Background The Ending the HIV Epidemic initiative aims to increase PrEP use among eligible Americans to 50% by 2030. As one of the most widely accessible healthcare providers, pharmacists are well positioned to support these efforts. The latest advancement in HIV prevention—long-acting injectable CAB for PrEP—offers a novel solution to the adherence challenges of oral regimens. Understanding the current landscape of medication administration privileges for pharmacists is critical to facilitating uptake of CABr and preventing HIV transmission. Methods This was a cross sectional analysis of state pharmacy statues and regulations from 50 US states and the District of Columbia (States). Data were obtained from publicly accessible, official websites of the regulatory agencies with jurisdiction over the practice of pharmacy in each respective state. We analyzed current laws in effect as of February, 2022 in accordance with best practices for legal mapping. Using a standardized analysis algorithm, we determined the impact of state laws on pharmacists’ ability to administer CAB. Results Current state legislature allows administration of CAB by pharmacists in 44 States (80.3%). Broad authority is granted in 28 states (55.0%) where administration is defined within scope of practice. In 5 states, pharmacists can administer injectable medications if the prescription order contains explicit instructions for pharmacist administration, or a standing protocol. Among 8 states that require a collaborative practice agreement for CAB administration, 3 currently allow pharmacists to administer other long acting injectable medications without restrictions. Of the 6 states where pharmacist administration of CAB is prohibited, 2 allow administration of similar formulations. Private rooms for gluteal injections are only required in 13 states. Furthermore, treatment-specific training is only required in 3 laws, while 11 require completion of relevant continuing education. Conclusion Considerable variation exists among state laws governing the practice of pharmacy. Differences in scope of practice definition, medications expressly discussed, and continuing education and training requirements limit the ability of pharmacists to facilitate PrEP uptake through administration of cabotegravir. Disclosures All Authors: No reported disclosures.
COVID-19 has brought renewed attention to the physical and mental health needs of underserved populations and the settings that assist them in receiving services. This introduction presents six articles of a special section on disease management approaches used within criminal justice settings to address such needs. Articles span a range of settings, including prisons, jails, mental health courts, forensic settings, and crisis units. Collectively, the articles in this special section discuss medical conditions, substance use, and mental health. They provide information on the diverse approaches taken across various settings in managing the physical and mental health challenges of those involved in the criminal justice system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Background One previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG). Objectives To describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics' EBNPG for Type 1 and Type 2 diabetes and examine impact of a midpoint training on care alignment with the guideline. Methods In this 2-year, quasi-experimental study, 19 RDNs providing outpatient medical nutrition therapy to adults with diabetes ( n = 562) documented 787 initial and follow-up encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores. Results Most patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85 and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training ( n = 19 RDNs, 519 encounters pre-training; n = 14 RDNs, 204 encounters post-training; β = −0.06, SE = 0.04; 95% CI: −0.14, 0.03). Conclusions Most RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.
Background A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource–constrained settings. Methods We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey ( n = 25) and qualitative data through in-depth interviews ( n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. Results All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. Conclusion We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention’s success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
Racial and ethnic disparities are documented among children and adolescents with reported cases of child physical abuse (CPA) and child sexual abuse (CSA) and with substantiated and unsubstantiated cases in the United States. Yet, little is known about factors contributing to disparities, including how characteristics of the child and the person accused of maltreatment influence child maltreatment substantiation. Utilizing data from the 2016 National Child Abuse and Neglect Data System, the current study assessed which factors contribute to racial and ethnic group disparities in CPA and CSA substantiation. Results indicated characteristics of the child and accused person differentially influence CPA and CSA case outcomes. Altogether, relative to White children, findings indicate CPA and CSA cases are more likely to be substantiated among Native North American children whereas Black children have a reduced likelihood of CPA and CSA substantiation. The race of the person accused of harming a child also significantly impacted child case outcomes. Findings from this study suggest we must re-examine and likely modify select policy and clinical practices in relation to reporting and substantiation (versus outcomes involving no substantiation) of CPA, CSA, (and likely neglect – which needs to be examined in follow-up research) considering observed racial inequities in child maltreatment case outcomes.
The examination of violence perpetrated by female offenders remains an understudied topic, as research typically focuses on male offender samples. As such, it remains unclear what personality characteristics may be associated with the perpetration of violence among female offenders. This study sought to examine the relationship between personality characteristics, as assessed by the MMPI-2-RF, and engagement in violence, within a sample of 228 incarcerated women. Results indicated that women serving time for a violent offense obtained higher mean scores on MMPI-2-RF scales related to underreporting, atypical thoughts/experiences, and paranoia. Women who obtained disciplinary reports for violence within the institution obtained higher mean scores on MMPI-2-RF scales related to behavior/externalizing dysfunction, overactivation, and aggression. Taken together, violence was most strongly associated with the MMPI-2-RF scales related to paranoia and atypical thoughts/experiences (e.g., THD, PSYC-r). This study provides new data on the viability of the MMPI-2-RF to provide critical insights into violent and aggression behavior in female inmates, an understudied population and demonstrate the instrument’s efficacy in assessing characteristics associated with violent behavior.
Previous research has found higher rates of burnout among mental health professionals (MHPs) working in correctional settings and among those treating sex offenders, but it is not clear whether the setting or the client type is associated with greater burnout. Burnout has been linked with decreased empathy among healthcare providers, but this relationship has not been explored in MHPs. The present study explored differences in burnout and empathy among 219 MHPs working in correctional or community settings and among those primarily treating sex offenders versus other types of clients in the United States. Those working in correctional settings had higher levels of burnout than those working in community settings, but no differences in burnout were found for those treating sex offenders versus other types of clients, regardless of setting. No differences in empathy were found across the four groups, but self-reported empathy was inversely associated with levels of burnout. This research suggests that correctional settings may be more likely to result in burnout as compared to working with offender populations more generally. Implications for training professionals who desire to work in correctional settings are discussed. Interventions for preventing and reducing burnout are also discussed.
Although the overrepresentation of people with mental illness in the criminal justice system is known, research is needed to identify the frequency of criminal justice involvement and criminogenic treatment needs in inpatient populations to improve continuity of care and access to appropriate treatments. The purpose of this study is to document the frequency of criminal justice involvement among people receiving inpatient community care, as has been done for persons with mental illness in correctional institutions, and to test the association between criminogenic risk and psychiatric symptomatology. The present study uses two samples (n = 94 and n = 142) of adults from two separate acute psychiatric inpatient hospitals in Texas. Data on psychiatric symptoms, mental health history, criminal risk, and criminal justice history were gathered from file review and self-report. Linear and negative binomial regressions were used to test associations of interest. In both samples, the frequency of prior criminal justice involvement was over 50%. The current results indicate there is a significant, positive association between measures of criminal risk and psychiatric symptoms. These findings highlight the need to address the reciprocal association between mental illness and criminal risk among people receiving inpatient psychiatric treatment with appropriate assessment and treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid crisis is not improving but has become dire with the surge in fentanyl-related overdose deaths. Evidence-based strategies have to be implemented in the U.S. to control this epidemic before it destroys more lives. Other countries, including European countries and Canada, have invested more in harm reduction strategies than the U.S. even though they (especially Europe) do not face anywhere near the level of crisis as the U.S. In the long-run, upstream measures (tackling the social determinants of health) are more effective public health strategies to control the epidemic. In the meantime, however, harm reduction strategies have to be employed to mitigate the harm from addiction and overdose deaths.
Although counseling in itself can be a stressful task, counseling complex clients can exacerbate this stress and can lead to burnout. Burnout negatively affects the counselor's personal life, client care, and the health care system. Dialectical behavior therapy (DBT) is a multimodal treatment designed specifically for treating complex clients. The treatment contains counselor supports to protect against burnout. This study used a national sample of 209 counselors to assess whether DBT counselors (n = 87) possess higher levels of burnout than non‐DBT counselors (n = 122). The results suggest that despite literature stating that working with complex clients increases counselor burnout, there was no difference in client‐related burnout between DBT counselors and non‐DBT counselors. However, DBT counselors had higher levels of personal burnout and work‐related burnout compared with non‐DBT counselors, even after controlling for known covariates. Implications for future research and practice regarding mitigating counselor burnout are discussed.
Over 50,000 defendants are referred for competency to stand trial evaluations each year in the United States (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, New York, NY: The Guildford Press; 2018). Approximately 20% of those individuals are found by courts to be incompetent and are referred for “restoration” or remediation (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, 4th edn. New York, NY: The Guildford Press; 2018; Bull Am Acad Psychiatry Law. 1991;19:63–9). The majority of those incompetent defendants meet criteria for psychotic illnesses (J Am Acad Psychiatry Law. 2007;35:34–43). Forensic mental health professionals frequently have such patients/defendants decline recommended treatment with psychotropic medication. For a significant minority of defendants diagnosed with psychotic disorders, treatment with medication is thought to be necessary to restore their competency to stand trial. Without psychiatric intervention to restore competency, defendants may be held for lengthy and costly hospitalizations while criminal proceedings are suspended. In these situations, clinicians are guided by the Supreme Court decision, Sell v. United States (2003). The Sell opinion describes several clinical issues courts must consider when determining whether a defendant can be treated involuntarily solely for the purpose of restoring his/her competency. This paper offers some guidance to clinicians and evaluators who are faced with making recommendations or decisions about involuntary treatment. Using a question and answer format, the authors discuss data that support a decision to request, or not request, court authorization for involuntary treatment. Specifically, eight questions are posed for forensic evaluators to consider in determining the prognosis or viability of successful treatment and restoration. Finally, a clinical vignette is also presented to highlight important factors to consider in Sell‐related evaluations.
In December 2018, the First Step Act of 2018 was signed into law, which required the Federal Bureau of Prisons (BOP) to begin using risk and needs assessment to assign programs and provide inmates with required treatment. The Attorney General was tasked to develop an assessment to assess and assign inmates to four possible risk levels. In response, BOP and National Institute of Justice (NIJ) researchers created the Prisoner Assessment Tool Targeting Estimated Risk and Needs (PATTERN). Developed and validated on a large sample (N = 222,970) of inmates released between 2009 and 2015, the PATTERN is a gender-specific instrument and uses static and dynamic items to assess general and violent recidivism. Using a boosted regression procedure, the PATTERN achieved a high level of predictive validity. Tests for bias revealed the PATTERN further reduced racial/ethnic disproportionality.
A prison setting with its congregate environment is at high risk for widespread transmission of respiratory illnesses. Identifying COVID-19 cases as early as possible and isolating cases and tracing contacts is critical to halting the spread of this disease. The Centers for Disease Control and Prevention (CDC) added new loss of taste or smell to its list of symptoms and, initially, only if associated with at least one of six other symptoms. The CDC has since updated the guidance to remove this qualifier as of May 13, 2020. New loss of taste or smell, alone, can help to identify COVID-19 cases. Solitary anosmia/ageusia should be strongly considered in routine symptom screening protocols for COVID-19.
Introduction People living in correctional facilities are at high risk for contracting the novel coronavirus disease 2019 (COVID-19). To characterize the burden of COVID-19 in the Federal Bureau of Prisons, inmate testing, case, and mortality rates are calculated and compared with the U.S. Methods Bureau of Prisons data were derived from its inmate management system and a Bureau of Prisons COVID-19–specific database. U.S. data were derived from the Centers for Disease Control and Prevention and the U.S. Census. Data were aggregated from February to September 2020 and accessed in September and November 2020. Testing rates were calculated for both the Bureau of Prisons and U.S. Case and infection fatality rates were calculated overall and by institution and compared with the U.S. An age- and sex-standardized mortality ratio was calculated. Results The Bureau of Prisons tested more than half of its inmates (50.3%); its crude case and mortality rates were 11,710.1 and 77.4 per 100,000, respectively. Compared with the U.S., the case ratio was 4.7 and the standardized mortality ratio was 2.6. The infection fatality rate for both the Bureau of Prisons and U.S. was 0.7%. Among institutions that tested ≥85% of inmates, the combined infection fatality rate was 0.8% and ranged from 0.0% to 3.0%. Conclusions The Bureau of Prisons COVID-19 case rates and standard mortality ratio were approximately 5 and 2.5 times those in U.S. adults, respectively, consistent with prisons nationwide. High testing rates and standardized death reporting could result in a more accurate infection fatality rate in the Bureau of Prisons than the U.S. Testing and other mitigation strategies, including reducing the population, have likely prevented further transmission and mortality in the Bureau of Prisons.
This chapter explores prison education in Nigeria and examines its history, programs, methods, and challenges. It makes the point that prison services and education are not alien to the Nigerian and African settings. However, whereas traditional African prison education emphasizes restorative justice and learning, modern prison services tend to amplify punishment. While rehabilitation is one goal of incarceration, an all-inclusive prison education in Nigeria is still at a nascent stage. The chapter suggests ways of improving current practices and consolidating gains through specific interventions and researches.
Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time. Funding: None Disclosures: None
The feet have an increased load, they are often injured, especially with diabetes. Because of the violation of innervation, patients do not notice minor injuries: abrasions, bruises, cracks, cuts. Because of the circulatory disorders associated with diabetes, the protective function of tissues decreases, and the smallest injury can lead to the formation of a long-term wound that does not heal, which turns into an ulcer when infected. Despite advances in the study of the pathogenesis of diabetes and its complications, diabetic foot ulcers are difficult to treat, can recur, and lead to amputations of the lower limbs. The main reason for pathological dryness of the foot skin in diabetes is dysfunction of the sweat glands of the skin of feet due to diabetic neuropathy. Regular skin care with specially selected products can help restore and improve the barrier function of the skin, as well as increase the moisture level of the stratum corneum. Adequate skin hydration reduces itching and the risk of infection if the skin is damaged. In most patients with diabetes, conventional cosmetics slowly eliminate dry skin of the feet. In addition, traditional remedies contain a large amount of oils and can cause unpleasant sensations, which often causes rejection of their use. In patients with DM, it is desirable to use drugs that quickly and effectively eliminate dryness and cracks. Treatment of dry skin is indicated as a prevention of diabetic foot syndrome. Taking into account the fact that the skin of patients with diabetes mellitus has a low level of humidity, we recommend daily care using moisturizing or nourishing creams or lotions. Some studies have confirmed that the use of external dry skin care products containing dexpanthenol improves the protective function of the skin, increasing the hydration of the stratum corneum.
The article describes modern approaches to the organization of rehabilitation in patients with limb amputations and exarticulations: it highlights technology of using the International Classification of Functioning, Disability and Health, as a tool allowing to form rehabilitation diagnosis, rehabilitation prognosis, assess rehabilitation potential, determine the purpose and plan of rehabilitation, as such as to give recommendations at end of rehabilitation course in the process of rehabilitation in patients with amputations. Taking in to account the limitations of mobility and self-service opportunities assessed by the rehabilitation routing scale, we propose a tactics for patients’ transfer from the first to subsequent rehabilitation stages. The presented approach allows to optimize the rehabilitation process and to achieve designed results.
In the completion of CST evaluations, evaluators frequently utilize collateral records and third-party information. One such source of collateral used increasingly in recent years is media produced by defendants on social networking sites (SNS). Its potential use can present several challenges for evaluators. This chapter addresses some of those challenges, including whether SNS data should be used, how it should be obtained, and how it should be considered during a competency evaluation. Various clinical applications of SNS data are considered, such as its use in assessing present mental state, how the intended audience of SNS productions affect the assessment, and how it is considered during competency restoration. Legal and ethical concerns CST evaluators face when utilizing SNS are described, including issues related to informed consent, the reliability and relevance of the data, and the impact on evaluator bias. We conclude with the use of two case examples that highlight these matters.
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