Identifying and evaluating foundation and advanced pharmacy practice competencies in a global context

The expertise of the health professionals involved in care delivery influences the overall quality of care provided in the health sector. Empirical evidence demonstrates that when the competencies that are essential for practice are identified, compiled to form a framework, and used alongside standards of practice: it aids expertise development and fosters improvement of professional performance. This research aimed to identify and evaluate foundation and advanced level pharmacy practice competencies. Its objective was to validate the FIP Global Competency Framework (GbCF v1) as a mapping tool for use in the development of country-specific pharmacy practice frameworks in the African region. Its second objective was to evaluate the competencies that are essential for global advanced pharmacy practice. An online cross-sectional survey of pharmacists from fourteen African countries (n=469) demonstrates that 90% of the foundation level competencies contained in the GbCF v1 are relevant to practice. This validates the GbCF v1 as a mapping tool that can be used to develop country-specific frameworks for early career practitioners in the selected countries. A systematic literature review and content analysis of two national frameworks identified 64 competencies and 237 behaviours for advanced pharmacy practice. An expert panel review (n= 14) developed consensus on these competencies via a modified Delphi technique. Based on consensus, 89.5% of the identified behaviours were similar between the two frameworks. A crossover mapping experiment involving advanced practitioners (n=42) from four countries showed within-subject agreement for matching competencies in the frameworks. This agreement was significant for 84% of the competencies (k ≥ 0.25; p ≤ 0.05). Semi structured interviews of advanced practitioners (n=17) indicates the identified competencies were all relevant to practice. General consensus on similarity between the two frameworks was also obtained from the interviews. This demonstrates the existence of a core set of competencies applicable to advanced pharmacy practitioners from different countries. It provides evidence of the feasibility of defining the competencies essential for global advanced pharmacy practice. The research reported in this thesis provides evidence that was previously lacking on the validity of the Global Competency Framework in specific countries in Africa. It also provides preliminary data on the competencies that are required for global advanced pharmacy practice. Overall, these findings provide valuable insights that can be developed through further research to serve as a driver for global policy.

ABO phenotypes and malaria related outcomes in mothers and babies in The Gambia: a role for histo-blood groups in placental malaria?

BACKGROUND: Host susceptibility to P.falciparum is critical for understanding malaria in pregnancy, its consequences for the mother and baby, and for improving malaria control in pregnant women. Yet host genetic factors which could influence placental malaria risk are little studied and there are no reports of the role of blood group polymorphisms on pregnancy outcomes in malaria endemic areas. This study analyses the association between ABO blood group phenotypes in relation to placental malaria pathology. METHODS: A total of 198 mother/child pairs delivering in Banjul and the Kombo-St Mary District (The Gambia) were analysed. ABO blood group was measured by agglutination. Placental malaria parasites wee enumerated and the presence of malaria pigment noted. Birth anthropometry was recorded and placental weight. Maternal and infant haemoglobin was measured. RESULTS: 89 (45%) subjects were primiparae and 110 (55%)multiparae. The ABO phenotype distribution was 38(A), 52(B), 6(AB) and 102(O). Placental histo-pathology showed active placental malaria in 74 (37%), past infection in 42 (21%) and no infection in 82 cases (41%). In primiparae blood group O was associated with a higher risk of active infection (OR = 2.99; 95% CI = 1.24–7.25), and a lower risk of past infection (OR = 0.31, 0.10–1.01, p < 0.05). In multiparae the O phenotype was associated with reduced prevalence of active or past placental infection (OR = 0.45; 95% CI 0.21–0.98). The mean feto-placental weight ratio was significantly higher in multiparae with group O women compared to non-O phenotypes (5.74 vs 5.36; p = 0.04). Among primiparae with active placental infection, mean birth weight was higher in children of mothers with the O phenotype (p = 0.04). CONCLUSION: These results indicate that blood group O was significantly associated with increased placental malaria infection in primiparae and reduced risk of infection in multiparae. This parity related susceptibility was not present with other ABO phenotypes. Cell surface glycans, such as ABO and related antigens have special relevance in reproductive biology and could modulate specific cell interactions as those associated with the pathogenesis of placental malaria

Comparison of the concentration of glycated haemoglobin in the diabetic and hypertensive-diabetic patients

A total of 150 patients were divided into four groups. The groups were; A, normal subjects; (the control group); B, hypertensive group; C, the diabetic group. Group C was farther divided into two subgroups, the insulin dependent diabetes mellitus (IDDM–diabetics) and the non-insulin dependent diabetes mellitus (NIDDM–diabetics). The last group, (group D) consisted of hypertensive–diabetics patients. This group was also divided into two subgroups, the hypertensive–IDDM patients and the hypertensive–NIDDM patients. Blood samples were collected from each patient in each group for the estimation of the fasting blood sugar levels and the levels of glycated haemoglobin (HbAic). Results showed marked elevated blood sugar levels in the diabetic and hypertensive-diabetic groups. The levels of glycated haemoglobin followed a similar trend, showing about 10.9% and 5.6% (% control) increases in IDDM and NIDDM diabetics respectively (p < 0. 05 in both cases). In the hypertensive - diabetic group, the increases were 13.0% and 15.2% (%control) in the IDDM and NIDDM subgroups respectively. There was no significant increase in blood sugar and glycated haemolobin levels in the hypertensive group. Correlation analysis showed that there is a good or positive correlation between the fasting blood sugar and the level of haempglobin glycation in the hypertensive–diabetic and diabetics patients. This relationship was linear but was weaker in the NIDDM than the IDDM of both the diabetic and the hypertensive-diabetic patients. Such a relationship did not appear to exist in patients suffering from hypertension. The increase in haemoglobin glycation level was more in the hypertensive-diabetics than the non-hypertensive diabetics. From the results, we suggest that there is a good and positive correlation between the fasting blood sugar level and the level of haemoglobin glycation in the diabetic and hypertensive–diabetics. That the haemoglobin glycation was more in the hypertensive–diabetics than the non-hypertensive diabetics provides an insight into the severe complications seen in hypertensive-diabetic patients. Keywords: Blood sugar, glycated haemoglobin, diabetics, hypertensive-diabetics, positive correlation Nigerian Journal of Health and Biomedical Sciences Vol. 5 (2) 2006: 45-5

Antimicrobial Properties of the Dark Variety of Lasianthera africana(Obubit editan) Leaf Extracts on Some Clinical Isolates

No Abstract

Risk Factors Associated With Oral Cavity Colonization By Candida Albicans, Among Immunosuppressed Persons In Uyo, South South Nigeria

No Abstract

The Activities of NADH-MethB Reductase and Glucose-6 – Phosphate Dehydrogenase (G-6-Pd) in the Red Cells of Malaria Patients

The activities of NADH-MetHB reductase and G-6-PD were investigated in malaria patients in Calabar, Nigeria. Seventy malaria patients were selected for this study. Sixty-two age, sex – matched apparently healthy children were used as controls. Ages of subjects ranged from 6 months to 12 years (Mean = 5±1.3 years). Blood samples were collected from the patients before the commencement of treatment. The controls were confirmed to be malaria parasite negative. Blood samples were examined for the presence and type of malaria parasite. Plasmodium falciparum was the commonest infection encountered. NADH-MetHB reductase activity in malaria patients was 46% of the activity in controls. This indicates a lower enzyme activity in malaria patients than in controls (

Compound presentation in labour: highlighting the importance of skilled attendants at birth

Objective: To describe the occurrence of compound presentation in labour, as an obstetric emergency.Background: Compound presentation is a rare obstetric event, defined as the presentation of the hand or foot alongside the head or breech. It places both mother and baby at severe risk. The presence of skilled attendants at birth is crucial to prevent maternal and neonatal morbidity and mortalityCase Report: A 28 year old G4P3A3 presented to the labour ward with a history of drainage of liquour of twelve hours duration. Examination revealed the foetal hand and arm presenting alongside the head. Emergency Caesarean Section was performed with favourable outcome for both mother and baby.Conclusion: This case clearly illustrates the importance of skilled attendants at birth and Advanced life support for Obstetrics (ALSO) in reducing maternal and perinatal morbidity and mortality

Hypertension enhances haemoglobin glycation in diabetics

No Abstract

A Review of Recent Advances in HLA and Tissue Typing

Human Leukocyte Antigens (HLA) are alloantigens which make up the major histo-compatibility complex in man. They are known to play major roles in the pathogenesis and development of cancer and some infectious diseases. They are also responsible for graft rejection. HLA testing has useful applications in forensic medicine, paternity testing and immuno-genetics. This review looks at recent advances in HLA and tissue typing. Biological methods, monoclonal antibody typing procedure, serology, flow cytometry and isoelectric focusing are discussed. It is concluded that molecular biological methods are the best in spite of the few limitations. Mary Slessor Journal of Medicine Vol.3(2) 2003: 5-1

Antihypertensive Agents Cause Unfavourable Changes in the Serum Cholesterol Profile of Nigerian Hypertensive Patients

Lowering blood pressure by treatment prevents renal and cerebrovascular complications in most hypertensives, but does not substantially protect against coronary heart disease (CHD). This study investigated serum lipid changes in hypertensive patients which may predispose the patients to CHD. Serum total and high density lipoprotein (HDL) cholesterol of 130 hypertensives who had been treated for at least 5 years with various agents, and those of 130 age and sex-matched controls were assayed using cholesterol and HDL kits from Randox. The ratio of HDL cholesterol to total cholesterol (HDLC/TC) was calculated for each subject. HDLC/TC ratios of hypertensives were plotted against systolic and diastolic blood pressures, and the tension factor defined as the product of the two blood pressures. Hypertensive subjects had significantly (P < 0.001) higher TC and lower HDCL (P < 0.01) than normotensives, irrespective of the drugs used for their treatment. Female hypertensives had identical TC to their male counterparts but their mean HDCL was significantly higher than those of the males (P < 0.05). HDLC/TC ratios were lower in hypertensives and showed strong negative correlation with systolic blood pressure (r = -0.48; P < 0.05), diastolic blood pressure, (r = -0.79; P < 0.001), and tension factor (r = -0.64; P < 0.01). It is concluded that most anti-hypertensives alter the distribution of cholesterol in lipoprotein fractions in Nigeria patients. Key words: cholesterol, hypertension, CHD risk, anti-hypertensive agents Journal of Medical Laboratory Sciences Vol.12(1) 2003: 32-4