Connecting the dots in pharmacy education: The FIP International Pharmaceutical Federation Global Competency Framework for Educators and Trainers in Pharmacy (FIP-GCFE)

The FIP (International Pharmaceutical Federation) Global Competency Framework for Educators and Trainers in Pharmacy (FIP-GCFE) is an ongoing project of the Academic Pharmacy Section of FIP in cooperation and collaboration with Sections, Special Interest Groups and Working Groups across the Federation. It was developed by a group of experts in pharmaceutical education to enable and promote the continuing professional development of pharmacists and pharmaceutical scientists who plan to advance their competence as educators and trainers in pharmacy and the pharmaceutical sciences, whether in a formal or informal context, and at all levels of education and professional development. The FIP-GCFE will be an essential resource for multiple stakeholders including individual educators, faculties of pharmacy, and accreditation agencies. This article presents the introductory text of the GCFE first version, connecting previously launched concepts and tools and explaining the integration with all other FIP workforce support frameworks, to provide a holistic approach to global workforce development

Stripping the Boss : The Powerful Role of Humor in the Egyptian Revolution 2011

The Egyptian Revolution 2011 has shaken the Arab world and stirred up Middle-East politics. Moreover, it caused a rush in political science and the neighboring disciplines, which had not predicted an event like this and now have troubles explaining it. While many things can be learned from the popular uprising, and from the limitations of previous scholarship, our focus will be on a moral resource, which has occasionally been noticed, but not sufficiently explored: the role of humor in keeping up the spirit of the Revolution. For eighteen days, protestors persevered at Liberation Square in Central Cairo, the epicenter of resistance; at times a few dozens, at times hundreds of thousands. What they did was to fight the terror of the regime, which reached absurd peaks during those days, with humor – successfully. We offer a social-functionalist account of the uprising, which includes behavioral as well as cultural levels of analysis, and illuminates how humorous means helped to achieve deadly serious goals. By reconstructing how Egyptians laughed themselves into democracy, we outline a social psychology of resistance, which uses humor both as a sword and a shield.Peer reviewe

Association of Anticholinergic burden with adverse effects in older people with Intellectual Disabilities in Ireland: An observational cross-sectional study

Background:Older people with intellectual disabilities (ID) receive anticholinergic drugs but no studies to date have investigated cumulative anticholinergic exposure and its effects in adults with ID. Aim: To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. Methods A modified Anticholinergic Cognitive Burden scale (ACB) was calculated for a representative cohort of 736 people over 40 years with intellectual disabilities, and associations with demographic and clinical factors assessed. Results Age over 65 years was associated with higher exposure (ACB 1-4- OR 3?28; 95% CI 1?49-7?28, ACB 5+- OR 3?08; 95% CI 1?20-7?63), as was a mental health condition (ACB 1-4- OR 9?79; 95% CI 5?63-17?02, ACB 5+- OR 23?74; 95% CI 12?29-45?83). Day time drowsiness was associated with higher ACB (p<0?001) and chronic constipation reported more frequently (26?6% ACB 5+ vs 7?5% ACB 0) (p<0?001). Conclusions Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation

The Use of Proton Pump Inhibitors Among Older Adults with Intellectual Disability: A Cross Sectional Observational Study.

Background: Older people with Intellectual Disability (ID) have a high prevalence of gastrointestinal conditions such as Gastro-Oesophageal Reflux Disease (GORD). However, despite this, information about treatment, in particular the use of Proton Pump Inhibitors (PPIs), in this population is sparse and limited. Objective: To investigate the prevalence and pattern of PPI use among older people with ID. Method: Data on PPI use and key demographics was analysed from Wave 2 (2013/2014) of IDS-TILDA, a nationally representative longitudinal study of 677 participants aged 40 years and above in Ireland. Descriptive statistics, bivariate analyses and binary logistic regression were carried out. Results: Just over a quarter, 27.9% (n = 189), of participants reported use of PPIs, and 53.4% (n = 101) were female. The largest proportion of PPI users (53.4%) were aged between 50 and 64 yrs. Most of the PPIs were used in maximum doses (66.7%). However only 43.9% of PPI users had an indication for PPI use (GORD, stomach ulcer or/and an NSAID use), and further 13.2% were also taking an antiplatelet agent. Use among those in residential care homes (54.3%) was much higher than for those living independently or with family (7%). PPI use among those who have severe/profound ID was 25% higher than those with mild ID. Information about the length of PPI use was missing for 31.2%, but of those with data, just over half recorded using the PPIs for more than a year. Apart from an indication, the factors associated with PPI use were older ages (over 50 years), severe/profound level of ID. Conclusion: PPI use among older people with intellectual disability is prevalent and frequently long term, often without a clear indication. PPI use especially among those with severe/profound ID and those who live in residential care homes, could predispose these individuals to additional comorbidities and in order to avoid inappropriate long term of use regular review is required

Drug Burden Index to Define the Burden of Medicines in Older Adults with Intellectual Disabilities: An Observational Cross-Sectional Study

Aims: The drug burden index (DBI) is a dose?related measure of anticholinergic and sedative drug exposure. This cross?sectional study described DBI in older adults with intellectual disabilities (ID) and the most frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. Methods: This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS?TILDA), a representative study on the ageing of people with ID in Ireland. Self? and objectively?reported data were collected on medication use and physical health, including health conditions. The Barthel index was the physical function measure. Results: The study examined 677 individuals with ID, of whom 644 (95.1%) reported taking medication and 78.6% (n = 532) were exposed to medication with anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high DBI score (?1). Adjusted multivariate regression analysis revealed no significant association between DBI score and daytime dozing, constipation or falls. After adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that challenge, history of falls), DBI was associated with significantly higher dependence in the Barthel index (P = 0.002). Conclusions: This is the first time DBI has been described in older adults with ID. Scores were much higher than those observed in the general population and higher scores were associated with higher dependence in Barthel index activities of daily living

Psychotropic medicines’ prevalence, patterns and effects on cognitive and physical function in older adults with intellectual disability in Ireland: longitudinal cohort study, 2009–2020

Background The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring. Aims To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Method Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar–Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants’ characteristics and health outcomes. Results Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2–64.2%) and psychotropic polypharmacy (42.7–38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6–44.6%). A significant decrease was observed for anxiolytics (26.8–17.6%; P &lt; 0.001) and hypnotics/sedatives (14.1–9.0%; P &lt; 0.05). A significant increase was recorded for antidepressants (28.6–35.8%; P &lt; 0.001) and mood-stabilising agents (11.5–14.6%; P &lt; 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21–2.69; P &lt; 0.05). Conclusions The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm. </jats:sec

Nudge in the clinical consultation: an acceptable form of medical paternalism?

Background: Libertarian paternalism is a concept derived from cognitive psychology and behavioural science. It is behind policies that frame information in such a way as to encourage individuals to make choices which are in their best interests, while maintaining their freedom of choice. Clinicians may view their clinical consultations as far removed from the realms of cognitive psychology but on closer examination there are a number of striking similarities. Discussion. Evidence has shown that decision making is prone to bias and not necessarily rational or logical, particularly during ill health. Clinicians will usually have an opinion about what course of action represents the patient's best interests and thus may "frame" information in a way which "nudges" patients into making choices which are considered likely to maximise their welfare. This may be viewed as interfering with patient autonomy and constitute medical paternalism and appear in direct opposition to the tenets of modern practice. However, we argue that clinicians have a responsibility to try and correct "reasoning failure" in patients. Some compromise between patient autonomy and medical paternalism is justified on these grounds and transparency of how these techniques may be used should be promoted. Summary. Overall the extremes of autonomy and paternalism are not compatible in a responsive, responsible and moral health care environment, and thus some compromise of these values is unavoidable. Nudge techniques are widely used in policy making and we demonstrate how they can be applied in shared medical decision making. Whether or not this is ethically sound is a matter of continued debate but health care professionals cannot avoid the fact they are likely to be using nudge within clinical consultations. Acknowledgment of this will lead to greater self-awareness, reflection and provide further avenues for debate on the art and science of clinical communication