobacco cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies. Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists prescribing under these authorities. As of June 2022, 17 states have enacted laws for pharmacists prescriptive authority for tobacco cessation medications; most (N = 16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004. The number of states with pharmacists prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. Although the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.

Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists' perceptions of factors associated with the implementation of "Ask-Advise-Refer", a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers' Diffusion of Innovations Theory, assessed pharmacists' perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.

Abstract The COVID‐19 pandemic has affected nearly everyone, however experiences and perceptions of COVID have been different across rural and urban areas in the United States, including effects on mental health. The purpose of the current study is to examine changes in levels of reported anxiety and depression within rural and urban populations before and during the COVID‐19 pandemic in the United States. Using the National Health Interview Survey (NHIS), we used a repeated cross‐sectional study design including adults (age 18 or older) who were sampled in 2019 and 2020. We examined the relationship between worsening mental health outcomes (depression and anxiety) and rurality, controlling for individual's demographic and health‐related measures. Individuals living in an urban area were more likely to report worsening anxiety (28.8% vs. 23.0% p

ObjectiveTo evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies.DesignQuasi-experimental study.Setting and populationPatients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States.MethodsAggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014-May 2016) and after the intervention (June 2016-December 2018). These data were compared using interrupted time series analysis.ResultsIn total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality.ConclusionsReductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population.

There is a dearth of literature that has empirically examined ecological factors that influence school counselors' engagement in leadership. Thus, using hierarchical regression analysis, we examined whether sociocultural factors (i.e., race/ethnicity, childhood socioeconomic status, current socioeconomic status, age, gender), professional developmental experiences (i.e., leadership experience, supervision, mentorship, leadership training), intra- and interpersonal factors (i.e., multicultural competence, leadership self-efficacy, psychological empowerment), and school climate significantly and uniquely predicted school counselors' leadership practices. The final hierarchical regression model, using 647 school counselors nationwide, accounted for 57% variance in these practices. Sociocultural factors, professional developmental experiences, and intra- and interpersonal factors significantly and uniquely contributed to the school counselors' leadership practices. We discuss implications for the profession.

Abstract Background Biologics have revolutionized the management of psoriasis, but response to treatment varies. Loss of treatment efficacy may occur over time, requiring treatment switching or escalation. Claims data on persistence may be informative of real-world treatment outcome. This analysis described persistence and rates of remission of patients with psoriasis initiated on current biologics. Methods Adults with psoriasis initiated (index date) on guselkumab, adalimumab, secukinumab, or ixekizumab between 07/13/2017 and 07/31/2020 were identified in the IBM MarketScan Databases. Discontinuation (or end of persistence) was defined as gaps in index biologic supply of more than twice the labelled dosing interval or mode days of supply (> 120 days for guselkumab and > 60 days for adalimumab, secukinumab, and ixekizumab). The proportion of patients reinitiating index therapy post-discontinuation and the proportion achieving remission (proxy definition: no claims for psoriasis-related treatment post-discontinuation among patients with ≥ 6 months of follow-up post-discontinuation) were assessed. Results There were 3408 patients in the guselkumab (mean age: 47.9 years old; female: 47.1%), 8017 in the adalimumab (47.4 years old; 54.1%), 6123 in the secukinumab (49.4 years old; 54.2%), and 3728 in the ixekizumab cohorts (49.1 years old; 50.3%). The median time to discontinuation was 26.2 months in the guselkumab cohort and 9.9, 12.4, and 12.5 months in adalimumab, secukinumab, and ixekizumab cohorts, respectively. Among those who discontinued index therapy, 22.9% in the guselkumab cohort and 21.1%, 31.9%, and 32.0% in the adalimumab, secukinumab, and ixekizumab cohorts reinitiated it. Remission rates were 17.2% in the guselkumab cohort and 12.4%, 10.5%, and 9.0% in adalimumab, secukinumab, and ixekizumab cohorts, respectively. Conclusions Patients on guselkumab showed trends toward better persistence and higher remission rates relative to other biologics. Finding patients who may be in remission suggests potential disease modification with current agents.

Abstract We present a robust insulin delivery system that includes automated meal detection and carbohydrate content estimation using machine learning for meal insulin dosing called robust artificial pancreas (RAP). We conducted a randomized, single-center crossover trial to compare postprandial glucose control in the four hours following unannounced meals using a hybrid model predictive control (MPC) algorithm and the RAP system. The RAP system includes a neural network model to automatically detect meals and deliver a recommended meal insulin dose. The meal detection algorithm has a sensitivity of 83.3%, false discovery rate of 16.6%, and mean detection time of 25.9 minutes. While there is no significant difference in incremental area under the curve of glucose, RAP significantly reduces time above range (glucose >180 mg/dL) by 10.8% (P = 0.04) and trends toward increasing time in range (70–180 mg/dL) by 9.1% compared with MPC. Time below range (glucose

This study assessed the total costs of testing, including the estimated costs of delaying care, associated with next-generation sequencing (NGS) versus single-gene testing strategies among patients with newly diagnosed metastatic non-small cell lung cancer (mNSCLC) from a Canadian public payer perspective. A decision tree model considered testing for genomic alterations using tissue biopsy NGS or single-gene strategies following Canadian guideline recommendations. Inputs included prevalence of mNSCLC, the proportion that tested positive for each genomic alteration, rebiopsy rates, time to test results, testing/medical costs, and costs of delaying care based on literature, public data, and expert opinion. Among 1,000,000 hypothetical publicly insured adult Canadians (382 with mNSCLC), the proportion of patients that tested positive for a genomic alteration with an approved targeted therapy was 38.0% for NGS and 26.1% for single-gene strategies. The estimated mean time to appropriate targeted therapy initiation was 5.1 weeks for NGS and 9.2 weeks for single-gene strategies. Based on literature, each week of delayed care cost CAD 406, translating to total mean per-patient costs of CAD 3480 for NGS and CAD 5632 for single-gene strategies. NGS testing with mNSCLC in current Canadian practice resulted in more patients with an identified mutation, shorter time to appropriate targeted therapy initiation, and lower total testing costs compared to single-gene strategies.

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers’ Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

The present work describes the development of a new measure of school counselors' perceived self-efficacy regarding their knowledge of information and processes necessary to effectively guide their students through the college transition process. Researchers developed the School Counselor Efficacy for College Knowledge Questionnaire and examined data from a national sample of 600 school counselors to determine its psychometric properties and factor structure. Exploratory and confirmatory factor analyses supported use of a modified five-factor model. Results showed strong internal consistency and preliminary evidence for convergent and divergent validity of the resultant scales.

Summary: Background: Exercise can rapidly drop glucose in people with type 1 diabetes. Ubiquitous wearable fitness sensors are not integrated into automated insulin delivery (AID) systems. We hypothesised that an AID can automate insulin adjustments using real-time wearable fitness data to reduce hypoglycaemia during exercise and free-living conditions compared with an AID not automating use of fitness data. Methods: Our study population comprised of individuals (aged 21–50 years) with type 1 diabetes from from the Harold Schnitzer Diabetes Health Center clinic at Oregon Health and Science University, OR, USA, who were enrolled into a 76 h single-centre, two-arm randomised (4-block randomisation), non-blinded crossover study to use (1) an AID that detects exercise, prompts the user, and shuts off insulin during exercise using an exercise-aware adaptive proportional derivative (exAPD) algorithm or (2) an AID that automates insulin adjustments using fitness data in real-time through an exercise-aware model predictive control (exMPC) algorithm. Both algorithms ran on iPancreas comprising commercial glucose sensors, insulin pumps, and smartwatches. Participants executed 1 week run-in on usual therapy followed by exAPD or exMPC for one 12 h primary in-clinic session involving meals, exercise, and activities of daily living, and 2 free-living out-patient days. Primary outcome was time below range (

This study examined the self-efficacy of school counselors' college knowledge in the college process. Exploratory factor analysis revealed five characteristic factors: school counselors' knowledge related to the college application process, systems advocacy, direct services with disadvantaged populations, direct service with special populations, and coordination of college access events. Hierarchical regression analyses revealed that both school counselors' individual characteristics (e.g., years of experience, race/ethnicity, time engaged in advising, conducting lessons, and using technology and data) and ecological factors (e.g., school level, rate of college-going culture) were significant predictors of school counselors' self-efficacy for promoting college knowledge. We discuss implications for equity and school counselors' training.

To address gaps in care for individuals from under-resourced communities disproportionately affected by tobacco use, this pharmacist-led demonstration project evaluated the feasibility of implementing tobacco use screening and brief cessation interventions during mobile health access events. A brief tobacco use survey was administered verbally during events at two food pantries and one homeless shelter in Indiana to assess the interest and potential demand for tobacco cessation assistance. Individuals currently using tobacco were advised to quit, assessed for their readiness to quit, and, if interested, offered a tobacco quitline card. Data were logged prospectively, analyzed using descriptive statistics, and group differences were assessed by site type (pantry versus shelter). Across 11 events (7 at food pantries and 4 at the homeless shelter), 639 individuals were assessed for tobacco use (n = 552 at food pantries; n = 87 at the homeless shelter). Among these, 189 self-reported current use (29.6%); 23.7% at food pantries, and 66.7% at the homeless shelter (p < 0.0001). About half indicated readiness to quit within 2 months; of these, 9 out of 10 accepted a tobacco quitline card. The results suggest that pharmacist-led health events at sites serving populations that are under-resourced afford unique opportunities to interface with and provide brief interventions for people who use tobacco.