Use of Standardized Patient Simulations to Assess Impact of Motivational Interviewing Training on Social--Emotional Development

The objective of this study was to assess the impact of motivational interviewing (MI) training on students’ social–emotional development. Two simulations using standardized patients (SP) were conducted within a smoking cessation module. Students first completed a 4 h self-study module focused on smoking cessation tools and general counseling techniques. Faculty then administered a 15-item rubric focused on students’ self-assessment of their verbal/non-verbal communication, social–emotional competence and MI skills. Students then participated in a smoking cessation counseling session with an SP. SPs used the same rubric to assess student performance. Teaching assistants (TAs) observed and assessed the students using the same rubric and an additional 22 items related to clinical skills. TAs and SPs then provided feedback on areas of improvement. The following week, students first completed a 3 h self-study module on MI then participated in a different smoking cessation scenario. After completion, the 15-item self-assessment rubric was administered. There was a significant improvement in TA assessed student performance with an average score improvement of 8% (pre-intervention score = 67%; post-intervention mean = 75%). Students had dramatic gains in their self-assessment with their scores rising by an average of 22%. Using MI techniques can improve students’ self-assessed and perceived social–emotional competency

Effectiveness of music interventions to reduce test anxiety in pharmacy students

Background: The main objective of this pilot study was to evaluate the impact of a classroom activity involving music on anxiety associated with preparing for and taking an assessment. Methods: Two hundred and two (202) pharmacy students were randomly assigned to one of two conditions of the experimental study: active music playing (n = 103) versus passive music listening (n = 99). All students completed a pre-test, a mid-test, and a post-test including: an “Attitudes and Perceptions” survey, State-Trait Anxiety Inventory for Adults (STAI Survey), and a knowledge assessment. Data were analyzed to determine the impact each of the music interventions had on students’ test anxiety. Results: Both types of musical interventions produced similar results in terms of anxiety reduction. Faced with an upcoming test prior to the musical intervention, average state-trait anxiety scores increased; after the musical intervention, state-trait anxiety scores decreased. Conclusions: The use of music helped to reduce test anxiety, even after one brief musical intervention, regardless of whether students passively listened to music or actively played music

Training Students on the Pharmacist Patient Care Process using an Electronic Health Record and Simulations

Objective: To measure the impact of an electronic health record (EHR) and simulated physician encounters on student knowledge and skills related to the implementation phase of the Pharmacist Patient Care Process (PPCP). Secondary objectives were to measure students’ self-perceived abilities. Methods: Students enrolled in a therapeutics course worked-up patient cases within an EHR. Students entered orders/ prescriptions into the computerised provider order entry (CPOE) platform. Faculty graded student work using a rubric. Students completed an instructor-developed pre-post attitudes survey and knowledge quiz. Results: Two hundred students participated in this study and worked-up seven cases. Scores ranged from 67.7% to 88.2% on the case work-ups and 78.6% to 91.1% on the order/prescription-entry components. Individual scores on the quiz improved from 15.3/20 to 17.3/20 (p\u3c0.001). Aggregate ratings on the attitudes survey increased from 23.2 to 31.0 (p\u3c0.001). Conclusion: Use of an EHR coupled with simulation was well-received and improved student understanding of the PPCP

Healthcare Provider Utilization and Patient Outcomes: The Call for Enhanced Coordinated Care for Medicare Beneficiaries

Background: The use of complementary and alternative medicine (CAM) and other non-physician health care providers (dentists, optometrists, etc.) has steadily increased in the United States; however, the associated outcomes reported in the Medicare population is limited. Objective: To evaluate the utilization of different healthcare providers by Medicare beneficiaries and assess resultant patient outcomes. Methods: Fourteen outreach events targeting Medicare beneficiaries were conducted throughout Northern/Central California during the 2014 open enrollment period. Trained student pharmacists (working under licensed pharmacist supervision) provided beneficiaries with comprehensive medication therapy management (MTM) services. During each intervention, demographic, quality-of-life, health behavior, and health provider/service utilization data were collected. Results: Of 620 respondents, 525 (84%) and 84 (14%) reported using at least one non-physician healthcare professional or CAM provider, respectively. Beneficiaries who reported using non-physician healthcare providers were significantly (p\u3c0.05) more likely to indicate being ‘very confident’ in managing their chronic health conditions. The number of providers seen with prescriptive authority was correlated with the number of prescription medications taken (rs=0.342, p\u3c0.001). The total number of providers seen was correlated with the number of drug related issues identified (rs= 0.179, p\u3c0.001). Beneficiaries using acupuncturists were significantly (p\u3c0.05) less likely to report having chronic pain. Conclusion: Many beneficiaries have multiple chronic conditions and increasingly utilize a variety of healthcare professionals. As such, bridging the communication chasm between these professionals can improve humanistic outcomes and minimize medication related issues of Medicare beneficiaries. Coordinated care, a key strategy for improving healthcare delivery under the Affordable Care Act, is a step in the right direction

»Programmable« Selective Inexpensive Potentiometric Detector for Flow Injection Analysis. Potassium Determination with a Nafion Membrane Modified Electrode

The study of a nafion membrane (ISE membrane) for the inexpensive potentiometric detection of potassium ion in a flow injection system is reported. The nafion membrane doped with potassium ion showed that excellent selectivity could be achieved for various cations, except for Rb+, and some interference for Cs+. A linear potential response of 10-2 - 10~® M for the potassium ion was obtained with a detection limit of about 0.5 x 10-6 M. This approach can be employed for constructing a potentiometric detector for virtually any cation (soluble at basic pH values) by simply changing the electrode pretreatment (or doping solution)

Cost variability of suggested generic treatment alternatives under the Medicare Part D benefit

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap. OBJECTIVE: To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PDP) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs. METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (ARBs), bisphosphonates, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California PDPs. RESULTS: The highest cost difference between a brand medication and a Centers for Medicare Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and$195.49 at full cost and between $51.37 and$82.35 in the coverage gap. The lowest cost difference varied between $38.45 and$76.93 at full cost and between -$4.11 and$18.52 during the gap. CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications made available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested generic treatment alternatives during the gap is less compelling and will decrease as subsidies increase

A collaborative approach to combining service, teaching, and research

Objective. To describe a faculty-student collaborative model and its outcomes on teaching, service, and scholarship. Design. A Medicare Part D elective course was offered that consisted of classroom and experiential learning where pharmacy students participated in community outreach events to assist Medicare beneficiaries with Part D plan selection. The course training was expanded to include medication therapy management (MTM) and the administration of immunizations. At the completion of the course, students collaborated with faculty members on research endeavors. Evaluation. During the first 6 years of this course, the class size more than doubled from 20 to 42 students, and all students participating in the course met the IPPE requirements for community outreach. Over that same period, the number of beneficiaries receiving assistance with their Part D plan grew from 72 to 610; and with the help of students starting in 2011, faculty members had 28 poster presentations at national conferences, 7 invited podium presentations at national/international meetings, and published 8 manuscripts in peer-reviewed journals. Conclusion. Through collaborative efforts, this model took an elective course and provided classroom and experiential learning for students, needed health services for the community, and opportunities to pursue wide ranging research projects for faculty members and students

Medicare Part D Plan Optimization: The Need for an Annual Check-Up

Background: Since its inception, Medicare Part D requires beneficiaries to choose from a myriad of insurance plans in order to receive prescription drug coverage. Moreover, each year beneficiaries are confronted with plan cancellations, new plan offerings, changes in existing plan formularies and cost-sharing structure. Objective: This study prospectively examined the relationship between stand-alone prescription drug plan (PDP) costs, subsidy status, and the number of plans offered in California from 2009-2012. Methods: Forty-one community outreach events were held throughout Central/Northern California during the Medicare Part D annual election periods from 2008-2011. In total, 1,578 beneficiaries were assisted, 983 (62.2%) of whom had a PDP. During each intervention, beneficiary subsidy status, cost data for the beneficiary\u27s current plan and lowest cost plan for the upcoming year were recorded from the Medicare website. The percent of beneficiaries that did not need to switch plans to reduce their out-of-pocket (OOP) drug costs was compared to the number of available plans in the subsequent year.Results: On average, 14.3-23.7% of beneficiaries would have been enrolled in the lowest cost plan in the upcoming year had they remained in their current plan. Subsidy recipients were significantly more likely to be in the lowest cost plan each year. The chance of being in the lowest cost plan was significantly negatively correlated to the number of drug plans offered in the subsequent year. Conclusion: Annual Part D plan reexamination is essential to ensure that beneficiaries optimize their prescription medication coverage and minimize their OOP costs

Jean-François Kosta-Théfaine, Le Chant de la douleur dans les poésies de Christine de Pizan

Cet essai propose un examen du thème de la douleur dans les poésies de Christine de Pizan. On sait combien le deuil marque l’œuvre de Christine et est la clé de voûte de son entrée en écriture. Deuil triple en quelque sorte avec la disparition première du roi modèle, Charles V, puis du père Thomas de Bologne, enfin de l’époux, Étienne du Castel. Peu à peu s’effondre la stabilité matérielle de Christine et, selon ce qu’elle dit, son univers affectif, puisque – fait rare à l’époque – elle prése..

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed