Pharmacist-social worker interprofessional relations and education in mental health: a scoping review

Background

One in eight patients is affected by a mental health condition, and interprofessional mental health teams collaborate to improve patient care. While pharmacists and social workers are recognized as mental health team members, there is a lack of literature describing interprofessional relations and education between these professions, especially as it pertains to mental health. The purpose of this review was to identify and characterize reports describing pharmacist-social worker interprofessional relations and education within mental health.

Methodology

To address this knowledge gap, this scoping review was conducted to collect and characterize reports published between January 1, 1960 and August 18, 2023 describing pharmacist-social worker interprofessional relations and education within the field of mental health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Ovid MEDLINE, CINAHL, and Social Work Abstracts were searched using keywords "pharmacy student," "pharmacist," "social work student," "social worker," and "social work." Reports were included if they were published in English and interprofessional relations or education occurred directly between (student) pharmacists and social workers.

Results

Three hundred twenty records were identified and three records were included: one cross sectional study, one qualitative educational project, and one case report. Each record suggested positive patient and/or educational outcomes developing from pharmacist-social worker interprofessional relations and education. In clinical practice, pharmacist-social work teams identified mental health risk factors, reduced 30-day readmissions, and improved post-discharge telehealth care. In the classroom, a social worker improved pharmacy students' confidence assessing patient suicidal ideations.

Conclusions

This scoping review identified needs and areas for future research: pharmacist interprofessional education with Master of Social Work and Doctor of Social Work degree students, transitional care and mental health outcome measure reporting using evidence-based outcomes, and development of scholarly teaching projects utilizing higher-level educational frameworks beyond learner reactions.

Gender Differences in Self-reported Faculty Developmental Networks

Scholars have long recognized gender variation in social relationship dynamics. However, how gender shapes developmental networking relationships for career advancement, particularly among university faculty members, is understudied. This area of research is important since women comprise an increasing proportion of faculty and yet report receiving less mentoring and lower career satisfaction, productivity, and advancement than their male counterparts. This cross-sectional study assessed gender differences in self-reported dimensions of faculty participants' developmental networks by collecting information on relationships with developers, who are people who have taken concerted action and offered professional and personal guidance to help participants advance in their careers over the past year. The investigators used egocentric network data from an electronically administered Mentoring Network Questionnaire collected from 159 faculty involved in a mentoring intervention during the pandemic. Faculty were from multiple Southwest and Mountain West institutions. Statistical analyses were performed using the Chi-squared test, Wilcoxon rank-sum test, and unadjusted multilevel regression. Female faculty chose developers of lower gender diversity than male faculty (p=0.01). Compared to male faculty, female faculty reported receiving more psychosocial support from individual developers (p=0.03). Female faculty members' developers were more often characterized as friends and less often described as sponsors and allies than male faculty, based on relative levels of career and psychosocial support that individual developers provided (p<0.001). No gender differences were found in other network characteristics. Female faculty build developmental networks that have different factors compared to male faculty. Greater levels of psychosocial support and fewer allies and sponsors for female faculty may have long-term implications for differential career advancement for women vs. men in academic careers. Strategies to enhance networking should address gender differences and include a structured framework for assessing network gaps.

Curriculum-based Faculty Training in Networking: Knowledge and Self-efficacy Outcomes

Although the advantages of developmental networks are well-known, most faculty do not know how to participate in such networks actively. Additionally, institutions face challenges in teaching faculty the best practices of networking. This deficiency constitutes a critical gap in the literature, which may slow career advancement for faculty, particularly from underrepresented groups. The study's purpose was to examine the effectiveness of a curriculum-based faculty training in developmental networks, utilizing the Extension for Community Health Outcomes (ECHO) platform. In this pre-post study, 33 faculty members participated in the intervention utilizing eight modules involving four competencies. Each module followed a standard format, including a short didactic, two facilitated case study discussions based on real-life scenarios, and self-reading of selected literature. Outcomes included (i) change in knowledge scores obtained from two questions per module and (ii) self-efficacy scores measured on a scale of 0-100. Paired student's t-test and mixed model regression analyses were used. A significant increase in knowledge score was documented using mixed model regression for 4 of the eight modules (mean change score 0.4-0.8, p≤0.03 for all analyses). The proportion of faculty participants reporting correct knowledge items for all modules increased from 49.8% (pre) to 64.3% (post), which was statistically significant (p<0.001). Significant increases in paired self-efficacy scores were reported for each of the eight modules (mean change score 17-37, p<0.05 for all analyses). This study highlights the importance of curriculum-based training in networking. Participants showed a significant increase in pre-post networking self-efficacy and knowledge scores. Our ECHO-based curriculum, facilitator training, and manual enable easy implementation in other institutions, ensuring scalability and adaptability. Our analysis provides the evidence basis for examining the impact of a developmental network intervention in enhancing individual career networks.

Mentoring Network Questionnaire Support Scales Reliable and Valid with University Faculty

The Developmental Network Questionnaire (DNQ) is used in business to self-assess relationships with developers, or people who support one's career. The Mentoring Network Questionnaire (MNQ) is an online modification of the DNQ and includes two scales that rate developer's contributions to career or psychosocial help. The psychometrics of these scales for different populations are unreported. This study analyzed the construct validity and reliability of the two scales measuring support provided by developers of university faculty. Mentors and mentees (G=156) from multiple Southwestern and Mountain West universities rated 741 developers on the MNQ's five-item career- and psychosocial-support scales. Participants responded on a seven-point scale ranging from "never, not at all" to "to the maximum extent possible." Multilevel confirmatory factor analysis (MCFA) using Mplus and the multi-level reliability coefficient omega assessed construct validity and internal consistency reliability, respectively. Results supported the validity of two latent constructs of career- and psychosocial support, each measured by the established five-item scale: Comparative fit index (CFI)=.93, Tucker-Lewis Index (TLI)=.91, root mean square error of approximation (RMSEA)=.06, standardized root mean square residual (SRMR): W=.09, B=.10. The measurement model was improved when the "removes barriers" item was removed from the career-support scale (CFI=.96, TLI=.95, RMSEA=.05, SRMR: W=.06 B=.09. Factor loadings at both the within- and between-levels were strong and statistically significant. Reliability omegas ranged from .85 to .92. Career and psychosocial support provided to university faculty by developers in their networks may be validly and reliably measured at both the within- and between-levels by a modified four-item career support scale and the original five-item psychosocial support scale from the DNQ and the modified MNQ. Limitations include reduced statistical power due to small sample size and lack of testing at the university level. Future work will assess the responsiveness of these scales to measuring change over time in the amount of support provided.

Developmental Networks Among Mentors and Mentees Involved in a Mentoring Intervention

The growing application of social network-based theories and methods (Burt et al., 2013) in scholarship on mentoring illustrates that mentoring goes beyond dyadic relationships comprising a senior mentor and a junior protégé (Higgins & Kram, 2001). However, limited data exist on the state of developmental networks of university faculty. This study examines developmental network characteristics among mentors and mentees participating in an ongoing intervention that aims to enhance career success through improved mentoring. Cross-sectional data come from 81 faculty mentors and mentees at three universities in the Southwestern United States. Using the online Modified Mentoring Network Questionnaire (MNQ), participants provided information on relationships with developers, who are people that have taken concerted action, and provided professional and/or personal guidance to help participants advance in their careers. An individual's developmental network comprises relationships with developers. We conducted exploratory analyses examining key characteristics of mentors' and mentees' developmental networks. Participants received psychosocial and career support from an average of 4.9 developers (4.8 and 5.1 for mentors and mentees respectively) from 2.3 arenas (2.2 and 2.4 arenas for mentors and mentees, respectively). While the most common arena was the respondents' current job/position (62%, 64% and 59% for all participants, mentors, and mentees respectively), developers were from graduate school (11%, 6% and 17%); prior jobs/positions (13%, 16% and 9%) and family (8%, 5% and 11%). Our preliminary findings suggest that developers are important for university faculty and that methods and insights from social network analysis can be applied to examine their support networks. As our study is part of an ongoing longitudinal intervention, these findings will inform future analyses that will examine changes in developmental network characteristics and its impact on participants' careers.

Assessing fear of COVID-19 at an academic medical center

PURPOSE

This study measured the degree of COVID-19-related fear among academic medical center employees, identified subsections with high COVID-19 fear, and validated the Fear of COVID-19 Scale with medical professionals in the United States.

METHODS

This study is a cross-sectional, internet-based survey delivered by Qualtrics. The survey was conducted at the Oklahoma University Health Sciences Center between May 21 and June 18, 2020. The medical center is composed of seven healthcare colleges, child and adult hospitals, a Veterans Hospital, and outpatient services clinics across the Oklahoma city area. Faculty, staff, and students (N = 1,761) from the Oklahoma University Health Sciences Center completed the survey.

RESULTS

COVID-19 fear is highest among nonclinical employees, smokers, and those with pre-existing conditions. Males and females, both clinicians and nonclinicians, appear to express their COVID-19 fears differently. Employees worried most about their families contracting the virus. The Fear of COVID-19 Scale is a valid and reliable assessment instrument among US healthcare workers. Responses were compared based on pre-existing medical condition(s), patient care or nonpatient care, sex, and occupational specialization. Analyses reveal a strong Cronbach's α measure of internal consistency (α = 0.87). Significant differences were observed among employees with a nonclinical emphasis (p = 0.02), with a predisposing medical health condition (p < 0.001), and with a nonacademic occupational specialization (p < 0.01), and by sex (p < 0.001).

CONCLUSIONS AND DISCUSSION

COVID-19 fear significantly impacts academic medical center employees. Medical centers should address both healthcare and nonhealthcare workers' COVID-19-related fears. It is important to recognize that men and women may have different types of fears and express them differently, necessitating a gender-specific approach to managing COVID-19 fears. Employees with pre-existing conditions or who have vulnerable family members require additional support to remain fully functional and on the job.

Mentee Assessment of Mentoring Competencies at an Academic Health Sciences Center

The Oklahoma Center for Mentoring Excellence (OCME) initiated faculty workshops to enhance their mentoring skills and establish an intercampus network for faculty specializing in clinical and biomedical sciences. The initial importance of mentoring competencies based on early career faculty members' perception and experience had not yet been determined. The Mentoring Competency Assessment validated by Fleming et al. (2013b) was used to rate the perceived importance of competencies and assess senior faculty members' competencies using a seven-point range, Likert-type response scale. Responses were analyzed by presence or absence of a mentor, previous formal mentor training, sex, and health science discipline. Junior faculty (n = 144) rated each competency as important or greater across all categories. A majority (70%) reported not having a current mentor. Junior faculty with current mentors rated senior faculty competencies higher than junior faculty without; participation in formal mentor training as well as a clinical faculty appointment were independently associated with higher assessment scores. This study identifies specific population characteristics that may serve to enhance the effectiveness of OCME workshops and demonstrates that junior faculty identify mentoring as significantly important in their academic career success in a research and clinical health setting.

The role of the anteriolateral bed nucleus of the stria terminalis in stress-induced nociception

Activation of the central amygdala (CeA) by corticosterone (CORT) induces somatic and colonic hypersensitivity through corticotrophin-releasing factor (CRF)-dependent mechanisms. However, the importance of the bed nucleus of the stria terminalis (BNST), part of the extended amygdala, on nociception remains unexplored. In the present study, we test the hypothesis that stimulation of the CeA by CORT induces somatic and colonic hypersensitivity through activation of the anteriolateral BNST (BNST(AL)). Animals were implanted with micropellets of CORT or cholesterol (CHOL) onto the CeA or the BNST(AL). Mechanical sensitivity was quantified using electronic von Frey filaments, and colonic nociception was measured by quantifying a visceromotor response to graded colorectal distension. In situ hybridization was used to determine mRNA levels for CRF, CRF(1), and CRF(2) receptors in the BNST(AL). In a second group, animals were implanted bilaterally with 1) CORT or CHOL micropellets onto the CeA; and 2) cannulas localized to the BNST(AL) to administer a CRF(1) receptor antagonist (CP376395). Animals implanted with CORT onto the CeA, but not the BNST(AL), exhibited increased expression of CRF mRNA and increased CRF(1)-to-CRF(2) receptor ratio in the BNST, as well as somatic and colonic hypersensitivity compared with CHOL controls. Infusion of CP376395 into the BNST(AL) inhibited somatic and colonic hypersensitivity in response to elevated amygdala CORT. Somatic and colonic hypersensitivity induced by elevated amygdala CORT is mediated via a CRF(1) receptor-dependent mechanism in the BNST(AL). The CeA through a descending pathway involving the BNST(AL) plays a pivotal role in somatic and colonic nociception.

The aging colon: the role of enteric neurodegeneration in constipation

Constipation is a common problem in the elderly, and abnormalities in the neural innervation of the colon play a significant role in abnormalities in colonic motility leading to delayed colonic transit. The scope of this review encompasses the latest advances to enhance our understanding of the aging colon with emphasis on enteric neurodegeneration, considered a likely cause for the development of constipation in the aging gut in animal models. Neural innervation of the colon and the effects of aging on intrinsic and extrinsic nerves innervating the colonic smooth muscle is discussed. Evidence supporting the concept that neurologic disorders, such as Parkinson's disease, not only affect the brain but also cause neurodegeneration within the enteric nervous system leading to colonic dysmotility is presented. Further research is needed to investigate the influence of aging on the gastrointestinal tract and to develop novel approaches to therapy directed at protecting the enteric nervous system from neurodegeneration.

Rate of bacterial eradication by ophthalmic solutions of fourth-generation fluoroquinolones

INTRODUCTION

Antibacterial activity of ophthalmic fourth-generation fluoroquinolones has traditionally been evaluated by comparing only their active ingredients, gatifloxacin and moxifloxacin. However, ophthalmic formulations of fourth-generation fluoroquinolones differ in terms of the inclusion of preservatives. While gatifloxacin ophthalmic solution 0.3% (Zymar; Allergan, Inc., Irvine, CA, USA) contains 0.005% benzalkonium chloride (BAK), moxifloxacin ophthalmic solution 0.5% (Vigamox; Alcon Laboratories, Inc., Fort Worth, TX, USA) is preservative-free. Recent studies have demonstrated that the presence of BAK dramatically affects the antibacterial activity of the ophthalmic formulation of gatifloxacin. This study was designed to compare the kill rates of ophthalmic solutions of fourth-generation fluoroquinolones against isolates of common ocular bacterial pathogens.

METHODS

Approximately 5.6 log(10) colony-forming units (CFU)/mL of Haemophilus influenzae (n=1), Streptococcus pneumoniae (n=1), Staphylococcus aureus (n=2), methicillin-resistant Staphylococcus aureus (MRSA) (n=4), methicillinresistant Staphylococcus epidermidis (MRSE) (n=4), and fluoroquinolone-resistant S. epidermidis (n=1) were incubated with ophthalmic solutions of either gatifloxacin or moxifloxacin. Viable bacteria were quantified at specific time points up to 60 minutes.

RESULTS

Gatifloxacin 0.3% completely eradicated H. influenzae and Strep. pneumoniae in 5 minutes, one of two S. aureus isolates in 15 minutes, and the other S. aureus isolate in 60 minutes. Gatifloxacin 0.3% completely killed all MRSA, MRSE, and fluoroquinolone-resistant S. epidermidis isolates in 15 minutes. Moxifloxacin 0.5% completely eradicated Strep. pneumoniae and one of four MRSA isolates in 60 minutes. All other isolates incubated with moxifloxacin 0.5% retained viable bacteria ranging from 1.8 to 4.4 log(10) CFU/mL.

CONCLUSIONS

The ophthalmic solution of gatifloxacin 0.3% eradicated bacteria that frequently cause postoperative ocular infections substantially faster than did the ophthalmic solution of moxifloxacin 0.5%.

Diabetes reduces autophosphorylation of retinal insulin receptor and increases protein-tyrosine phosphatase-1B activity

PURPOSE

Protein-tyrosine phosphatase-1B (PTP1B) has been implicated in the negative regulation of insulin signaling. The expression, activity, and functional role of PTP1B in the retina are unknown. In this study, the authors examined the relationship between the retinal insulin receptor (IR) and PTP1B in normal and diabetic mouse retinas.

METHODS

IR and PTP1B localization was examined by immunohistochemistry. The activation of IR was analyzed using specific antibodies against phosphotyrosine. PTP1B activity was determined in anti-PTP1B immunoprecipitates. Glutathione-S-transferase fusion proteins containing wild-type and catalytically inactive mutant PTP1B was used to study the interaction between IR and PTP1B. Anti-IR immunoprecipitates and the cytoplasmic domain of purified IR were incubated in the presence of ATP, and the autophosphorylation of IR with antiphosphotyrosine antibody was analyzed.

RESULTS

Immunohistochemical analysis of PTP1B shows that it is predominantly expressed in nonphotoreceptor layers of the retina, though it is clearly expressed in the inner segments of the rod photoreceptors. The IR is predominately expressed in rod inner segments. Biochemical analysis of rod outer segments indicates the presence of IR and PTP1B. Retinal IR exhibits a high level of basal autophosphorylation, and this autophosphorylation is reduced in diabetic mouse retinas. In vitro, PTP1B is able to dephosphorylate the autophosphorylated IR. Substrate mutant-trap results indicate a stable interaction between IR and PTP1B. Further, PTP1B activity was increased in diabetic mouse retinas.

CONCLUSIONS

These studies indicate that diabetes reduces the autophosphorylation of retinal IR and increased PTP1B activity. Further, PTP1B regulates the state of IR phosphorylation in the retina.