Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research.

CONTEXT AND BACKGROUND: People and health systems worldwide face serious challenges due to shifting disease demographics, rising population demands and weaknesses in healthcare provision, including capacity shortages and lack of impact of healthcare services. These multiple challenges, linked with the global push to achieve universal health coverage, have made apparent the importance of investing in workforce development to improve population health and economic well-being. In relation to medicines, health systems face challenges in terms of access to needed medicines, optimising medicines use and reducing risk. In 2017, the International Pharmaceutical Federation (FIP) published global policy on workforce development ('the Nanjing Statements') that describe an envisioned future for professional education and training. The documents make clear that expanding the pharmacy workforce benefits patients, and continually improving education and training produces better clinical outcomes. AIMS AND PURPOSE: The opportunities for harnessing new technologies in pharmacy practice have been relatively ignored. This paper presents a conceptual framework for analysing production methods, productivity and technology in pharmacy practice that differentiates between dispensing and pharmaceutical care services. We outline a framework that may be employed to study the relationship between pharmacy practice and productivity, shaped by educational and technological inputs. METHOD AND RESULTS: The analysis is performed from the point of view of health systems economics. In relation to pharmaceutical care (patient-oriented practice), pharmacists are service providers; however, their primary purpose is not to deliver consultations, but to maximise the quantum of health gain they secure. Our analysis demonstrates that 'technology shock' is clearly beneficial compared with orthodox notions of productivity or incremental gain implementations. Additionally, the whole process of providing professional services using 'pharmaceutical care technologies' is governed by local institutional frames, suggesting that activities may be structured differently in different places and countries. DISCUSSION AND CONCLUSION: Addressing problems with medication use with the development of a pharmaceutical workforce that is sufficient in quantity and competence is a long-term issue. As a result of this analysis, there emerges a challenge about the profession's relationship with existing and emerging technical innovations. Our novel framework is designed to facilitate policy, education and research by providing an analytical approach to service delivery. By using this approach, the profession could develop examples of good practice in both developed and developing countries worldwide

Fumonisins affect the intestinal microbial homeostasis in broiler chickens, predisposing to necrotic enteritis

Fumonisins (FBs) are mycotoxins produced by Fusarium fungi. This study aimed to investigate the effect of these feed contaminants on the intestinal morphology and microbiota composition, and to evaluate whether FBs predispose broilers to necrotic enteritis. One-day-old broiler chicks were divided into a group fed a control diet, and a group fed a FBs contaminated diet (18.6 mg FB1+ FB2/kg feed). A significant increase in the plasma sphinganine/sphingosine ratio in the FBs-treated group (0.21 +/- 0.016) compared to the control (0.14 +/- 0.014) indicated disturbance of the sphingolipid biosynthesis. Furthermore, villus height and crypt depth of the ileum was significantly reduced by FBs. Denaturing gradient gel electrophoresis showed a shift in the microbiota composition in the ileum in the FBs group compared to the control. A reduced presence of low-GC containing operational taxonomic units in ileal digesta of birds exposed to FBs was demonstrated, and identified as a reduced abundance of Candidatus Savagella and Lactobaccilus spp. Quantification of total Clostridium perfringens in these ileal samples, previous to experimental infection, using cpa gene (alpha toxin) quantification by qPCR showed an increase in C. perfringens in chickens fed a FBs contaminated diet compared to control (7.5 +/- 0.30 versus 6.3 +/- 0.24 log10 copies/g intestinal content). After C. perfringens challenge, a higher percentage of birds developed subclinical necrotic enteritis in the group fed a FBs contaminated diet as compared to the control (44.9 +/- 2.22% versus 29.8 +/- 5.46%)

PENERAPAN SANKSI PIDANA PENJARA MINIMUM OLEH HAKIM PENGADILAN NEGERI SUMBAWA BESAR DALAM TINDAK PIDANA KORUPSI

In the criminal justice system occupies a central position. This is because the decision on the punishment would have broad consequences, both directly relating to criminal and society at large. Moreover, if the criminal decision by both academics and practitioners community deemed inappropriate, it will cause a reaction that controversial, because the truth in this case is relatively dependent nature of which looked at. The problem in this research is whether the legal consequences of court decisions in criminal cases of corruption that does not comply with the provisions of the Corruption Act and whether remedies taken against the verdict in corruption case that does not comply with the Corruption Act. This study used the type of research with statute approach and conceptual approach. Legal materials used are of primary law materials and secondary legal materials. The results explain that the legal consequence of a court decision that does not comply with the provisions of the Corruption Act could not be justified, the decision is null and void, meaning that the decision is deemed not exist or the decision has no legal effect. Remedy against the decision that is not appropriate is the public prosecutor filed an appeal in the Supreme Court as the ordinary remedy, although in those cases that are used as a reference should file an ordinary law, namely an appeal to the Court of Appeal and Cassation at the Supreme Court, because the judge's decision that there is a perception of a deliberate and judges use the principle of freedom in deciding the case excessive

ASUHAN KEPERAWATAN GANGGUAN INTEGRITAS KULIT PADA PASIEN DIABETES MELLITUS DI RSUD KARDINAH KOTA TEGAL

Latar Belakang : Diabetes mellitus tetap menjadi masalah kesehatan dunia. Pravalensi diabetes mellitus terus meningkat diseluruh dunia, termasuk juga di Indonesia. Diabetes mellitus termasuk dalam golongan penyakit metabolik yang ditandai dengan adanya hiperglikemia, yang terjadi karena kelainan sekresi insulin, kelainan kerja insulin, atau kedua-duanya. Kadar gula darah tinggi jangka panjang pada pasien diabetes dapat menyebabkan berbagai komplikasi jika tidak ditangani dengan baik. Komplikasi yang sering terjadi pada penderita DM antara lain kelainan vaskuler, retinopati, nefropati, neuropati dan ulkus kaki diabetik. Ulkus kaki diabetik termasuk golongan luka kronis yang sulit untuk disembuhkan. Kerusakan jaringan yang terjadi pada ulkus kaki diabetik disebabkan oleh sistem saraf kaki (neuropati) dan penyakit vaskuler pada tungkai.Tujuan : Karya tulis ini bertujuan untuk menggambarkan Asuhan Keperawatan Gangguan Integritas Kulit Pada Pasien Diabetes Mellitus di RSUD Kardinah Kota Tegal. Metoda : metode yang digunakan dalam memberikan asuhan keperawatan dengan menggunakan metode deskriptif dengan pendekatan studi kasus dan menggunakan proses pendekatan keperawatan convenience sampling method (non-probability sampling technique), yaitu subjek dipilih karena keinginan peneliti. Hasil : setelah dilakukan asuhan keperawatan selama 3x24 jam hasil studi kasus untuk keperawatan yaitu masalah teratasi sebagian dengan memberikan perawatan luka dan edukasi tentang perawatan luka secara mandiriKesimpulan : pengetahuan tentang perawatan luka dan perawatan luka pada pasien yang diberikan sesuai asuhan keperawatan mengalami perubahan dan perbaikan jaringan pada luka.Background : Fixed diabetes mellitus Becomes problem health world . The prevalence of diabetes mellitus continues increase throughout the world , including also in Indonesia. Diabetes mellitus includes in group disease marked metabolic _ with existence hyperglycemia , which occurs because abnormality insulin secretion , abnormalities insulin action , or both . Sugar level blood tall period long on diabetic patients can cause various complications if no handled with good . Frequent complications _ occur on DM patients , including abnormalities vascular , retinopathy , nephropathy , neuropathy and diabetic foot ulcer . Diabetic foot ulcer including group wound difficult chronic _ for healed . Damage network happening _ on diabetic foot ulcer caused by system nerves of the feet ( neuropathy ) and disease vascular on limbs Purpose : This paper aims to describe the Nursing Care of Skin Integrity Disorders in Diabetes Mellitus Patients at Kardinah Hospital, Tegal City.Method: the method used in providing nursing care using a descriptive method with a case study approach and using a convenience sampling method (non-probability sampling technique) nursing approach. that is the subject chosen because of desire researcher .Results: after nursing care for 3x24 hours the results of the case study for nursing were the problem was partially resolved by providing wound care and education about wound care independentlyConclusion: knowledge about wound care and wound care in patients who were given according to nursing care experienced changes and tissue repair in wounds

ASUHAN KEPERAWATAN GANGGUAN RASA NYAMAN NYERI PADA PASIEN POST OP APENDIKTOMI DI RSUD KARDINAH KOTA TEGAL

ABSTRAK Latar belakang : Apendisitis merupakan penyakit peradangan pada usus yang mempunyai kecenderungan progresif dan dapat mengalami perforasi. Namun, Perforasi jarang terjadi dalam 8 jam pertama, observasi aman untuk dilakukan dalam masa tersebut. Tanda-tanda terjadinya perforasi meliputi meningkatnya nyeri, spasme otot dinding perut kuadran kanan bawah dengan tanda peritonitis umum atau abses yang terlokalisasi, ileus, demam, malaise, dan leukositosis semakin jelas. Biasanya akan dilakukan tindakan operasi apendiktomi, apendiktomi sendiri merupakan pengobatan melalui prosedur tindakan operasi hanya untuk penyakit apendisitis atau penyingkiran atau pengangkatan usus buntu yang terinfeksi. Apendiktomi dilakukan sesegera mungkin untuk menurunkan risiko perforasi lebih lanjut seperti peritonitis maupun abses.Tujuan : Mengetahui gambaran tentang asuhan keperawatan nyeri pada pasien post operasi apendiktomi di RSUD Kardinah Kota Tegal.Metoda : Metode yang digunakan dalam memberikan asuhan keperawatan mengguanakan metode penelitian deskriptif yaitu melalui pendekatan asuhan keperawatan melalui pengkajian, penegakkan diagnosa, perencanaan, implementasi, dan evaluasi keperawatan. Penelitian ini meliputi 2 pasien sebagai partisipan di RSUD Kardinah Kota Tegal.Hasil : Hasil studi kasus keperawatan yaitu masalah teratasi, dengan kriteria hasil tercapai setelah dilakukan tindakan keperawatan selama 3x24 jam

De Novo Mutations Affecting the Catalytic Cα Subunit of PP2A (PPP2CA) Cause Syndromic Intellectual Disability Resembling Other PP2A-Related Neurodevelopmental Disorders.

Type 2A protein phosphatases (PP2As) are highly expressed in the brain and regulate neuronal signaling by catalyzing phospho-Ser/Thr dephosphorylations in diverse substrates. PP2A holoenzymes comprise catalytic C-, scaffolding A-, and regulatory B-type subunits, which determine substrate specificity and physiological function. Interestingly, de novo mutations in genes encoding A- and B-type subunits have recently been implicated in intellectual disability (ID) and developmental delay (DD). We now report 16 individuals with mild to profound ID and DD and a de novo mutation in PPP2CA, encoding the catalytic Cα subunit. Other frequently observed features were severe language delay (71%), hypotonia (69%), epilepsy (63%), and brain abnormalities such as ventriculomegaly and a small corpus callosum (67%). Behavioral problems, including autism spectrum disorders, were reported in 47% of individuals, and three individuals had a congenital heart defect. PPP2CA de novo mutations included a partial gene deletion, a frameshift, three nonsense mutations, a single amino acid duplication, a recurrent mutation, and eight non-recurrent missense mutations. Functional studies showed complete PP2A dysfunction in four individuals with seemingly milder ID, hinting at haploinsufficiency. Ten other individuals showed mutation-specific biochemical distortions, including poor expression, altered binding to the A subunit and specific B-type subunits, and impaired phosphatase activity and C-terminal methylation. Four were suspected to have a dominant-negative mechanism, which correlated with severe ID. Two missense variants affecting the same residue largely behaved as wild-type in our functional assays. Overall, we found that pathogenic PPP2CA variants impair PP2A-B56(δ) functionality, suggesting that PP2A-related neurodevelopmental disorders constitute functionally converging ID syndromes.status: publishe