bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of an Organizational Network for Patient Safety on Safety Event Reporting
Authors: Jeffs Lianne , Hayes Chris , Smith Orla , Mamdani Muhammad , Nisenbaum Rosane , Bell Chaim M. , McKernan Patricia , Ferris Ella
Published: June 2013

Health care organizations continue to implement organization-wide educational approaches to enhance patient safety with less attention on evaluating the impact of these approaches. In this context, a study was conducted to measure the impact of an organization-wide patient safety network approach on patient safety event reporting. A time-series analysis with reported rates of adverse events (major and moderate), near misses, sentinel events, and incidents from 2 years prior through 13 months following implementation was conducted. Study findings include a significant increase in reporting of patient safety events (an approximately 50% increase in overall reporting of safety events was observed; p < .001), especially near misses (an approximately 100% increase following implementation; p = .002). Study findings suggest that a multifaceted networked approach does contribute to improving patient safety event reporting.
Relative Valuation
Authors: Pandey Asheesh
Published: June 2013

In this paper we studied the sectoral behavior of Indian capital market through relative valuation for a period over a period of 21 years. The period covered under the study is from 1990–2010. The study has been done both for a total period (1990–2010) and three sub-periods, viz. 1990–96, 1997–2003, 2004–10. The research finds that price multiple distributions tend to be non-normal prior to 2003. On post-2003 basis these sample distributions are approximately normal, thereby implying that mean and standard deviations are relevant descriptive statistic measures in the Indian context, for a more recent period. The study also finds that we cannot judge all the sectors by classifying them with single high or low price multiples. Different sectors tend to have different high and low multiples which stand true both for total period as well as for sub-periods.
Competency-based Training Needs Assessment Model
Authors: Priyadarshini R. Rani Geetha , Dave Deepa
Published: June 2013

Competency mapping is an effective methodology used to integrate the HR functions with the key competencies of the organization. It is found to be a valuable resource to incorporate the competencies throughout the various processes and to assess the training needs of the organization. This article describes a research undertaken in an auto component company, to identify the training needs using the competency mapping methodology. The experiences of the study have been discussed and have been consolidated and presented as an effective training assessment model.
Transtibial Versus Anteromedial Portal Technique in Single-Bundle Anterior Cruciate Ligament Reconstruction
Authors: Wang Hongsheng , Fleischli James E. , Zheng Naiquan (Nigel)
Published: June 2013

Background:

In anterior cruciate ligament (ACL) reconstruction, the transtibial (TT) technique often creates a nonanatomically placed femoral tunnel, which is a frequent cause of surgical failure and postsurgical knee instability. Several studies reported that drilling the femoral tunnel through an anteromedial portal (AMP) yields a more anatomic tunnel position compared with the TT technique.

Purpose:

To compare the effectiveness of these two surgical techniques in restoring the intact knee joint kinematics during a physiological loading situation.

Study Design:

Controlled laboratory study.

Methods:

Twenty-four patients (TT, n = 12; AMP, n = 12; sex, weight, and height matched, and half with dominant leg involved) who underwent unilateral single-bundle ACL reconstruction by the same surgeon were recruited. Twenty healthy patients with no history of lower limb injuries were recruited as the control group. Tibiofemoral joint motion in 6 degrees of freedom (3 translations and 3 rotations) was determined during level walking by using a least mean square–based optimization algorithm. A redundant marker set was used to improve the accuracy of the motion analysis. Knee joint kinematics as well as spatiotemporal parameters were compared between these two techniques.

Results:

The AMP technique restored the anterior-posterior translation of the knee joint, while the TT technique resulted in significantly greater (TT, 22.2 mm vs controls, 13.2 mm; P < .01) anterior femoral translations than in the healthy controls during the swing phase. Excessive femoral external (tibial internal) rotation (3.8°; P < .05) was found at midstance in the knees that were reconstructed using the TT technique; using the AMP technique, the external rotation offset was greatly reduced during the stance phase. However, knees repaired using the AMP technique were significantly less extended (5°; P < .05) compared with the knees of the controls during the late stance phase. Neither surgical technique restored the superior-inferior femoral translation to the intact level during the swing phase.

Conclusion:

The AMP technique better restores the anterior-posterior translation during the swing phase and femoral external rotation at midstance than the TT technique does. However, the AMP technique is also correlated with an extension loss during the late stance phase.

Clinical Relevance:

The AMP femoral tunnel drilling technique can improve overall knee joint stability, but the increased difficulty with full extension may need to be considered.
Physical and mechanical characterization of jute reinforced soy composites
Authors: Avancha Sridevi , Behera Ajaya Kumar , Sen Ramkrishna , Adhikari Basudam
Published: June 2013

Jute fiber and soymilk extracted from soy seed were selected as ecofriendly and fully biodegradable components for making rigid and strong composite as a replacement of composites made from synthetic components. Rigid composites were prepared using non-woven jute fabric (felt) as reinforcing component and soymilk as matrix resin and properties of the composite specimens were characterized. Jute fiber in the non-woven jute fabric was modified by treating with different concentrations of sodium hydroxide for various time periods before composite fabrication. Significant increase in tensile strength (upto 42%) of jute fibers in the felt was achieved by 2 h, 2% alkali treatment. Both raw and alkali-treated jute felts were used for preparing composites with soy milk as resin using furfuraldehyde as cross linking agent. Different composites were fabricated by varying the quantity of jute felt, crosslinking agent and hot compression time and the process parameters were optimized. Mechanical properties of alkali-treated jute felt composites exhibited better tensile properties than those of raw jute felt composites. These biodegradable jute soy composites with comparable mechanical properties can potentially serve as cost-effective eco-friendly alternative to synthetic polymer-based non-biodegradable fiber composites in automobile, furniture and packaging industries.
Using sieving and pretreatment to separate plastics during end-of-life vehicle recycling
Authors: Stagner Jacqueline A , Sagan Barsha , Tam Edwin KL
Published: June 2013

Plastics continue to be a challenge for recovering materials at the end-of-life for vehicles. However, it may be possible to improve the recovery of plastics by exploiting material characteristics, such as shape, or by altering their behavior, such as through temperature changes, in relation to recovery processes and handling. Samples of a 2009 Dodge Challenger front fascia were shredded in a laboratory-scale hammer mill shredder. A 2 × 2 factorial design study was performed to determine the effect of sample shape (flat versus curved) and sample temperature (room temperature versus cryogenic temperature) on the size of the particles exiting from the shredder. It was determined that sample shape does not affect the particle size; however, sample temperature does affect the particle size. At cryogenic temperatures, the distribution of particle sizes is much narrower than at room temperature. Having a more uniform particle size could make recovery of plastic particles, such as these more efficient during the recycling of end-of-life vehicles. Samples of Chrysler minivan headlights were also shredded at room temperature and at cryogenic temperatures. The size of the particles of the two different plastics in the headlights is statistically different both at room temperature and at cryogenic temperature, and the particles are distributed narrowly. The research suggests that incremental changes in end-of-life vehicle processing could be effective in aiding materials recovery.
Fire retardancy of a new polypropylene-grafted starch
Authors: Dupretz Renaud , Fontaine Gaëlle , Bourbigot Serge
Published: June 2013

Reaction to fire of several intumescent Gaialene formulations (Gaialene is a polypropylene-grafted starch) was investigated by mass loss cone calorimeter. Formulations exhibiting promising results were optimized by a design of experiments using mass loss cone calorimeter, UL-94, and limiting oxygen index tests as response. It is shown that melamine-/ammonium polyphosphate–based formulations do not exhibit as good results as ammonium polyphosphate used alone. High performance is observed for 30 wt% ammonium polyphosphate: 60% reduction of the peak heat release rate, high limiting oxygen index (30 vol% O2), and UL-94 V0 ranking at 1.6 mm (V2 at 0.8 mm).
Episodic Migraines in Children
Authors: Shamliyan Tatyana A. , Kane Robert L. , Ramakrishnan Rema , Taylor Frederick R.
Published: June 2013

The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions.
Neurologic Complications Following Pediatric Renal Transplantation
Authors: Ghosh Partha S. , Kwon Charles , Klein Melanie , Corder Julie , Ghosh Debabrata
Published: June 2013

We reviewed neurologic complications after renal transplantation in children over a 20-year period. Neurologic complications were classified as early (within 3 months) and delayed (beyond 3 months). Of 115 children, 10 (8.7%) had complications. Early complications were found in 4.35% of patients: seizures in 4 (posterior reversible leukoencephalopathy syndrome due to immunosuppressant toxicity [2], sepsis/presumed meningitis [1], and indeterminate [1]) and headaches in 1. One patient with seizures received levetiracetam for 6 months and 1 with headaches received amitriptyline prophylaxis. Late complications were noted in 4.35% of patients: seizures in 3 (posterior reversible leukoencephalopathy syndrome due to hypertension [2], hypertensive encephalopathy [1]), headaches in 2, and tremors in 1. Two patients with seizures were treated with anti-epilepsy medications; 1 with migraine received cyproheptadine prophylaxis. Neurologic complications develop in children after renal transplantation. Seizures due to posterior reversible leukoencephalopathy syndrome were the commonest complication. Early detection and appropriate management of these complications is important.
Emotion Recognition in Mild Cognitive Impairment
Authors: McCade Donna , Savage Greg , Guastella Adam , Hickie Ian B. , Lewis Simon J. G. , Naismith Sharon L.
Published: June 2013

Background:

Impaired emotion recognition in dementia is associated with increased patient agitation, behavior management difficulties, and caregiver burden. Emerging evidence supports the presence of very early emotion recognition difficulties in mild cognitive impairment (MCI); however, the relationship between these impairments and psychosocial measures is not yet explored.

Methods:

Emotion recognition abilities of 27 patients with nonamnestic MCI (naMCI), 29 patients with amnestic MCI (aMCI), and 22 control participants were assessed. Self-report measures assessed patient functional disability, while informants rated the degree of burden they experienced.

Results:

Difficulties in recognizing anger was evident in the amnestic subtype. Although both the patient groups reported greater social functioning disability, compared with the controls, a relationship between social dysfunction and anger recognition was evident only for patients with naMCI. A significant association was found between burden and anger recognition in patients with aMCI.

Conclusions:

Impaired emotion recognition abilities impact MCI subtypes differentially. Interventions targeted at patients with MCI, and caregivers are warranted.
Weight Status in Adolescence Is Associated With Later Life Functional Limitations
Authors: Vasunilashorn Sarinnapha , Martinson Melissa L.
Published: June 2013

Objectives:

This study examines the relationship between weight status in adolescence and later life functional limitations.

Method:

We use the Wisconsin Longitudinal Study to characterize the relationship between standardized relative body mass ascertained from high school photograph portraits in 1957 and self-reported functional imitations in 2004.

Results:

Compared to individuals with normal body mass, those who were overweight in high school had poorer later life physical function, with observed gender differences. Women who were underweight in adolescence had better functioning in older adulthood than their normal weight counterparts. This relationship, however, was not found among men.

Conclusions:

These findings underscore the long-term consequences of being overweight in adolescence on the functional disadvantages conferred in late life.
Feasibility of online determination of the quality of 304L stainless steel machined components using acoustic emission
Authors: Ward Charles R , Reuben Robert , Wilkinson Peter , Lamb Julian
Published: June 2013

This article examines the relationships between the quality of a machined component and the non-intrusive measurements that can be made during the manufacturing process. For the purposes of this study, the overall quality of a machined component is defined by the surface finish and any residual stress induced by the machining process. The focus of the work involves turning of difficult-to-machine metals and non-intrusive measurements recorded during machining. These measurements were acoustic emission, cutting forces and cutting insert temperature. An austenitic stainless steel was chosen as a commonly available metal whose high work-hardening rate and ability to strain transform to martensite make it potentially difficult to machine. Tests were carried out under different cutting conditions to promote thermally and mechanically induced residual stress and variations in the surface finish. Analysis of the mean frequency of the acoustic emission signal has made it possible to determine whether thermal or mechanical interactions dominate the machining process. The mean frequency of the machined samples provided evidence of a thermally driven process. This was confirmed by the close relationship between cutting insert temperature and component residual stress. The analysis of low-frequency acoustic emission generated during machining (below 100 kHz) identified poor surface finish derived from vibrations of the cutting insert.
Effect of pulsed electric fields on microbial inactivation and physico-chemical properties of whole porcine blood
Authors: Boulaaba Annika , Egen Nathalie , Klein Günter
Published: June 2013

The objective of this study was to determine the lethal effectiveness of pulsed electric fields on the inactivation of the porcine blood endogenous microflora. Furthermore, the impact of pulsed electric field application on physico-chemical and sensory properties in this medium should be proved. Blood samples from a commercial abattoir in Germany were processed by a continuous pilot plant-pulsed electric field system at electric field strength of 11 kV/cm for treatment times of 163 and 209 µs. The applied pulse frequencies of 134 and 175 Hz correspond to an energy input of 91 and 114 kJ/kg, respectively. In these conditions, the effectiveness of pulsed electric field processing on microbial inactivation was limited: 1.35 log10 CFU/mL reduction of total aerobic plate count ( p < 0.05), 1.0 log10 CFU/mL for Pseudomonas spp. ( p < 0.05), 0.97 and 0.66 log10 CFU/mL reduction for Enterobacteriaceae and sulfite-reducing anaerobic bacteria, respectively. However, the storage experiment (14 days at +3 ℃) showed a significant reduced growth of total aerobic plate count ( p < 0.05) and Pseudomonas spp. ( p < 0.05) in the pulsed electric field-treated blood samples. Pulsed electric field processing leads to a complete hemolysis of the red blood cells, in addition significant decreased L* (lightness), a* (redness) and b* (yellowness) values ( p < 0.0001) were observed. Furthermore, changes in the sensory attributes color (changed from red to dark brown) and odor (changed from fresh to musty and tangy) were noticed.
The influence of fish age, salt level, and MTGase addition on the quality of gels prepared from unwashed mince of Farmed Meagre (Argyrosomus regius)
Authors: Cardoso Carlos , Ribeiro Bernardo , Mendes Rogério
Published: June 2013

The potential of using the unwashed mince of farmed meagre as raw material for the preparation of heat-induced gel products was assessed taking into account the effect of age (small size <1 kg meagre vs commercial size >2 kg meagre), lower salt levels (1.0%, w/w, vs 2.5%, w/w), and microbial transglutaminase (MTGase) incorporation (0.0%, w/w, vs 0.5%, w/w). Heat-induced gel products from >2 kg fish were of superior quality. Salt reduction from 2.5% to 1.0% (w/w) was detrimental for textural quality, particularly, of gels prepared from >2 kg meagre mince. MTGase addition improved texture. Moreover, MTGase incorporation led to a greater importance of non-covalent hydrophobic bonding.
Ultrasonic characterization of the fat source and composition of formulated dry-cured meat products
Authors: Jimenez Edith Corona , García-Pérez Jose Vicente , Canillas Sonia Ventanas , Fort Jose Javier Benedito
Published: June 2013

The aim of this work was to test the feasibility of using ultrasonic measurements to estimate the fat content and identify the fat sources used in formulated dry-cured pork meat products. For that purpose, dry-cured sausages were prepared using different fat sources (two Iberian pork backfats, Iberian lard, and sunflower oil) and contents (fat content from 3% to 17% wet basis) and characterized by measuring the ultrasonic velocity (at 2 ℃, 6 ℃, 10 ℃, 15 ℃, 20 ℃, and 25 ℃), fatty acid profile, thermal behavior, and composition. The fatty acid composition affected the melting behavior of the sausages, which also involved different ultrasonic velocities, depending on the fat source used for the sausage formulation. Significant ( p < 0.05) linear relationships were established between the ultrasonic velocity and the percentage of melted fat, by means of which the sausage batches were differentiated according to the fat source used. The ultrasonic velocity temperature dependence allowed the determination of the fat content (explained variance 96.1%) by measuring the ultrasonic velocity in the dry-cured sausages at 2 ℃ and 25 ℃ and using a semi-empirical equation. Therefore, the ultrasonic measurements could be considered as a reliable tool for the characterization and differentiation of formulated dry-cured meat products with different fat sources and contents.
Pre-harvest treatments of pepper plants with nitrophenolates increase crop yield and enhance nutritive and bioactive compounds in fruits at harvest and during storage
Authors: Valero D , Zapata PJ , Martínez-Romero D , Guillén F , Castillo S , Serrano M
Published: June 2013

Pepper plants ( Capsicum annuum L. cv Lamuyo) were treated with a mix of nitrophenolates either by foliar spray or in the irrigation system, and its effect on crop yield and the content of nutritive and bioactive compounds in fruit were analysed at harvest and after post-harvest storage. Treatments were applied at 2-week intervals from the development of first floral bunch (1 March) to end of August. Pepper fruits were harvested at commercial ripening stage (red surface colour) along the growth cycle (from May to September). Total yield (cumulative kilogram per plant) was increased (≈4.5% more) by nitrophenolate treatments due to significant increases in fruit mass, although the number of fruits per plant was unaffected. Pepper fruit quality (weight, firmness and pericarp thickness), its content in nutritive (sugars and organic acids) and bioactive compounds (vitamin C and total phenolics) and antioxidant activity were also enhanced by nitrophenolate treatments at the three harvested dates assayed (end May, mid July and end August). In addition, all these parameters were maintained at higher levels in treated peppers during storage, while diminutions in these parameters occurred generally in control fruit. Thus, nitrophenolate treatments were able to improve crop yield as well as the nutritional value and antioxidant properties of peppers at harvest and after fruit storage.
Ends of sandwich beams subjected to pure bending. Analysis and design
Authors: Caballero Daniel Fernández , de la Cruz Víctor Rodríguez , Munoz-Guijosa Juan Manuel , Nair Sudhakar
Published: June 2013

Multi-component sandwich panels have emerged in recent years for new engineering and structural uses. These structures have been modeled as large deflections and multi-component sandwich beams subjected to pure bending with its ends with monolithic section. In the case of curved beams subjected to pure bending, a linear distribution has been considered. Different end-section reductions and sandwich–monolithic transitions have been analyzed with a finite element analysis model developed. Finally, the results of the finite element model are validated using an experimental test.
A review of the vibroacoustics of sandwich panels: Models and experiments
Authors: D'Alessandro Vincenzo , Petrone Giuseppe , Franco Francesco , De Rosa Sergio
Published: June 2013

This paper reviews the most significant works in literature about the acoustic behaviour of sandwich panels, starting from the first examples of multi-layered structures, comprising a series of different layers enclosing an air-gap, to the actual configurations in which the opportunities of emerging manufacturing technologies are considered in the design stages. The focus is on presenting an exhaustive list of dedicated and validated models, which are able to predict the sound transmission through sandwich panels according to their specific configuration. Some experimental works, aimed to the model correlations, are reviewed, too.
A relational understanding of sibling experiences of children with rare life-limiting conditions
Authors: Malcolm Cari , Gibson Faith , Adams Sally , Anderson Gillian , Forbat Liz
Published: June 2013

Mucopolysaccharidoses (MPS) and Batten disease are rare life-limiting conditions (LLCs) characterised by progressive and permanent physical and cognitive decline. The impact of such conditions on families, and notably on siblings, has not yet been described or documented. This paper presents data from a UK-wide study that sought to understand the family experience of supporting a child with the rare degenerative LLCs of MPS and Batten disease. The aim of this paper is to report sibling experiences related to these rare degenerative and progressive conditions, in order to inform the future development of supportive interventions. Eight siblings of children with MPS ( n = 7) and Batten Disease ( n = 1) participated in semi-structured qualitative interviews. A card sort technique was utilised to support and engage the children. Siblings are clearly impacted emotionally, pragmatically and relationally by the ill health of another child in the family. The data indicate four key themes which demonstrate impacts on siblings: perceptions of the condition and its symptoms, impact on daily life, emotional consequences and ways of coping. Siblings often had considerable knowledge of the condition and took on important roles in symptom management. However, these experiences were in the context of managing relationships within the family (often protecting parents from an awareness of how much they knew) and relationships at school (including distraction from learning and being bullied by peers). The data highlight how sibling experiences are generated through a combination of negative disability discourses and support through peers and family members. The data indicate how these features shift as a consequence of witnessing the advancement of their brother’s or sister’s condition and the emotional sequelae of disease progression. Exploration of siblings’ experiences of living with such rare progressive and degenerative LLCs suggest the focus of interventions to support this group should address their emotional health and ways to overcome isolation and build connections with other siblings who share their unique experiences. Critically, the data suggest that sibling support should be cognisant of the trajectory of the illness as well as the family, school and peer relational contexts that siblings inhabit.
Diabetes and coronary artery disease in South Asians
Authors: Swaminathan Krishnan , Mathavan Alagarsamy , Jebamani Sharanika
Published: June 2013

South Asians originate from the Indian sub-continent and represent roughly one fifth of the world’s population. This ethnic group contributes to the highest proportion of coronary artery disease (CAD) burden, mainly attributed to the high prevalence of diabetes. However, other established and emerging risk factors are overrepresented in this population at a younger age. Further large scale research is needed to identify various genetic and environmental mechanisms underlying the increased diabetes and vascular risk in the South Asian population. Effective clinical strategies to reduce the risk of diabetes and CAD in the South Asian population are the need of the hour.
High-glucose levels and elastin degradation products accelerate osteogenesis in vascular smooth muscle cells
Authors: Sinha Aditi , Vyavahare Naren R
Published: June 2013

Diabetes mellitus (DM) is a chronic disease in which the body either does not use or produce the glucose metabolising hormone insulin efficiently. Calcification of elastin in the arteries of diabetics is a major predictor of cardiovascular diseases. It has been previously shown that elastin degradation products work synergistically with transforming growth factor-beta 1 (TGF-β1) to induce osteogenesis in vascular smooth muscle cells. In this study, we tested the hypothesis that high concentration of glucose coupled with elastin degradation products and TGF-β1 (a cytokine commonly associated with diabetes) will cause a greater degree of osteogenesis compared to normal vascular cells. Thus, the goal of this study was to analyse the effects of high concentration of glucose, elastin peptides and TGF-β1 on bone-specific markers like alkaline phosphatase (ALP), osteocalcin (OCN) and runt-related transcription factor 2 (RUNX2). We demonstrated using relative gene expression and specific protein assays that elastin degradation products in the presence of high glucose cause the increase in expression of the specific elastin–laminin receptor-1 (ELR-1) and activin receptor-like kinase-5 (ALK-5) present on the surface of the vascular cells, in turn leading to overexpression of typical osteogenic markers like ALP, OCN and RUNX2. Conversely, blocking of ELR-1 and ALK-5 strongly suppressed the expression of the osteogenic proteins. In conclusion, our results indicate that glucose plays an important role in amplifying the osteogenesis induced by elastin peptides and TGF-β1, possibly by activating the ELR-1 and ALK-5 signalling pathways.
A Mixed Methods Approach for Identifying Influence on Public Policy
Authors: Weaver-Hightower Marcus B.
Published: June 2013

Fields from political science to critical education policy studies have long explored power relations in policy processes, showing who influences policy agendas, policy creation, and policy implementation. Yet showing particular actors’ influence on specific points in a policy text remains a methodological challenge. This article presents a five-stage, embedded mixed methods design for establishing influence on educational policy moving from a policy text outward. I use an example analysis of Australia’s policy making on boys’ education—the report Boys: Getting it Right (2002)—to show how data transformation measures, both quantitizing and qualitizing, within a larger qualitative study helped identify influence. This mixed design, I argue, can be useful in other research contexts, with variations for data availability and researcher resources.
Retaining Pharmacists in Rural Canada
Authors: Woodend A. Kirsten , Cooper Janet , Buske Lynda , Marcus Louise , Chauhan Tara S. , Little Lisa , Teperman Lee , Adams Owen
Published: June 2013

Background:

The Multistakeholder Framework of Rurality project was funded by Health Canada's Rural and Remote Health Innovations Initiative. The aim of this project was to develop a tool to assist rural communities with health human resource planning and to help governments and communities in recruiting and retaining health care providers in rural and remote communities.

Methods:

A national survey was sent to nurses, physicians, and pharmacists living in rural or remote communities to determine, among other factors, satisfaction with their personal and professional lives in those communities. One of the questions asked in the survey was “Do you plan to be in practice in the community in two years?”

Results:

Completed surveys were returned by 1019 pharmacists. Pharmacists who were married, had children living at home, were between the ages of 35 and 54 years, and had between 6 and 24 years in practice were more likely to say they would remain in the community. Communities where there were better working hours, better availability of coverage and backup, higher earning potential, and greater opportunities were more likely to retain pharmacists, as were communities where there were better opportunities for family members. Pharmacists were also more likely to state an intention to remain in communities where they had a sense of belonging and a sense of being appreciated. Multivariate predictors of pharmacists' intent to remain were children living at home, professional factors, and personal factors.

Conclusions/Implications:

Despite some study limitations, the results presented here could be used to help communities select pharmacists who are most likely to remain in practice in the communities for longer periods. Community attributes such as distance to large population centres cannot be changed, but attributes that contribute to personal and professional satisfaction could be altered.
On the Front Line of Smoking Cessation: Pharmacists' Practices and Self-Perception
Authors: Brewster Joan M. , Ashley Mary Jane , Laurier Claudine , Dioso Rachel , Victor J. Charles , Ferrence Roberta , Cohen Joanna
Published: June 2013

Background:

Pharmacists can be effective in helping patients to quit smoking, and opportunities for such interaction have been facilitated by legislative change making nicotine replacement therapy (NRT) available without prescription in Canada. However, there are no previous studies of Canadian pharmacists' preparation for, perception of, or practices regarding their roles in smoking cessation.

Methods:

Practising community pharmacists in four Canadian provinces were surveyed about their tobacco-related education and knowledge, practice environment, perceptions of their roles and practices related to helping people quit smoking, and factors perceived to facilitate tobacco-related practice.

Results:

A corrected response rate of 72% was obtained, giving a weighted n of 960 responses. Most pharmacists reported good or excellent knowledge of the health effects of smoking and the use of NRT in smoking cessation. Fewer reported being knowledgeable about behavioural approaches to quitting smoking. Advising patients about NRT was seen as a more important role for pharmacists than giving patients pamphlets or behavioural counselling. Pharmacists' reported practices corresponded to their knowledge and judged importance of roles; pharmacists were not proactive in approaching patients about smoking, but when smokers were identified, pharmacists gave brief advice about the use of NRT. Respondents reported that their smoking cessation practice was facilitated by their own knowledge and skills, patients' interest in quitting, opportunities for patient interaction, and the support of pharmacy management for patient counselling.

Conclusions:

Improving pharmacist education in patient counselling and behavioural approaches to smoking cessation would help to develop skills in initiating discussions about smoking and would give pharmacists a wider range of options to help patients quit smoking.
Corticosteroids and Multiple Sclerosis: To Treat or Not to Treat?
Authors: Namaka Mike , St-Laurent Carol , Vandenbosch Raelene , Gill Ranbir , Ruhlen Dana , Melanson Maria
Published: June 2013

Although a rare disease, multiple sclerosis (MS) has a high prevalence rate in Canada and affects many Canadians and their families. An autoimmune disease of the central nervous system, it results in the destruction of the myelin sheath that surrounds the nerve axons. High-dose IV steroid therapy is often used to treat an acute exacerbation in MS. Steroids have immunosuppressant effects that work to decrease the autoimmune pathology component of the disease and to reduce the inflammation around the nerve axon, thereby promoting closer contact of the damaged myelin and subsequently partially restoring adequate electrical nerve conduction to reduce symptoms.

The high prevalence rate of MS in Canada makes it vital for pharmacists to become more aware of the different aspects of the disease and how these relate to therapy. The pharmacist should be aware of the adverse effects and impact of high-dose IV steroids in MS patients. The purpose of this review is threefold: 1) to provide a better understanding of MS pathology; 2) to contribute a systematic review of steroids; and 3) to assist in the clinical decision-making process and in the counselling requirements for patients on high-dose steroids.
The Roles of Community Pharmacists in Managing Patients with Diabetes: Perceptions of Health Care Professionals in Nova Scotia
Authors: Hartnell Nicole R. , MacKinnon Neil J. , Sketris Ingrid S. , Gass David
Published: June 2013

Background:

Community pharmacists could reduce the clinical and economic burden of diabetes by participating in diabetes management. Pharmacists' roles in collaboration with other health care professionals should be understood before any community pharmacy—based programs focusing on diabetes management are designed and implemented.

Methods:

A sample of primary health care physicians, community pharmacists, and nurses and dieticians from Diabetes Centres in the Capital Health District of Nova Scotia were interviewed on their perceptions of community pharmacists' role in diabetes care. A semistructured format was used. Data were compiled and analyzed descriptively, and are reported here in terms of the roles of community pharmacists in this setting.

Results:

A total of 18 health care professionals were interviewed: 8 (44%) primary health care physicians, 6 (33%) community pharmacists, and 4 (22%) nurses and dieticians. All responses were analyzed, and six general roles for community pharmacists were identified, such as education about drug therapy (83% of respondents), followed by providing information to patients about glucose monitoring and healthy lifestyles (67% of respondents).

Conclusion:

In a pilot project ( n = 18), Nova Scotia health care professionals supported pharmacists' role in diabetic care, such as educating patients about drug therapy.
The Truer Picture of the Continuing Education Preferences of NL Pharmacists: Can We Apply What We Learned to Managing Diseases Such as HIV?
Authors: Mugford Gerry
Published: June 2013

Background:

The treatment of HIV disease is made more complex by rapid changes in disease management. Two primary objectives of this study were to evaluate the continuing education (CE) needs and preferences of pharmacists and to utilize this information to develop CE HIV disease management strategies. Our hypothesis was that current knowledge of HIV disease management is outdated and that CE related to HIV should be delivered in ways that meet the preferences of pharmacists.

Methods:

A 14-page needs assessment (NA) was developed to assess the CE needs and preferences of Newfoundland and Labrador (NL) pharmacists and their knowledge of HIV disease management. The NA was validated by pharmacists, physicians, nurses, and social workers from Memorial University of Newfoundland and the Health Care Corporation of St. John's. Respondents' answers were scored using a six-point Likert scale. Space was available for respondents to provide open answers and opinions related to the questionnaire, CE, and HIV. Piloting and feedback suggested the NA could be completed in 20–30 minutes. The NA was mailed to 470 pharmacists.

Results:

Thirty percent of the pharmacists returned a completed questionnaire. Mean scores (MS) were calculated for specific CE topics. The top three CE topics were: update professional skills (MS = 4.46); current standards of care (MS = 3.9); and professional practice standards (MS = 3.85). CE topics for clinical skills were also highlighted and included pharmacology and therapeutics, infectious disease, and patient education. CE topics specific to HIV included drug interactions, resistance, management of adverse events, opportunistic infections, alternative therapies, HAART therapy, post-exposure prophylaxis, and pregnancy in HIV/AIDS. Most pharmacists (81%) had access to Internet and e-mail (76%). Few respondents had access to teleconference (19%) and videoconference (11%). Pharmacists' preferences for CE delivery times were workday evenings (2–3 hours), weekend half-day, and workday half-day. Conferences, correspondences courses, structured courses, and seminars were the preferred delivery modes.

Conclusions/Implications:

Pharmacists in NL appear to have specific educational needs. Although the study achieved a lower-than-expected response rate, perhaps partly due to its length, most respondents indicated that computer-based technology could enhance the delivery of CE. Continuous, discipline-specific, real-time assessment of educational needs may be essential for optimum management of patients with HIV. It is likely the findings reflect the needs of pharmacists across the country, especially those outside urban areas. The preferences identified in this study could apply to delivering CE for a variety of diseases.
An Assessment of Patient Knowledge and Awareness of Issues Surrounding Cholesterol Risk Management
Authors: Olson Kari L. , Gromnisky Lisa
Published: June 2013

Background:

A lack of patient understanding and awareness of issues surrounding cholesterol risk management may be one reason that a significant number of patients receiving cholesterol-lowering therapy do not achieve optimal cholesterol levels. This study was conducted to assess patients' knowledge and awareness of issues surrounding cholesterol risk management.

Methods:

Community pharmacists within the Edmonton, Alberta, area were identified and asked to recruit patients within their practice who had been receiving cholesterol-lowering therapy for a minimum of six weeks. A 32-question telephone survey was developed and used as the instrument to assess patient knowledge and awareness. All surveys were conducted by the same individual, and data analysis was primarily descriptive.

Results:

Seventeen community pharmacies recruited 136 potential subjects over an eight-week period. Surveys were conducted with 105 (77%) of the eligible subjects. Of those surveyed, 37% identified elevated cholesterol as a risk factor for heart disease. While the majority of respondents felt it important to know their cholesterol targets (82%) and their specific levels (91%), only 23% and 29% of respondents indicated that they knew their high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels, respectively. Gaps in knowledge with respect to cholesterol-lowering therapy also existed.

Conclusions:

The results of this survey indicate gaps in patient knowledge of various issues surrounding cholesterol risk management. Pharmacists are in an excellent position to provide better education to patients about cholesterol levels and cardiovascular disease risk management. Further research is required to determine whether improved patient knowledge leads to improved clinical outcomes.
Barriers to General Practitioner Participation in a Clinical Trial Initiated by Pharmacists
Authors: Bateni Bita , Shalansky Stephen , Simpson Scot
Published: June 2013

Objective:

The purpose of this study was to determine general practitioners' (GPs) reasons for not entering patients into a randomized trial that compared outpatient anticoagulation management by community pharmacists with that of physicians.

Methods:

An anonymous survey was mailed to all GPs who were invited to participate in the anticoagulation study ( n = 118).

Results:

Completed surveys were received from 78/110 (71%) of GPs who had declined to participate in the anticoagulation study. Of those who had consented to participate, 8/8 completed surveys were received. The top-ranked reasons for not entering patients were “pharmacist should accept legal liability” (40%), “concern about other health care professionals taking over physician responsibilities” (33%), and “concern about responsibility for my patients” (29%). Other frequently cited barriers included concern about pharmacists' ability to manage warfarin patients, general issues related to control over patient care decisions, and lack of time. The top-ranked reason for agreeing to participate was the belief that “research advances the profession” (87%). Shortly after this survey, a statement published by the College of Physicians and Surgeons of BC reinforced physicians' concern about legal liability and recommended that physicians avoid referring patients to community pharmacy—based anticoagulation programs.

Conclusion:

Pharmacists who plan to conduct research in the community setting should thoroughly investigate potential barriers to GP involvement in patient recruitment, because of the difficulty in anticipating the most crucial issues. Local physicians may not support pharmacy-based anticoagulation programs, whether or not they are implemented as part of a clinical trial.
Entry-Level PharmD Degree Programs in Canada: Some Facts and Stakeholder Opinions
Authors: Koleba Tamar , Marin Judith G. , Jewesson Peter J.
Published: June 2013

The face of pharmacy education in Canada is about to change radically with the initiation of the first entry-level PharmD (ELPD) degree program in the country. The University of Montreal is planning to replace its 4-year baccalaureate degree program in pharmacy with a 4-year ELPD degree program as its sole professional practice degree for pharmacy, starting as early as fall 2007. Laval University has announced similar intentions and expects to initiate a program as early as 2008. The Universities of Toronto, Alberta, and British Columbia are reported to have ELPD degree programs under consideration, while the remaining 4 faculties of pharmacy across Canada appear to have no immediate plans for conversion. As we move toward a potential nation-wide modification of our entry-to-licensure requirement, a summary of existing programs in Canada and the United States, a preview of some of the characteristics of the University of Montreal's ELPD degree program, and some stakeholder opinions about the merits of such a curriculum conversion are warranted.
Pharmacist Intervention in Risk Reduction Study: High-Risk Cardiac Patients
Authors: Semchuk William , Taylor Jeffrey , Sulz L. , Deschamps M. , Tsuyuki Ross T. , Duffy P. , Wilson T.
Published: June 2013

Objectives:

Although there are guidelines for managing patients at high vascular risk, many people remain undertreated. This community-based study was designed to 1) measure the ability of the pharmacist—physician collaboration to affect a broad array of drug-related endpoints and 2) to compare 2 methods of training community pharmacists to collaborate with physicians on cardiac patient care. This paper focuses on the first outcome, and a companion paper will address the second outcome.

Methods:

We used a before-and-after design to assess pharmacists' ability to affect drug-related endpoints. We identified patients by various methods, one of which was medication profiles. Those providing consent were educated on risk factor modification and encouraged to consult their physicians. Pharmacists subsequently faxed the details of their assessments to the primary care physician, along with suggestions for therapy changes. Our outcome measure was the proportion of patients who achieved a composite of either a dose increase or a new target medication as a result of pharmacist recommendations during the study.

Results:

A total of 61 pharmacists recruited 217 patients, and of these, follow-up was completed on 216. Of the patients for whom a pharmacist made a suggestion, pharmacologic risk reduction therapy was initiated or enhanced in 53.7%.

Conclusion:

This community pharmacist—based program improved utilization of the therapies known to decrease vascular risk in patients considered high risk.