Purpose The impact of pharmacist-assisted management (PAM) of pharmacotherapy for patients with human immunodeficiency virus (HIV) infection was investigated. Methods A retrospective cohort analysis was conducted to evaluate antiretroviral therapy (ART) outcomes in treatment-naive patients initiated on ART at an HIV clinic. Eligible patients enrolled in the clinic during the period 1999–2013 were classified into two groups: those referred to a clinic-based HIV pharmacist for initiation of ART (the PAM group) and those managed by a primary care provider (the control group). The primary study objective was the median time to viral suppression; secondary objectives included the durability of response to the first ART regimen. Relative hazards for the events of interest were estimated using a marginal structural Cox proportional hazards model and Kaplan–Meier curves, with inverse probability weights used to control for selection and confounding bias. Results Patients referred for PAM services (n = 819) typically had higher baseline viral loads and lower CD4+ cell counts than those in the control group (n = 436). The likelihood of viral suppression during the first two years after ART initiation was significantly higher in the PAM group versus the control group (hazard ratio, 1.37; 95% confidence interval, 1.18–1.59; p < 0.0001). The median durability of the first ART regimen was 100 months in the PAM group versus 44 months in the control group (p > 0.05). Conclusion In treatment-naive patients, suppression of HIV viral load occurred earlier when pharmacists assisted with initiating ART than when ART was initiated without that assistance.

Purpose To identify and analyze postmarketing cases of complex sleep behaviors (CSBs) resulting in serious injuries, including death, associated with eszopiclone, zaleplon, or zolpidem (Z‐drugs). Methods Retrospective analysis of the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from 16 December 1992 through 27 February 2018 and medical literature using PubMed and EMBASE. We used random sampling and descriptive statistics. Results We identified 66 cases that met inclusion and exclusion criteria, four of which were identified in the medical literature. Twenty cases reported death and 46 cases reported serious injuries in association with CSBs occurring after the use of a Z‐drug. Fatal cases described events, such as carbon monoxide poisoning, drowning, falls, hypothermia, motor vehicle collisions, and apparent completed suicide. Nonfatal cases resulting in serious injuries described events, such as accidental overdoses, falls, gunshot wounds, hypothermia, third‐degree burns, and self‐injuries or suicide attempts. Twenty‐two cases reported a previous episode of a CSB while taking a Z‐drug prior to the event reported in this case series. Conclusions The FAERS and medical literature cases support the need for increased awareness of the consequences that may occur because of CSBs associated with the use of Z‐drugs. Therefore, to protect public health, regulatory actions were taken, including adding a Boxed Warning, a Contraindication in patients who have experienced a prior episode of a CSB with a Z‐drug, and updating the existing Warnings and Precautions. An FDA Drug Safety Communication was also disseminated to alert healthcare professionals and the public of this potential risk.

ABSTRACT Bottom Line Up Front: In this perspective essay, ENS Ofir Nevo and Dr Laura Lambert briefly discuss the concept of an outward mindset and how they have applied it in the context of medical education. ENS Nevo shares his story of deciding to attend medical school at the Uniformed Services University, as part of his desire and commitment to serve others. Early on, the requirements of medical school created intense demands that began to disconnect him from the commitment and connection that first drew him to a medical career. ENS Nevo describes how an awareness of the choice of mindset helped him address these challenges and stay better connected to his purpose and calling. A case analysis by Dr Lambert further explores how the awareness and practice of an outward mindset may help students, residents, and attendings see how they can improve their own well-being and connection to the people that brought them to medicine in the first place. Their experiences demonstrate how outward mindset principles can be a valuable tool for empowering students and physicians with a perspective that invites new solutions for the challenges of life and work.

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