Perceived patient-pharmacist communication and diabetes management: Assessing medication adherence among older patients

With 50% of patients in North America not taking their medications as they should (Brown & Bussell, 2011), a better understanding of medication adherence among older patients could be helpful to health professionals and service providers. The purpose of this study was to examine whether the perceived pharmacist-patient quality of communication is associated with diabetes medication adherence. Eighty-four older adults from the Primary Care Diabetes Support Program were recruited. Diabetes medication adherence and pharmacist-patient quality of communication were measured using self-report questionnaires. No significant correlation was found between medication adherence and perceived pharmacist-patient quality of communication. Results indicated a significant correlation between medication adherence and the number of years the patient had been diagnosed with diabetes (r=-0.233), as well as the number of medications the patient took (r=-0.284). Patients diagnosed with diabetes for a longer time and patients taking both injections and pills reported to be less adherent

Exploring the Perspectives of Older Adults and Health Care Providers on Patient Participation in Transitional Care from Hospital to Cardiac Rehabilitation during the COVID-19 Pandemic

Older adults who transition from hospital to cardiac rehabilitation settings often are vulnerable and at risk of experiencing adverse health care outcomes. Given the complexities of transitional care, it is crucial to engage older adults in the clinical decision-making process and to promote their active participation in their medical care. Older adults have unique ways of understanding their participation in the transitional care process. Gaining an in-depth understanding of their specific needs during this process can help inform clinical practice and interventions aiming to improve care for older adults living with cardiovascular disease. Focused ethnography methodology was used to explore the perspectives of older adults and health care providers on patient participation in transitional care from hospital to cardiac rehabilitation. The study also sought to identify and to gain a better and more in-depth understanding of the challenges and opportunities that shape participation for older adults during transitional care from hospital to cardiac rehabilitation. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers from cardiac rehabilitation and cardiology units. Additional methods included document analysis and reflexive journaling. Thematic analysis revealed six themes and fifteen subthemes. Themes included: Follow-up from Healthcare Provides, Interactions with Healthcare Providers, Support from Family Members, Information about Medical Care and Rehabilitation, Decision-Making and Participation, and Healthcare Journey during COVID-19. Older adults reported gaps in follow-up and insufficient spaces or opportunities for participation in decision-making. Healthcare provider’s support was reported as essential for a smooth transition, particularly nurses’ support. The COVID-19 pandemic was mostly reported as a major barrier for participants, especially in terms of delayed medical procedures and difficult hospitalization experiences. Some participants, particularly those who seek social connection, viewed technology and virtual care negatively. However, virtual care delivery also was reported as a fruitful strategy to engage older adults in their care and to overcome transportation barriers. The results of this study can help inform the implementation of strategies that will engage older adults more actively in their care, as they transition from hospital to cardiac rehabilitation settings

Interdisciplinary Health Care Evaluation Instruments: A Review of Psychometric Evidence.

Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After excluding duplicates and irrelevant articles, 15 articles met the inclusion criteria for full assessment. Seven surveys were validated and most frequently identified in the literature. This review aims to facilitate the selection of instruments that are most appropriate for research and clinical practice. More research is required to develop surveys that better reflect the current reality of teamwork in our evolving health system, including a greater consideration for patient as team members. Additionally, more research is needed to encompass an increasing development of team assessment tools

Comparing Individual Versus Team Decision-Making Using Simulated Exercises in a Master of Public Health Program

In line with the complex modern health care system and the increasing importance of interprofessional teams, a powerful strategy to facilitate the acquisition of essential teamwork skills and expose students to complex decision-making processes is learning in teams. The purpose of our study was to obtain empirical evidence of superior decision-making by teams versus individuals in two simulated decision-making exercises conducted 4 months apart. We collected quantitative data from three cohorts of Master of Public Health students to determine if teams make better decisions than individuals (“team effect”) between September and January. Students completed simulated emergency survival exercises requiring them to make correct decisions individually and then as teams. Decision quality was determined by comparison to survival experts’ decisions. We calculated the “team effect” as the gain or loss of mean individual versus group scores across 10 learning teams per cohort for fall and winter exercises. All three cohorts had a consistently small average team effect in September and a much larger team effect in January. Our study showed consistent improvements in decision-making after students had worked in teams for 4 months. Overall, this study demonstrates the potential benefit of incorporating team learning into a public health curriculum and the importance of strategies to teach teamwork in health education. Using simulation in health education and promoting team learning activities can help prepare students for interprofessional collaboration, a part of the demanding public health landscape. These results might help convince students of the benefits of teamwork, facilitate collaborative decision-making, and enhance the learning experience

Clima social familiar y habilidades sociales en liberados de un establecimiento post penitenciario - Chiclayo

La presente investigación tuvo como objetivo determinar la relación entre Clima Social Familiar y Habilidades Sociales, en los liberados de un establecimiento post penitenciario de Chiclayo, 2012. Para lograr el objetivo propuesto se aplicaron dos instrumentos psicológicos a 55 internos, dichos instrumentos permitieron medir las variables mencionadas, la escala de Clima Social Familiar (Moos & Trickeet, 1974) teniendo una validez y confiabilidad que fluctúa entre 0.88 a 0.91 y la Escala de Habilidades Sociales (Gismero, 2000), el cual tiene una validez y confiabilidad de 0.88. Con la realización de la investigación se pudo establecer relación significativa entre la Dimensión Estabilidad del Clima Social Familiar y el factor decir no y cortar interacciones de la Escala de las Habilidades Sociales (p<0.05).Tesi

Local Anesthetics in Odontology

Pain has been a faithful companion of human beings and is a result of most of the dental procedures and illness; therefore a good control of dental pain is inevitable and feasible. The administration of local anesthetics has come to be the standard of care of dental profession. All local anesthetics are effective and high safety margin in all patients including childhood. The choice of using a local anesthetic depends on time of the surgical procedure, patient’s medical history, and the interaction between local anesthetics and patient usual medications. The use of vasoconstrictors is priority in surgical/dental bleeding, but it must be used with caution in patients with cardiovascular disease to avoid a dental catastrophe. Dentists should be experts in dental-anesthetic techniques and in pharmacology of local anesthetics, since they are the most used medications in odontology. The accidental injection or a high absorption of local anesthetics in blood results in systemic toxicity. In such situation sedation, stunning, diplopia, sensory disturbances, disorientation, muscles spasm, respiratory depression, seizures, or cardiac arrest may be present; the dentist must immediately recognize this clinical complication to stablish an early treatment

D'Pasadita S.A : Minisuper drive - THRU - 24hrs

Seminario Desarrollo de Emprendedores. 2011. Carrera Administración de Empresas. Docente MAE. Vegacruz, Carlos.Minisúper con un servicio de drive thru. Este contará con todos los productos básicos y de mayor consumo, como también productos farmacéuticos elementales y materiales de librería que necesiten los consumidores. Posee pantallas digitales para que el cliente seleccione el producto que desea consumir, donde también estará reflejado el precio, las ofertas y otros datos principales. Cuenta con servicio de 24 horas, los 7 días de la semana. Tiene 2 cajas rápidas (dos para hacer pedidos, dos cajas de cobro y 2 cajas para la entrega del pedido). Está ubicado en el Km. 6 ½ Carretera a Masaya, contiguo a Movistar. El sitio elegido posee tres vías para posibles accesos

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication