bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARAÇÃO DO CONSUMO DE SÓDIO E FIBRAS ENTRE ADOLESCENTES DE AMBOS OS SEXOS
Authors: Reis Ingrid Rafaella Mauricio Silva , Omena Messias Cristhiane Maria Bazílio de , Souza Havena Mariana dos Santos
Published: January 2018

Embora apresentem manifestação clínica na idade adulta, há fortes evidências de que as doenças cardiovasculares podem ter início na infância e na adolescência, sendo os fatores dietéticos os mais condicionantes. O objetivo desta pesquisa foi comparar o consumo de sódio e fibras entre adolescentes de ambos os sexos de uma escola pública de Petrolina, Pernambuco. Tratou-se de estudo transversal, realizado nos meses de fevereiro de 2013 a novembro de 2014, com alunos matriculados da faixa etária de 15-17 anos de ambos os sexos, totalizando 209 participantes. Foi usado o Recordatório 24 horas como instrumento de avaliação do consumo alimentar. Os resultados indicaram que a maioria, de ambos os sexos, apresentou o consumo de sódio superior ao recomendo (2.000 mg de sódio). Enquanto que, para ingestão de fibras, a maioria apresentou um consumo inferior. Concluiu-se que não foi observada diferença estatísticas entre sexo, faixa etária e o consumo de sódio e fibra, destacando a necessidade de intervenções nos hábitos de vida devem ser iniciadas o mais cedo possível, inclusive na adolescência, fase em que ocorrem mudanças importantes de personalidade e o indivíduo ganha autonomia para escolher seu próprio alimento, sendo considerada como uma fase favorável para a consolidação de hábitos que poderão trazer implicações diretas para a saúde na idade adulta.

Palavras-chave: Adolescente. Sódio. Fibras alimentares. Alimentos industrializados.
DOENÇAS E AGRAVOS DO TRABALHO EM MINAS GERAIS DE 2008 A 2012
Authors: Lamy Renata de Lourdes Ribeiro Franco , Dazini Paula Oliveira , Goulart Thaís Pereira , Horta de  Lima Rafaela Caetano , Balbi Guilherme Guimarães Moreira , Almeida Vitor de Assis
Published: January 2018

A notificação dos acidentes de trabalho é de fundamental importância na gestão da saúde pública, tendo grande impacto no atendimento dos serviços de emergência e nos benefícios acidentários da Previdência Social. O objetivo deste estudo foi realizar uma análise descritiva dos dados de doenças ou agravos relacionados ao trabalho notificados em Minas Gerais, Brasil por meio de sistemas de informação do SUS, disponíveis no DATASUS. Tratou-se de estudo ecológico, exploratório descritivo, quantitativo, retrospectivo, apoiado em análise de base de dados secundários, no período de janeiro de 2008 a dezembro de 2012. Os resultados apontaram um aumento de 101,1% na proporção de municípios com casos de doenças ou agravos notificados relacionados ao trabalho e de 39,1% na taxa de acidentes de trabalho em Minas Gerais por 100 mil habitantes, taxa não proporcional ao crescimento populacional do estado no mesmo período. Concluiu-se que havia ainda um grande sub-registro nos sistemas de informação, principalmente no Sistema de Informação de Agravos de Notificação, apesar do crescimento das variáveis analisadas.

Palavras-chave: Notificação de acidentes de trabalho. Saúde do trabalhador. Saúde pública.
INTERNAÇÕES POR CONDIÇÕES SENSÍVEIS À ATENÇÃO PRIMÁRIA EM MINAS GERAIS, ENTRE 1999 E 2007
Authors: Oliveira Éder Samuel Bonfim Esteves , Oliveira Veneza Berenice , Caldeira Antônio Prates
Published: January 2018

O indicador Internações por Condições Sensíveis à Atenção Primária tem sido utilizado no Brasil para avaliar o impacto das atividades da Estratégia Saúde da Família, possibilitando a identificação de fragilidades regionais, para que possam ser enfrentadas de modo mais efetivo pelos gestores de saúde. Este estudo objetivou analisar as taxas de Internações por Condições Sensíveis à Atenção Primária nas regiões de saúde de Minas Gerais, no período de 1999 a 2007. Desenvolveu-se estudo ecológico, com análise de correlação entre as taxas de internações e a cobertura da Estratégia Saúde da Família. Os números de internações foram fornecidos pelo departamento de informática do Sistema Único de Saúde e a população, a cada ano, foi obtida com base nas estimativas populacionais do Instituto Brasileiro de Geografia e Estatística. Os resultados indicaram que, no período avaliado, as taxas das Internações por Condições Sensíveis à Atenção Primária passaram de 244,19 para 143,5/10.000 habitantes, uma redução de 41,2% ao longo dos anos. Houve redução em todas as regiões de saúde, mas de forma heterogênea, com piores resultados para as regiões mais carentes. Registrou-se correlação negativa e estatisticamente significante entre a cobertura populacional pela Estratégia Saúde da Família e o número dessas internações. Concluiu-se que houve melhora da efetividade da Atenção Primária em Saúde em Minas Gerais e redução das taxas e do percentual das Internações por Condições Sensíveis à Atenção Primária no total de internação entre os anos de 1999 e 2007.

Palavras-chave: Atenção Primária à Saúde. Hospitalização. Qualidade da assistência à saúde. Avaliação.
CONHECIMENTO E COMPORTAMENTO DOS ADOLESCENTES DE UMA ESCOLA PÚBLICA SOBRE SEXUALIDADE E MÉTODOS CONTRACEPTIVOS
Authors: Jorge Sandra Antunes , Alves Bruno Vinícius Cantuária , Alves Janine Cinara Silveira , Gonçalves Dias Ernandes
Published: January 2018

A sexualidade envolve aspectos sociais, culturais e pessoais, e intensifica-se com a puberdade. O objetivo deste artigo foi investigar o conhecimento dos adolescentes de uma Escola Pública sobre sexualidade e métodos contraceptivos. Para tanto, fez-se uma pesquisa descritiva, exploratória de natureza quantitativa, utilizando como instrumento de coleta de dados um questionário respondido por 57 adolescentes no período de março e abril de 2014. Evidenciou-se que 66,67% dos entrevistados eram mulheres e 82,46% tinham 16 anos. Os resultados indicaram, quanto ao conhecimento sobre sexualidade e contracepção, que 66,67% conversavam sobre o assunto com amigos, 29,55% responderam adquirir conhecimento sobre métodos contraceptivos pela internet, 59,65% afirmaram que a escola não fornece informações sobre sexualidade, 31,58% já praticaram o ato sexual e, destes, 55,56% utilizaram métodos contraceptivos nas relações sexuais. Concluiu-se que existe uma insuficiência de conhecimentos dos adolescentes acerca da sexualidade e dos métodos contraceptivos, o que pode levar ao aumento dos riscos de ocorrência de gravidez na adolescência e à possibilidade de exposição às DST.Palavras-chave: Conhecimento. Adolescente. Sexualidade. Comportamento contraceptivo.
PENGEMBANGAN TEKNIK SEROLOGI UNTUK DETEKSI DINI PENYAKIT JAMUR AKAR PUTIH (RIGIDOPORUS MICROPORUS) PADA TANAMAN KARET
Authors: Dalimunthe Cici Indriani , Tistama Radite , Wahyuni Sri , Darwis Hilda Syafitri
Published: January 2018

Penyakit Jamur Akar Putih (JAP) yang disebabkan oleh Rigidoporus microporus merupakan salah satu penyakit penting pada tanaman karet. Penyakit ini dapat menimbulkan kerugian besar karena mengakibatkan kematian tanaman dan tambahan biaya yang cukup tinggi untuk pengendalian penyakit tersebut. Oleh karena itu, usaha pencegahan melalui deteksi dini akan lebih efektif dan ekonomis dari pada pendekatan kuratif. Deteksi dini gejala penyakit JAP secara konvensional masih sulit dilakukan, dan baru diketahui secara pasti ketika serangan patogen sudah sampai pada tahap lanjut (stadia berat). Upaya mempercepat deteksi ini membutuhkan teknologi yang praktis dan mudah diadopsi oleh para pekebun. Perangkat teknologi untuk mendeteksi adanya materi protein dapat dilakukan melalui pemeriksaan antibodi yang berada di dalam serum. Tujuan dari penelitian ini adalah mengembangkan teknik serologis untuk mendeteksi gejala serangan dini penyakit jamur akar putih. Hasil penelitian menunjukkan bahwa produksi antibodi untuk mendeteksi JAP dapat diperoleh dengan mengimunisasi ayam petelur dengan ekstrak kasar fruiting body (AgF) atau miselium (AgM) sebanyak dua kali dengan interval 3 hari. Antibodi hasil reaksi inokulasi ekstrak badan buah (AbF) dan ekstrak miselium (AbM) dapat mengenali AgM dan AgF dengan tingkat reaksi yang berbeda. AbM tidak dapat secara spesifik mendeteksi adanya infeksi JAP melalui  daun dan kurang sensitif mendeteksi miselium di tanah. Sebaliknya AbF dapat mendeteksi tanaman terserang JAP melalui daun dan dapat mendeteksi miselium di dalam tanah.
Bradicardia extrema por infarto talámico paramediano bilateral
Authors: Cortés B Giovanny A , Romero H Camilo Andrés , Pinzón C Stefhany , Correa H Andrea
Published: January 2018

Alteraciones autonómicas agudas por infartos cerebrales se han descrito con frecuencia comprometiendo la región insular, dentro de las anormalidades se han documentado alteraciones de severidad variable del ritmo cardíaco, incluyendo la bradicardia extrema sintomática; en la literatura solo hay un reporte de caso de bradi-cardia extrema asociado a un infarto talámico paramediano bilateral, a continuación, describimos un segundo caso de un infarto talámico con la misma presentación.
Metodologías utilizadas en la diferenciación de células madre mesenquimales a linaje neuronal
Authors: Garzón-Perdomo Diana Katherine , De los Reyes Lina María , Turner Liliana Francis
Published: January 2018

INTRODUCCIÓN:
Las células madre mesenquimales son células con la capacidad de autorrenovarse y diferenciarse a linajes mesenquimales e inclusive a células de origen no mesenquimal, como las del tejido nervioso. Teniendo en cuenta la idoneidad de estas células para diferenciarse en neuronas, han sido utilizadas con propósitos terapéuticos debido a que son capaces de restaurar neuronas que se deterioran en diversas enfermedades neurodegenerativas.

OBJETIVO:
Informar y comparar los métodos más utilizados para inducir a las células madre mesenquimales a diferenciarse en neuronas, además de mencionar las ventajas y desventajas de cada una de estas.

METODOLOGÍA:
La primera metodología para inducir a la diferenciación neural fue utilizada en 1999 y a partir de ese momento, se han empleado compuestos químicos, factores de crecimiento, compuestos sintéticos, entre otros métodos para diferenciar este tipo de células a linaje neuronal. El problema radica en que algunas de estas metodologías son tóxicas para las células, costosos o presentan otro tipo de efecto colateral.

CONCLUSIÓN:
La elección de uno de estos métodos depende de los intereses y las condiciones con las que cuente cada investigador. Además, es indispensable conocer las falencias que tenemos en este campo de la investigación con el propósito de continuar con la búsqueda de alternativas que no tengan desventajas, si no por el contario, reúna todas las ventajas de los métodos aquí mencionados.
Synergy of foreign policy and defence policy
Authors: Jeremic Zlatan
Published: January 2018

The relationship of the subsystem of foreign policy and defense of the state
has a cause-and-effect character, but nevertheless with a more significant
influence of foreign policy on the defense of the state. The state defense
system is a relatively independent factor, but in practice, it functions as a
means or an instrument of foreign policy, which contributes to the successful
realization and protection of the unified state goals on the international
plane. The basic question asked in this paper is "What kind of the
relationship between the state sub-systems of foreign policy and defense can
be considered optimal in the state's efforts to realize and protect vital
interests in the current state of international relations"? Each of the
aforementioned subsystems has its own specifics of organizing and functioning
in the process of creating and practicing the foreign policy of the state.
The attitude of the state's subsystems of foreign policy and defense is most
visible in the legal normative arrangement, the contents of the foreign
policy positions of the highest state managers and strategic documents,
functional cohesion, participation in regional and global international
initiatives and organizations, participation in multinational operations, as
well as in the process of information supply state leadership need for
foreign policy decisions. Through analysis and description of the current
situation in the foreign policy and defense subsystem, as well as their
mutual relationship, critical elements of the systems and processes have been
identified in order to be able to overcome the projection of the foreign
policy of the state.
Antecedentes ideológicos del primer núcleo del Movimiento Nacionalista Tacuara (1956-1958)
Authors: Jiménez Mario Virgilio Santiago
Published: January 2018

Se argumenta que la tradición nacionalista, aunque mostraba una cara doctrinaria rígida, realmente se caracterizó por la heterogeneidad y permeabilidad, rasgos que heredó el primer núcleo del MNT y que influyeron en su exposición ideológica. El trabajo se divide en dos partes: en la primera, utilizando fundamentalmente historiografía, se reconstruye de forma general la tradición nacionalista de la que abrevó Tacuara, y en la segunda, utilizando testimonios orales, documentación desclasificada y prensa de la época, se tratan los primeros años del MNT.
Hospitalized Patients' Perceived Knowledge and Risk of Monoamine Oxidase Inhibitor Medications Before and After a Pharmacist's Classroom-Based Education
Authors: Wenzel Richard G. , Schommer Jon C.
Published: January 2018

Objective: Assess if a classroom-based pharmacy education service for hospitalized headache patients newly prescribed a monoamine oxidase inhibitor (MAOI) results in, 1) higher self-perceived medication knowledge, or 2) lower perceived risk of using MAOIs.

Subjects: Individuals admitted to an inpatient headache unit over a five month period

Methods: Patient survey administered before and after the education service to any patient newly prescribed an MAOI.

Results: Seventy-eight individuals completed the study. Paired-samples t-tests showed that for each of the four items related to self-perceived medication knowledge, the scores reflected higher knowledge after the MAOI class compared to before the class (p < 0.05). For three out of the four items related to perceived risk of using MAOIs, the scores reflected a lower level of perceived risk after the MAOI class compared to before the class (p < 0.05). One item did not significantly change: "The MAOI prescribed for me is just as good as other products available for treating headache." Conclusion: Our results demonstrate a pharmacist-conducted, classroom-based teaching method for newly prescribed MAOI patients can result in higher self-perceived medication knowledge and lower perceived risks.

Type: Original Research
Rigor: An Essentiality in Qualitative Research
Authors: Jamshed Shazia Qasim , Ibrahim Mohamed Izham Mohamed , Hassali Mohamed Azmi Ahmad , Shafie Asrul Akmal , Al-Haddad Mahmoud Sa'di Mohammad , Alkalami Ramadan
Published: January 2018

Type: Letter
Sharing Community Engagement in Pharmacy - An Invitation
Authors: Sorensen Todd D. , Davis Robin L. , Balidemaj Festina
Published: January 2018

Type: Invitation
Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons
Authors: Gatewood Sharon B.S. , Moczygemba Leticia R. , Alexander Akash J. , Osborn Robert D. , Reynolds-Cane Dianne L. , Matzke Gary R. , Goode Jean-Venable R.
Published: January 2018

An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.

Type: Clinical Experience
What's Past is Prologue: The Pharmaceutical Syllabus of 1910
Authors: Schommer Jon C. , Hadsall Ronald S. , Anderson Lowell J.
Published: January 2018

Type: Commentary
Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice
Authors: Pringle Janice , Melczak Michael , Aldridge Arnie , Snyder Margie , Smith Randall
Published: January 2018

Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients who received MTM without use of the TA scale (MTM only).

Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics.

Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting.

Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2.

Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome Measures Proportion of Days Covered (PDC) and PDC80.

Results: Using the therapeutic alliance scales in the context of community pharmacist-provided MTM was associated with a 3.1 percentage point increase in patients' overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales.

Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice.

Type: Original Research
A Description of Medication Therapy Management Services in Minnesota
Authors: Digatono Amie Jo
Published: January 2018

Objective: To describe Medication Therapy Management (MTM) services in Minnesota, quantifying how many patient encounters occur per week and compiling provider and practice site characteristics. Design: Cross-sectional study. Setting: Minnesota practice sites surveyed in June and July 2010. Participants: MTM providers in Minnesota who are registered users of the Assurance™ documentation system or are members of the Minnesota Pharmacists Association MTM Academy. Intervention: Self-administered online questionnaire completed by study participants. Main Outcome Measures: The number of patient encounters per week, practice site location, practitioner length of time as a MTM service provider, and the motivating factors for providing direct patient care services. Results: There were 56 respondents, reporting a median of 5 MTM patient encounters per week (range 0 to 35) and a median length of service of 4 years (range15). Clinic-based practices were reported by 66% of providers and community pharmacy-based practices by 30%. Eighty-five percent practice in an urban setting, 9% in a large rural town and 6% in a small rural town. Nearly half (46%) of providers are the sole practitioner at their site. The most commonly cited motivation for providing direct patient care services was to improve patient outcomes. Conclusion: MTM service providers in Minnesota were more likely to report practicing in an urban area and in a clinic. Many practices were low-volume or newly established, with half of all respondents reporting 5 or fewer MTM patient encounters per week and a length of service of four years or less.

Type: Student Project
What can StrengthsFinder™ add to a pharmacy curriculum?
Authors: Young Brandon
Published: January 2018

Type: Commentary
Clinical Pharmacy Clerkship in Pakistan: A leap from paper to practice
Authors: Aslam Nousheen , Ahmed Khwaja Zafar
Published: January 2018

This is the first article of its type to describe the advances taking place in clinical pharmacy education in Pakistan. The Pharmacy Council of Pakistan has developed a five-year Pharm.D program to replace the four-year B.Pharm degree. Completing clinical pharmacy clerkships is a prerequisite for receiving the Pharm.D degree. To meet this requirement, Ziauddin College of Pharmacy has developed a specialized clerkship program for its 4th and 5th year students. The College is fortunate to be linked with well developed tertiary care hospitals at three prime locations in the in the metropolitan city of Karachi, which provides opportunity for the students to gain exposure to real life situations and work with patients. The article presents an account of the efforts taken for development of the clinical pharmacy clerkship program, the problems encountered during its development, and the main outcomes of a clerkship program.

 

Type: Note
Chemical Stability of Hydrocortisone in Topical Preparation in Proprietary VersaPro™ Cream Base
Authors: Sarkar Arindam Basu , Dudley Richard , Melethil Srikumaran , Speidel Jonathon , Bhatt Gopalkumar Markandakumar
Published: January 2018

The United States Pharmacopeia-National Formulary (USP-NF) suggests beyond use dating ((BUD) for compounded topical preparations containing active pharmaceutical ingredients (API) [1]. The beyond the use dates of the preparations are based on the conservative and empirical guidelines of USP 795. Hydrocortisone (HC) content compounded in the VersaPro™ base cream was quantified using a HPLC method at time zero and after 30 and 60 days of storage at both room temperature and 4°C. The analysis suggests that the compounded preparations retain > 95% of the stated initial potency of HC regardless of storage conditions. Thus HC creams prepared in VersaPro™ cream base can be safely assigned a beyond the use date of two months when stored at room temperature.

 

Type: Original Research
Building a Community of Scholars in Educational Research: A Case Study for Success
Authors: Brahm Nancy C. , Davis Tamra S. , Peirce Gretchen L. , Lamb Michelle M.
Published: January 2018

Objective: To present the model of the Education Research/Scholarship of Teaching Community of Scholarship (EdCOS) as one Community of Scholars (COS) within a department of pharmacy.

Case Study: A case study describing the Education Research/Scholarship of Teaching Community of Scholars (EdCOS). Faculty members were self-selected into one or more of eight COS. The EdCOS was comprised of 14 members. The EdCOS developed a vision statement to "foster and support a learning culture that enables faculty to capture and evaluate teaching and learning experiences." The process by which the EdCOS set out to initiate this COS will be discussed. Since its inception all members of the EdCOS have become IRB Certified. Through a combined project, members had the opportunity to develop, learn, and acquire experience in areas of conducting research from the conception of a project through final submission of the manuscript. Departmental publications and grant funding increased over the years after the implementation of the COS.

Conclusion: Although cause and effect cannot be explicitly determined, the EdCOS has had a positive impact on its members building confidence, experience, and ideas for future projects.

 

Type: Idea Paper
Adopting an Advanced Community Pharmacy Practice Experiential Educational Model Across Colleges of Pharmacy
Authors: Rodis Jennifer L. , Jennings Brandon T.
Published: January 2018

Objective: To discuss the experience of sharing an experiential model of education and practice development between two colleges of pharmacy and to provide a framework to guide faculty in this type of collaboration.

Case Study: The Ohio State University College of Pharmacy (OSU COP) Partner for Promotion (PFP) program was developed in response to the need for advancing practice in the community pharmacy setting. After successful implementation of this program, the PFP program design and materials were shared, adapted, and implemented at the University of Utah College of Pharmacy (Utah COP). Collaborating faculty developed a framework based on lessons learned through this experience which proposes key guiding strategies as considerations to address prior to embarking on sharing any aspect of an educational program or model between institutions. Each step of the framework is described and applied to the process followed by The OSU COP and Utah COP in sharing the PFP program. Additional considerations related to transfer of educational models are discussed.

Results/Conclusion: Sharing the education model and materials associated with the PFP program between institutions has enhanced experiential opportunities for students and helped develop residency training sites in the community setting. In addition, the relationship between the two colleges has contributed to faculty development, as well as an increase in community pharmacy service development with community pharmacy partners at each institution. It is hoped this experience will help guide collaborations between other colleges of pharmacy to enhance education of future pharmacists while positively impacting pharmacy practice, teaching, and research by faculty.

 

Type: Case Study
Evaluating Pennsylvania Pharmacists' Provision of Community-based Patient Care Services
Authors: Osborne Maria A. , Snyder Margie E. , Hall Deanne L. , Coley Kim C. , McGivney Melissa Somma
Published: January 2018

Objective: To identify and describe Pennsylvania pharmacists who currently provide or are interested in providing community-based patient care services and are interested in joining a statewide practice network.

Design: Cross-sectional survey.

Setting: February to June 2009 in Pennsylvania.

Participants: 1700 pharmacists.

Intervention: Mailed and electronic survey.

Main outcome measures: Number and geographic location of pharmacists providing or interested in providing community-based patient care in Pennsylvania. Description of patient care documentation methods; physical space; services provided; perceived barriers to providing patient care; training needs; and interest in joining a statewide practice network.

Results: The final analysis included data from 1700 pharmacists. Approximately one-third of pharmacists (n=554) were providing patient care services to community-based patients. Most were routinely documenting (67.5%) and many had a semi-private or private space to provide care. MTM and immunizations were the most common services provided. Respondents reported the most significant barrier to providing MTM, diabetes education, and smoking cessation education was time constraints, whereas training was a barrier for immunization provision. Most pharmacists were not being compensated for patient care services. Of the 869 pharmacists interested in joining a statewide network, those providing care were more interested in joining than those who were not (70.8% vs. 43.8%, p < 0.001).

Conclusion: Pennsylvania pharmacists are interested in providing community-based patient care services and joining a statewide practice network focused on providing community-based patient care services. This research serves as a foundation for building a pharmacist practice network in Pennsylvania.

 

Type: Original Research
Experience Developing a Community Pharmacy Practice-based Research Network
Authors: Snyder Margie E. , Frail Caitlin K. , Seel Lindsey V. , Hultgren Kyle E.
Published: January 2018

In 2010, the Purdue University College of Pharmacy established the Medication Safety Research Network of Indiana (Rx-SafeNet), the first practice-based research network (PBRN) in Indiana comprised solely of community pharmacies. In the development of Rx-SafeNet and through our early project experiences, we identified several "lessons learned." We share our story and what we learned in an effort to further advance the work of the greater PBRN community. We have formed the infrastructure for Rx-SafeNet, including an Executive Committee, Advisory Board, member pharmacies/site coordinators, and Project Review Team. To date, 22 community pharmacies have joined and we have recently completed data collection for the network's first project. Lessons learned during the development of Rx-SafeNet may benefit PBRNs nationally. Although community pharmacy PBRNs are not yet commonplace in the U.S., we believe their development and subsequent research efforts serve as an important avenue for investigating medication use issues.

 

Type: Idea Paper
Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders' Perspectives
Authors: Elrod Shara , Snyder Margie E. , Hall Deanne , McGivney Melissa A. Somma , Smith Randall B.
Published: January 2018

Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change.

Design: Qualitative study.

Setting: Community pharmacy in rural Mississippi.

Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4), support staff (n=2), collaborating providers (n=4), patients (n=3), and a payer (n=1).

Intervention: Semi-structured interviews and participant-observation techniques were used.

Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators.

Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges.

Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice.

 

Type: Case Study
Prevalence of drug-related problems in self-medication in Danish community pharmacies
Authors: Frøkjær Bente , Bolvig Tina , Griese Nina , Herborg Hanne , Rossing Charlotte
Published: January 2018

Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this.

Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine) identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems.

Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies.

Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC) medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs) were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner.

Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended effects and, to a lesser extent, inappropriate self-medication.

 

Type: Original Research
Patient-perceived value of Medication Therapy Management (MTM) services: a series of focus groups
Authors: Schultz Heidi , Westberg Sarah M. , Oliveira Djenane Ramalho de , Brummel Amanda
Published: January 2018

Objective: To determine the patient-perceived value of MTM services and non-financial barriers preventing patients with insurance coverage from receiving MTM services.

Design: Focus groups.

Setting: Fairview Pharmacy Services, Minneapolis, MN.

Participants: Three focus groups, each with five to nine participants, consisting of different participant populations: (i) patients who paid out-of-pocket to receive MTM services; (ii) insurance beneficiaries, under which MTM is a covered benefit and participants may have received incentives for receiving MTM services; (iii) patients with an insurance plan which covers MTM services who were recruited to receive MTM services but declined. Intervention: MTM services.

Main Outcome Measure: Patient-perceived value of MTM services and non-financial barriers.

Results: Seven themes were identified relating to the patient-perceived value of MTM services: collaboration of the health care team, MTM pharmacist as a supporter/advocate/confidant, MTM pharmacist as a resource for questions and education, accessibility to the MTM pharmacist, financial incentives for participation in MTM services, MTM pharmacy as a specialty field, and the MTM pharmacist as a coordinator. Three themes were identified regarding patient-perceived non-financial barriers to receiving MTM services, including: availability of the MTM pharmacist, patient/physician lack of knowledge of MTM services, patient's belief that MTM services are not needed.

Conclusion: MTM is a service which patients identify as valuable. Patients are able to identify non-financial barriers that may prevent some patients from receiving MTM services. This study provides preliminary evidence of both the value and barriers perceived by patients.

 

Type: Original Research
Perspectives from the Hmong Population on Type 2 Diabetes
Authors: Xiong Phoua , Westberg Sarah M.
Published: January 2018

The primary goal of the study was to determine perceptions the Hmong population has about Type 2 diabetes. Specific information to be gathered from the Hmong participants were: reactions after being diagnosed with Type 2 diabetes, knowledge and beliefs about medications, and how pharmacists can help them with their diabetes care. Learning the beliefs of this population related to Type 2 diabetes will help identify methods to improve diabetes care and education for Hmong patients. A focus group was conducted with Hmong participants with Type 2 diabetes to explore their perceptions and experiences with diabetes. There were 9 participants in the focus group which lasted approximately 90 minutes. The major themes were a misunderstanding of diabetes and its treatment, a reluctance to adhere to medications, a reluctance to change cultural diet, and the need for clear education from pharmacists. Participant recommendations for pharmacists were to improve their diabetes care by educating them about the condition, medication, and available treatments.

 

Type: Original Research
Developing a Professionalism Plan
Authors: Grice Gloria R , Monson Kacie , Pitlick Jamie , Chereson Rasma , Duncan Wendy , Geslani Gemma , Kilgore Kimberly , Patel Puja B. , Pautler Heather
Published: January 2018

Professionalism is a way of being which underlies all the responsibilities of a pharmacist and associated general and professional abilities. The Student Affairs Committee was charged with developing a college-wide professionalism plan to meet the Accreditation Council for Pharmacy Education (ACPE) Standards 15.1 and 23. This plan was developed concurrently with a new curriculum. The plan was developed systematically with the following goals: 1) create a definition of professionalism, 2) determine outcomes of the plan, 3) identify existing components which should be continued and new components to be added, 4) ensure existing and new components are linked to outcomes and 5) develop a continuous assessment process for the plan. The proposed plan consists of curricular, co-curricular and extra-curricular activities designed to help students gain experience in three professionalism pillars: Competence, Connection and Character, as defined by Brown et al in "Taxonomy of Professionalism". While knowledge and skills will be enhanced, the focus of development will be on student virtues, values and attitudesäóîthat what they do defines who they are. The goal is to help students develop as people and professionals who value the high ideals expected of a pharmacist.

 

Type: Idea Paper
Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)
Authors: Wallace Margaret L , Moon Jean , Lounsbery Jody L , Uden Donald L
Published: January 2018

Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota.

Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state.

Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II), with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services.

Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services provided by clinical pharmacists.

 

Type: Original Research
Attitudes of Iraqi society towards the role of community pharmacists
Authors: Ibrahim Inas R. , Al Tukmagi Haydar F. , Wayyes Abdulrasoul
Published: January 2018

Objectives: The main aims of this study were to assess society's use of community pharmacies; evaluate attitudes towards the role of the community pharmacist; and describe required pharmacist characteristics and future services.

Study design: A cross-sectional survey with a stratified sampling technique.

Methods: A self-administered, validated, questionnaire was distributed to 500 consumers in attendance at 50 community pharmacies in Baghdad, Iraq. Data were gathered from January to April 2012. Mann-Whitney and Kruskal-Wallis tests were performed to test for statistical differences among the study variables. Further analysis through the Chi-square test and logistic regression was completed to assess the predictors of society's attitudes.

Results: Twenty-six percent of respondents visited their community pharmacies at least once per week and an additional 65% reported visiting their pharmacy at least once per month. Fifty-five percent of respondents listed the community pharmacist as the first person they would contact in case of any drug-related problem. However, the pharmacist's role was under-appreciated by the majority of respondents (79.8%). These attitudes varied significantly with regard to the demographic characteristics of respondents. Logistic regression analysis showed that gender and age were the influential predictors of favourable versus non-favourable attitudes towards the role of pharmacist.

Conclusions: The use of community pharmacies in Iraq was characterized by frequent visits to purchase medicines. Selection of the pharmacy primarily depended on its location. Overall, an under-appreciation of the professional performance of pharmacists was predominant. Raising public awareness towards the important role of community pharmacists in providing public health is warranted.

 

Type: Original Research
Student Scientific Inquiry in the Core Doctor of Pharmacy Curriculum: Critical Issues in Designing and Implementing a Student Research Program
Authors: Vaidean Georgeta D. , Vansai Sandeep S. , Moore Ronnie J. , Feldman Stuart
Published: January 2018

While student-driven research has been credited with many learning benefits, few schools of pharmacy require such activities. Professional organizations repeatedly urge for incorporating research content in schools' curricula, yet no guiding principles or recommendations currently exist to guide such implementation efforts. This paper provides an overview of the critical issues, guiding principles, benefits and challenges encountered in designing and implementing a required, research program in the Pharm.D. curriculum. Several critical issues are reviewed: goals, unitary focus and expectations, structure and deliverables, time and curricular integration, monitoring and institutional oversight, outcomes measurement, resources, students and faculty response, and dissemination. These general critical issues are then discussed as implemented in the student research program at Touro College of Pharmacy-New York. Different schools can address these core issues, based on their academic milieu. This paper invites an inter-institutional dialogue for the pursuit of successful incorporation of student scientific inquiry in the core curriculum.

 

Type: Idea Paper
Acceptance Rates for Pharmacist-Initiated Interventions in Long-Term Care Facilities
Authors: Carson Gina L. , Crosby Kimberly , Huxall Garrett R. , Brahm Nancy C.
Published: January 2018

Objectives: Describe individualized medication interventions, categorize intervention types, and report acceptance rates by prescribers following a pilot medication intervention program in which a pharmacist rounded with the patient care team in long-term care facilities in addition to their traditional medication regimen review (MRR) process.

Design: Prospective Chart review

Setting: Two primary long-term care (LTC) facilities

Participants: Fifty randomly selected patient charts. Inclusion criteria were adult patients (18 years old or older) residing in one of the LTC facilities receiving consultant pharmacist services. Patient charts not meeting inclusion criteria were excluded from the review.

Interventions: Recommendations made according to the needs of each patient and categorically reported.

Main Outcome Measures: Intervention acceptance rates by prescribers and aggregate reporting for type of medication interventions.

Results: For 50 patient charts (68% female, 32% male) 66 interventions were reported. The average patient age was 81.5 years. Approximately 45% of the interventions pertained to drug utilization concerns, and 21% involved pain management. Additional categories included treatment of eye and skin conditions and pharmacotherapy for mental health. A 'nonpharmacotherapy' designation was given to individual interventions not fitting into a larger category. New medications and regimen changes were the most common medication therapy outcomes (42% and 32%, respectively). Overall 92% of all pharmacist interventions were either fully or partially accepted by the prescriber where partial acceptance was defined as implementation of the recommendation with an adjustment. Interventions related to drug utilization or pain management each approached a 93% acceptance rate.

Conclusions: The consultant pharmacist provided personalized recommendations following extensive chart review and patient assessment. Our chart review suggests that high prescriber acceptance rates along with medication therapy optimization may produce similar benefits in other LTC facilities.

 

Type: Original Research
On house calls, healthcare, and hope: one student's perspective
Authors: Shelquist Ryan , Greene Elisa
Published: January 2018

Healthcare providers spend years studying pathophysiology and therapeutics, often neglecting to consider the whole picture of influences on a person's health. House calls are a beneficial tool in that they provide the opportunity for trainees to experience these concepts firsthand, often opening student eyes to suffering, poverty, and unexpectedly, hope. Exposure to this broader perspective may empower health care providers to see beyond the limitations of disease and medication, into deeper issues that affect patient health.

 

Type: Idea Paper
Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital
Authors: Schatz Kristina , Chapman Jennifer , Chang Jongwha
Published: January 2018

Purpose: To describe a pharmacist's counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking.

Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted.

Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p<0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p<0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, & 65%) to want counseling compared with the age range of 12-17 years (all p<0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours.

Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.

 

Type: Original Research