Investigating the impact of a clinical pharmacist on the health outcomes of a paediatric pharmacists

Background: Recent fiscal scrutiny and changes in health care financing have necessitated that health care providers justify a clinical and economical basis for their involvement in patient care. Although clinical pharmacists have been shown to enhance patient health outcomes and reduce costs among adult patients, the impact of a pharmacist in paediatric patient care has not been extensively documented. Method: A team of pharmacists was established to conduct a systematic review of the literature. A title scan of papers in 5 databases was performed by 14 pharmacists using the MeSH terms Pharmacists, Medical Intervention, Paediatrics and Cost-Benefit Analysis. The underpinning research question was: "How do the professional activities of a clinical pharmacist impact the health outcomes of paediatric in-patients?" The abstracts of suitable titles were scanned and articles were read to assess relevance. Relevant articles were then evaluated independently by at least two members of the team, using critical appraisal tools suitable for quantitative, qualitative or systematic review studies. Results: The initial search identified 327 citations which after full text review and application of the scoring tool, resulted in 12 studies included in the systematic review. The average number of interventions reported varied from study to study. Dosing recommendations, pharmacokinetics and drug allergy alerts were the most commonly recorded interventions by pharmacists for a paediatric population. Evidence from this review will be used to formulate improvements to in-patient paediatric care. Conclusion: Clinical pharmacists have a positive impact on inpatient paediatric care

The OSCE in a pre-registration osteopathy program: Introduction and psychometric properties

Objective To investigate the psychometric properties of the objective structured clinical examination (OSCE) conducted in the final year of a pre-professional osteopathy program. A variety of metrics are used to determine the reliability and validity of the examination. Methods Data from the OSCE conducted in 2011 was collated and analysed to establish the pass/fail rates, cost of the examination, internal consistency, and variance components. The examination was conducted over two days with students completing 5 stations on day 1 and 4 stations on day 2. Each station was of 15 min duration and there were 2 examiners per station. Results Forty-eight students and 31 examiners were involved in the examination. Twenty-six students failed at least one station with six students failing three or more stations. Cronbach's alpha was greater than 0.80 for all stations indicating that each is internally consistent and over 50% of the variance in the students' total score for a station was due to the students themselves. The total cost of conducting the examination was $AUD12,933.20. Conclusion The results of the study suggest that the OSCE format is an appropriate method for assessing clinical competency in osteopathic education. The OSCE should be used in conjunction with other forms of assessment to develop and overall picture of the students' clinical competency. Some modifications to the format of the assessment are required to improve the examination and these will be the subject of further studies

Concert recording 2017-05-04b

[Track 1]. Fanfare for the common man / Aaron Copland -- [Track 2]. Bach Buch / J.S. Bach translated by Pann -- [Track 3]. Highway musings / Ryan Key -- [Track 4]. Serenade in D minor / Antonín Dvorák

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

<p>Abstract</p> <p>Background</p> <p>End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.</p> <p>Methods</p> <p>Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.</p> <p>Results</p> <p>Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.</p> <p>Conclusions</p> <p>The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.</p

"Imagined guilt” versus “recollected guilt”: Implications for fMRI

Guilt is thought to maintain social harmony by motivating reparation (Haidt, 2003; Trivers, 1971). The present study compared two methodologies commonly used to identify the neural correlates of guilt. The first, imagined guilt, requires participants to read hypothetical scenarios and then imagine themselves as the protagonist. The second, recollected guilt, requires participants to reflect on times they personally experienced guilt. In the fMRI scanner, participants were presented with guilt/neutral memories and guilt/neutral hypothetical scenarios. Contrasts confirmed a priori predictions that guilt memories, relative to guilt scenarios, were associated with significantly greater activity in regions associated with affect (ACC, Basal GangliaCaudate, Insular, OFC) and social cognition (TP, precuneus). Similarly, results indicated that guilt memories, relative to neutral memories, were also associated with greater activity in affective (ACC, amygdala, Insular, OFC) and social cognition (mPFC, TP, precuneus, TPJ) regions. There were no significant differences between guilt hypothetical scenarios and neutral hypothetical scenarios in either affective or social cognition regions. The importance of distinguishing between different guilt inductions inside the scanner are discussed. We offer explanations of our results and discuss ideas for future research

Long-Lived Ames Dwarf Mice Are Resistant to Chemical Stressors

To probe the connection between longevity and stress resistance, we compared the sensitivity of Ames long-lived dwarf mice and control littermates with paraquat, diquat, and dobutamine. In young adult animals, 95% of male and 39% of female controls died after paraquat administration, but no dwarf animals died. When the experiment was repeated at an older age or a higher dosage of paraquat, dwarf mice still showed greater resistance. Dwarf mice also were more resistant to diquat; 80% of male and 60% of female controls died compared with 40% and 20% of dwarf mice, despite greater sensitivity of dwarf liver to diquat. Dwarf mice were also less sensitive to dobutamine-induced cardiac stress and had lower levels of liver and lung F2-isoprostanes. This is the first direct in vivo evidence that long-lived Ames dwarf mice have enhanced resistance to chemical insult, particularly oxidative stressors