Heart rate recovery after constant-load exercise tests is decreased in proportion to the importance (severity and diffusion) of exercise-induced lower-limb ischaemia

BACKGROUND: Conditions that may influence heart rate recovery at 1 min of recovery from exercise (HRR1: end-exercise heart rate minus heart rate 1 min after exercise) are not fully understood. We hypothesized that the \u27importance\u27 (both local severity and regional diffusion) of peripheral skeletal muscle ischaemia is associated with low HRR1. DESIGN AND METHODS: In 529 patients with suspected or confirmed peripheral vascular disease not receiving beta-blockers (61.4 +/- 11.3 years old), we retrospectively studied the relationship of HRR1 to exercise-induced changes in transcutaneous oxygen DROP index (limb changes minus chest changes from rest). The sum of DROP indices observed on both calves and both buttocks (DROPtot) provides the unique opportunity to estimate both the severity and the diffusion of exercise-induced ischaemia on the right and left side simultaneously. It was used during a constant-load treadmill test (3.2 km h(-1) ; 10% grade) to classify patients in quartiles, the fourth quartile representing the more \u27important\u27 ischaemias.RESULTS: There was an inverse relationship between quartiles of DROPtot and HRR1, even after adjustment for heart rate reserve (Delta HR: end-exercise minus resting heart rate), age (60 years), gender, body mass index, treadmill maximal walking distance and ankle brachial index: adjusted R = 0.629; P<0.0001. CONCLUSIONS: During constant-load treadmill testing, DROPtot, an index of the \u27importance\u27 of exercise-induced lower-limb ischaemia, correlates with HRR1. Whether HRR1 is improved in proportion of DROPtot improvement in patients undergoing surgery or rehabilitation for peripheral artery disease is a fascinating issue for future studies

Objective determination of the predefined duration of a constant-load diagnostic tests in arterial claudication

OBJECTIVE: The predefined duration to arbitrarily stop the tests during constant-load treadmill exercise is a subject of debate and widely variable in the literature. We hypothesized that the upper and lower limits for predefined durations of constant-load 3.2 km/hour 10% grade tests could be derived from the distribution of walking distances observed on a treadmill in a population of subjects referred for claudication or from the optimal cutoff point distance on a treadmill to confirm a limitation self-reported by history.METHODS: We conducted a retrospective analysis using a referral center, institutional practice, and ambulatory patients. We studied 1290 patients (86% male), 62.1 +/- 11.2 years of age, 169 +/- 8 cm height, 75.7 +/- 14.2 kg weight. Patients performed a standard constant-load treadmill test: 3.2 km hour(-1), 10% slope, maximized to 1000 meters (approximately 20 minutes). We analyzed the maximal walking distance self-reported (MWD(SR)) by history and the maximal walking distance measured on the treadmill (MWD(TT)). Patients reporting MWD(SR) >or=1000 meters were considered unlimited by history. RESULTS: Only 197 patients (15.3%) completed the 20-minute treadmill test. Among the 504 patients who did not stop before 250 meters, 47.8% stopped within the next 250 meters (were unable to walk 500 meters). This proportion falls to 7.5% among the 213 patients who did not stop before 750 meters. When the final goal was to estimate whether the treadmill test can discriminate patients with or without limitation by history, area under the receiver operating characteristic (ROC) curve was 0.809 +/- 0.016 (95% confidence interval [CI], 0.778-0.841; P < .0001), the best diagnostic performance was attained for an MWD(TT) of 299 meters (approximately 6.15 minutes). CONCLUSION: In patients undergoing constant-load treadmill exercise with a protocol of 3.2 km hour(-1) and 10% slope: a predefined duration of 7 minutes could be proposed as a lower limit for the predefined duration of the tests specifically if one aims at confirming the limitation by history with treadmill testing. Owing to the low risk that patients that could walk 750 meters (approximately 15 minutes) will have to stop in the next 250 meters, 15 minutes seems a reasonable upper limit for the predefined test duration in clinical routine

THE FINGERPRINT OF THE HUMAN GASTROINTESTINAL TRACT MICROBIOTA: A HYPOTHESIS OF MOLECULAR MAPPING

The precise etiology of Inflammatory Bowel Disease (IBD) remains unclear and several factors are believed to play a role in its development and progression, including the composition of microbial communities resident in the gastrointestinal tract. Human intestinal microbiota are extensive with at least 15.000-36.000 bacterial species. However, thanks to the new development in sequencing and molecular taxonomic methodologies, our understanding of the microbiota population composition, dynamics, and ecology has greatly increased. Intestinal microbiota play a critical role in the maintenance of the host intestinal barrier homeostasis, while dysbiosis, which involves reduction in the microbiome diversity, can lead to progression of the inflammatory disorders, such as IBD and colorectal cancer. It is hypothesized that fingerprinting characterization of the microbiota community composition is the first step in the study of this complex bacterial ecosystem and a crucial step in the targeted therapy. Molecular fingerprinting of human gastrointestinal tract microbiota could be performed by different techniques including the semi quantitation, 16srRNA, the DNA-microarray as well as other relatively new methods which were developed to study many complex bacterial ecosystem. These techniques provide individual data of the human intestinal microbiota and provide estimation of the relative presence of the microbial target groups within each individual. such personalized information serves as a remarkable and unprecedented opportunity to improve targeted medical treatment and probably develop strategies to prfevent disease

Descriptive assessment of graduates' perceptions of pharmacy-related competencies based on the Lebanese pharmacy core competencies framework

Background: Pharmacists possess a unique and complex body of knowledge, skills, attitudes, and behaviors necessary to enable them to optimize health outcomes. Pharmacy organizations publish routinely updated versions of professional competencies that help pharmacy schools integrate advances into their curricula. In Lebanon, no national framework for pharmacy education is officially adopted yet. In 2017, the Official Pharmacists’ Association in Lebanon [OPL - Order of Pharmacists of Lebanon] took the initiative to develop a pharmacy core competency framework. Objective: The primary objective of this survey was to evaluate graduates' perceptions of pharmacy-related competencies “taught” across Lebanese pharmacy schools/faculties, based on the suggested Lebanese Pharmacy Competencies Framework. This study also explored the association between graduates' demographics, university attributes, and self-assessed competency performance. Methods: A cross-sectional study involving pharmacists who graduated from Lebanese universities was performed through a 40-minute online questionnaire distributed over social media platforms and groups of pharmacists. Results: Pharmacists perceived their competence as moderate upon graduation, the lowest scores being in fundamental knowledge and medicine supply; the highest reported scores were in personal skills and safe/rational use of medicines. Moreover, females, younger graduates, PharmD holders, and pharmacists working in hospitals/clinical settings and academia had the highest perception of their competencies. Pharmacists in the public sector and medical laboratory directors had the lowest perception of competence. Conclusions: When comparing the taught curriculum to the suggested Lebanese Pharmacy Competency Framework, all domains need to be improved to optimize the perception, education, and practice of pharmacists. It is essential to emphasize fundamental knowledge, medicines supply, and public health competencies in undergraduate curricula and improve continuing professional education

Lebanese community-based pharmacists’ interest, practice, knowledge, and barriers towards pharmacy practice research: A cross-sectional study

Objective: To assess the interest, knowledge, practice and barriers of Lebanese community-based pharmacists towards research, and to examine factors associated with interest. Methods: A cross-sectional survey, conducted between January and May 2017, enrolled community pharmacists using a proportionate random sample of community pharmacies in the five districts of Lebanon, using the list of pharmacies provided by the Lebanese Order of Pharmacists. In the absence of validated questionnaires to answer our objectives, we created a questionnaire based on previous research. The questionnaire was modified based on the experiences and issues raised during focus groups with research active pharmacists and research oriented community pharmacists. Results: A total of 399 pharmacists was enrolled. The results showed that 231 (72%) were conscious about the important role of research in the community pharmacy setting whereas only 5.6% considered it not important. Over two-thirds (68.5%) of the pharmacists declared being interested in participating in research. There was a statistical difference in the percentage of correct answers between auto-declared and corrected responses for all terms, with all p < 0.001.The most reported barrier was lack of time during hours of work (90.9%), followed by the lack of pharmacy staff (73.7%), lack of financial resources (68.9%), patient’s lack of education and resistance to participation (64.8%), and lack of support (63.8%). Age (aOR = 0.92), years of experience (aOR = 1.06), and having been involved in research (aOR = 3.17) were associated with higher interest in research. Having studied in Lebanon (aOR = 3.63), having received previous research courses (aOR = 11.12) and being interested in research (aOR = 2.74) were associated with having participated in research projects during their professional experience. Conclusion: Lebanese pharmacists have the good will to conduct and participate in research, but are lacking knowledge; this issue needs to be addressed vividly. Addressing the identified barriers could improve the research output of Lebanese community pharmacists. Keywords: Barriers, Community pharmacist, Interest, Knowledge, Researc

Pharmacy education and workforce: strategic recommendations based on expert consensus in Lebanon

Abstract Pharmacy in Lebanon has been taught for years, and the profession has known the golden ages in previous years. However, with the recent graduation of hundreds of pharmacists, without prior workforce planning, the oversupply of non-specialized pharmacists caused a mismatch with the needs of the market. The context of severe socioeconomic and sanitary crises has further exacerbated the situation, with hundreds of pharmacists leaving the country. A group of pharmacy experts joined to suggest strategic solutions to face such challenges, suggesting a clear strategy for education and the workforce, overarched by educational and professional values and based on six main pillars: (1) implement a national competency framework (including the core and specialized competency frameworks) to be used as a basis for licensure (colloquium); (2) implement a national pharmacy program accreditation, encompassing standards related to competencies adoption and assessment, curricula, teaching methods, research and innovation, instructors’ and preceptors’ skills, and experiential training; (3) organize training for students and early-career pharmacists; (4) optimize continuing education and implement continuous professional development, fostering innovation and specialization among working pharmacists; (5) develop and implement a pharmacy workforce strategy based on pharmacy intelligence, job market, and academic capacities; (6) develop and implement a legal framework for the above-mentioned pillars in collaboration with ministries and parliamentary commissions. Under the auspices of the relevant authorities, mainly the Order of Pharmacists of Lebanon and the Ministry of Education and Higher Education, the suggested strategy should be discussed and implemented for a better future for the pharmacy profession

The association of management and leadership competencies with work satisfaction among pharmacists in Lebanon

Abstract Background Pharmacists are at the core of the healthcare system and are the most accessible healthcare professionals. Their new roles involve leadership skills, among others. Work satisfaction of pharmacists might affect the quality of the services they provide. Hence, the primary objective of this study was to evaluate the management/leadership skills and work satisfaction of pharmacists and working pharmacy students. The secondary objective was to establish the relationship between management/leadership competencies and work satisfaction. Methods This cross-sectional study enrolled 415 Lebanese pharmacists and fifth-year pharmacy students (undergraduates) working in different pharmacy sectors across Lebanon from August 2021 through October 2021 using the snowball sampling technique and validated tools to assess management/leadership competencies and work satisfaction. Results Management/leadership competencies were significantly correlated with work satisfaction (B = 0.288) and inversely associated with being engaged/married (B = − 2.825) and living outside Beirut or Mount Lebanon (B = − 1.873). Pharmacy students did not significantly differ in their leadership/management level from graduate pharmacists. Work satisfaction was significantly associated with management/leadership competencies (B = 0.062) and inversely related to education level (B = − 0.644). Conclusions Pharmacists’ work satisfaction and management/leadership competencies are interrelated, although the level of satisfaction seemed lower than the declared level of competencies. These concepts are differentially affected by personal and work-related characteristics. More efforts should be exerted to improve both the satisfaction and management/leadership competencies of pharmacists in Lebanon

The effect of research on the perceived quality of teaching: a cross-sectional study among university students in Lebanon

Abstract Introduction The complementarity between research and teaching is still debated, although several higher education institutions require instructors to do research. In the absence of a consensus on this matter and given the lack of related studies in Lebanon, this study aimed to describe students’ perception of research integration into teaching, and to link research and professional skills to quality teaching, using validated scales related to these concepts. Methods A standardized questionnaire was diffused to university students; it included validated scales: the Student Perception of Research Integration Questionnaire (SPRIQ), the Adapted-Teachers’ quality assessment questionnaire (A-TQAQ), the Student Evaluation of Teaching short form (SET37-QS), and Knowledge and Attitudes Towards Health Research Questionnaire. Results Research integration was well perceived, and teaching was well evaluated by 445 participants from various disciplines, particularly those of a higher socioeconomic level, majoring in health, and females, as indicated by their mean scores. Research-active instructors had a significantly better-perceived teaching quality (17%; p < 0.001) than their non-active counterparts. This finding was particularly true among postgraduate and higher GPA students. The multivariable analysis showed that the knowledge and attitude towards research were related to students’ better perception of research integration and higher evaluation of teaching. Conclusion This study showed an overall good perception of research and teaching evaluation among participants from various disciplines, with research-active instructors having a better-perceived teaching quality. These findings could guide decisions on research integration into curricula using multidisciplinary methodologies to strengthen research integration and involve students in research activities

Descriptive assessment of graduates' perceptions of pharmacy-related competencies based on the Lebanese pharmacy core competencies framework

Background : Pharmacists possess a unique and complex body of knowledge, skills, attitudes, and behaviors necessary to enable them to optimize health outcomes. Pharmacy organizations publish routinely updated versions of professional competenc ies that help pharmacy schools integrate advances into their curricula. In Lebanon, no national framework for pharmacy education is officia lly adopted yet. In 2017, the Official Pharmacists’ Association in Lebanon [OPL - Order of Pharmacists of Lebanon] t ook the initiative to develop a pharmacy core competency framework. Objective : The primary objective of this survey was to evaluate graduates' perceptions of pharmacy - related competencies “taught” across Lebanese pharmacy schools/faculties, based on the s uggested Lebanese Pharmacy Competencies Framework. This study also explored the association between graduates' demographics, university attributes, and self - assessed competency performance. Methods : A cross - sectional study involving pharmacists who gradua ted from Lebanese universities was performed through a 40 - minute online questionnaire distributed over social media platforms and groups of pharmacists. Results : Pharmacists perceived their competence as moderate upon graduation, the lowest scores being i n fundamental knowledge and medicine supply; the highest reported scores were in personal skills and safe/rational use of medicines. Moreover, female s, younger graduates, PharmD holders, and pharmacists working in hospitals/clinical settings and academia h ad the highest perception of their competencies. Pharmacists in the public sector and medical laboratory directors had the lowest perception of competence . Conclusions : When comparing the taught curriculum to the suggested Lebanese Pharmacy Competency Fra mework, all domains need to be improved to optimize the perception, education, and practice of pharmacists. It is essential to emphasize fundamental knowledge, medicines supply, and public health competencies in undergraduate curricula and improve continui ng professional educatio

LYCOPENE AND PROSTATE CANCER: AN OVERVIEW

Prostate cancer is one of the most common cancers in the world. Its pathogenesis is multifactorial and is linked to risk factors such as age, diet, cigarette smoking, family history and the onset of oxidative stress. In recent times, therefore, we are investigating the use of antioxidants as a primary and tertuary prevention of prostate cancer. Numerous studies in the literature focused on lycopene, a molecule belonging to the family of carotenoids that is commonly foud in tomatoes and products derived from it. The literature analyzed in the last two years shows how lycopene inhibits different mecchanism linked to carcinogenesis and tumor progression. However, there are still many points to be clarified the real antitumoral capacity of this substance