IMPORTANCE With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN). OBJECTIVES To characterize a new SD-OCT presentation of AMN as a paracentral acute middle maculopathy and to describe multimodal imaging findings that implicate an underlying pathogenesis related to retinal capillary ischemia. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational case series (January 1, 2012, to January 1, 2013) reviewing clinical and imaging data from 9 patients (11 eyes) with AMN at 6 tertiary referral centers. Lesions were classified as type 1 or 2 in relation to the SD-OCT location of the lesion above (type 1) or below (type 2) the outer plexiform layer (OPL) at 6 tertiary referral centers. RESULTS Of the 9 patients, 5 were female and 4 were male (mean age, 47.6 years; range, 21-65 years). All patients presented with an acute paracentral scotoma and demonstrated a classic dark gray paracentral lesion with near-infrared imaging. Visual acuity ranged from 20/15 to 20/30. Six eyes (5 patients) had type 1 SD-OCT lesions, also referred to as paracentral acute middle maculopathy, and 5 eyes (4 patients) had type 2 SD-OCT lesions. Although type 1 lesions lead to inner nuclear layer (INL) thinning, type 2 lesions resulted in ONL thinning. Type 2 lesions were always associated with significant outer macular defects, including disruption of the inner segment/outer segment and outer segment/retinal pigment epithelium bands, whereas type 1 lesions spared the outer macula. CONCLUSIONS AND RELEVANCE Paracentral acute middle maculopathy may represent a novel variant of AMN that affects the middle layers of the macula above the OPL as diagnosed with SD-OCT imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL. Type 1 refers to hyperreflective bands in the OPL/INL region with subsequent INL thinning. Type 2 is hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the inner segment/outer segment layer. We propose that each of these lesions may be explained by occlusion of either the superficial capillary plexus (type 1) or deep capillary plexus (type 2) located in the innermost and outermost portion of the INL, respectively, immediately adjacent to each corresponding lesion type.

The purpose of this paper is to provoke thought in the pharmacy academy about the critical and comprehensive need to address professionalism. Several forces are driving the need for this conversation: the movement toward pharmaceutical care as the practice standard requires a higher level of professionalism from practitioners; critical issues with regard to current practice that address patient safety, workload, and shortages in our profession; and the sentiment that there has been a decline in the professionalism of our students over the last several years as well as within society in general. This paper will comprehensively review the concept of professionalism, its value to pharmacy practice, challenges to its development, factors necessary to support it, and recommendations to foster it in the academy and in practice. We hope this paper serves as a call to action for administrators, faculty, practitioners, and students to think and discuss critically professionalism in pharmacy education, as well as to stimulate additional work in this important area.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

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The University of Maryland School of Pharmacy has systematically implemented professionalism assessment to establish expectations in experiential learning and to create a mechanism for holding students accountable for professionalism. The authors describe their philosophic approach to the development and implementation of these explicit criteria and also review the outcomes of applying these criteria.In 2001, 3 professionalism criteria were developed and applied to required intermediate and advanced pharmacy practice experiences (APPEs). Students were expected to achieve 100% acceptable ratings to pass the rotations. The criteria were subsequently enhanced and by 2005 applied to all experiential courses.Most students exhibited professional behavior; however, 9 students did not meet the established criteria. Strategies used in remediation and further professional development are discussed. The use of professionalism criteria has promoted a culture of professionalism throughout the School.

Introduction Scleritis is an inflammatory condition affecting the eye wall that may be associated with a number of systemic inflammatory diseases. Because scleritis can be refractory to standard treatment, knowledge of the body of available and emerging therapies is paramount and is reviewed here. Areas Covered This review focuses on both traditional and emerging therapies for non-infectious scleritis. We will cover the mechanisms of action and potential adverse effects of each of the treatment modalities. Additionally, a summary of the significant MEDLINE indexed literature under the subject heading “scleritis,” “treatment,” “immunomodulator” will be provided on each therapy, including commentary on appropriate use and relative contraindications. Lastly, novel treatments and potential drug candidates that are currently being evaluated in clinical trials with therapeutic potential will also be reviewed. Expert Opinion While oral non-steroidal anti-inflammatory drugs (NSAIDs) and oral corticosteroids are widely used, effective, first-line agents for inflammatory scleritis, refractory cases require anti-metabolites, T cell inhibitors, or biologic response modifiers. In particular, there is emerging evidence for the use of targeted biologic response modifiers, and potentially, for local drug delivery.

In 2005, the Council of Faculties and the Council of Deans within the American Association of Colleges of Pharmacy (AACP) formed a task force to review the status of the pharmacy faculty workforce and to identify factors that may influence the supply of and demand for pharmacy faculty members. This manuscript summarizes the Task Force on Faculty Workforce's findings and describes specific strategies needed to address the various issues facing the academy. Based on Task Force predictions, the academy will need approximately 1200 new faculty members over the next 10 years due to the creation of new pharmacy programs, the expansion of existing programs, faculty retirements, and recurring vacant faculty positions.

Purpose We investigated the effects of desiccating stress on murine corneal apical epithelial cell area and desquamation by using 4 defined parameters and evaluated the effects of the metalloproteinase inhibitor doxycycline on this process. Methods C57BL/6 mice were subjected to experimental dry eye (EDE) for 5 days without or with topical therapy with doxycycline 0.025% or 0.0025% or vehicle 4 times a day. C57BL/6 mice that were not exposed to desiccating stress served as controls. Whole mount corneas from each group were immunostained for occludin and visualized by laser scanning confocal microscopy. The images were analyzed in a masked fashion, and mean individual cell area, apical cell density, average cell number loss, and average percent loss were recorded. Results EDE caused a significant decrease in apical corneal cell area (1073 ± 135.9 μm2), an increase in apical cell density (895.8 ± 115.4 cells per mm2) and a greater percent of epithelial loss (21.29% ± 13.40%) than controls (1341 ± 95.28 μm2, 714.4 ± 55.60 cells per mm2, 2.897% ± 3.452%, P < 0.001 for all, respectively). Treatment with 0.025% doxycycline preserved cell area (1337 ± 144.6 μm2) and the apical cell density (721.0 ± 91.62 cells per mm2) and decreased percentage loss (5.117% ± 6.757%) compared with the vehicle control group (1154 ± 88.10 μm2, 830.2 ± 49.76 cells per mm2, 22.14 ± 9.616%, P < 0.001 for all, respectively). Conclusions Desiccating stress decreases apical corneal epithelial cell area, increases apical cell density, and promotes epithelial cell loss. Treatment with the metalloproteinase inhibitor doxycycline during desiccating stress preserves cell area and apical cell density and prevents EDE-induced corneal epithelial cell loss. These findings suggest that metalloproteinases mediate apical corneal epithelial loss during desiccating stress.