Postgraduate Year 1 Pharmacy Residency Accreditation Requirements and Challenges

The residency accreditation process can be a stress-inducing experience to many program directors. In 2014, the postgraduate year 1 (PGY1) pharmacy residency accreditation standards were updated from the previous 2005 version. The new standards were formulated to streamline program requirements with the intention of creating a more transparent accreditation process.1 The American Society of Health- System Pharmacists (ASHP) is the accrediting body for PGY1 residencies, PGY1 community pharmacy residencies, PGY1 residencies in managed care pharmacy, and PGY2 pharmacy residency programs in advanced practice areas. ASHP provides many resources to help programs to prepare for and navigate through the accreditation process [https://www.ashp.org/Professional-Development/Residency-Information/ Residency-Program-Directors]. Additionally, new Guidance Documents have been created for the PGY1 residency standards as well as the new competency areas, goals and objectives.2,3 The guidance documents aim to clarify the expectations of each standard and the manner in which it will be surveyed. However, during site visits and feedback from program directors, some common areas of the standards continue to be challenging for programs. Recently, ASHP released their bi-annual Communique’ newsletter for Spring 2016 [https://www.ashp.org/professional-development/residency-information/residencyprogram- directors/communique-newsletter].3 The Communique’ highlights common standards that are cited during accreditation visits. We will review some of these commonly cited standards as well as others that are often noted during site visits as being challenging to programs and provide some tips on how to navigate them

Detecting relic gravitational radiation from string cosmology with LIGO

A characteristic spectrum of relic gravitational radiation is produced by a period of ``stringy inflation" in the early universe. This spectrum is unusual, because the energy-density rises rapidly with frequency. We show that correlation experiments with the two gravitational wave detectors being built for the Laser Interferometric Gravitational Observatory (LIGO) could detect this relic radiation, for certain ranges of the parameters that characterize the underlying string cosmology model.Comment: 6 pages, 5 eps figures, Revte

Relating gravitational wave constraints from primordial nucleosynthesis, pulsar timing, laser interferometers, and the CMB: implications for the early universe

We derive a general master equation relating the gravitational-wave observables r and Omega_gw(f). Here r is the tensor-to-scalar ratio, constrained by cosmic-microwave-background (CMB) experiments; and Omega_gw(f) is the energy spectrum of primordial gravitational-waves, constrained e.g. by pulsar-timing measurements, laser-interferometer experiments, and Big Bang Nucleosynthesis (BBN). Differentiating the master equation yields a new expression for the tilt d(ln Omega_gw(f))/d(ln f). The relationship between r and Omega_gw(f) depends sensitively on the uncertain physics of the early universe, and we show that this uncertainty may be encapsulated (in a model-independent way) by two quantities: w_hat(f) and nt_hat(f), where nt_hat(f) is a certain logarithmic average over nt(k) (the primordial tensor spectral index); and w_hat(f) is a certain logarithmic average over w_tilde(a) (the effective equation-of-state in the early universe, after horizon re-entry). Here the effective equation-of-state parameter w_tilde(a) is a combination of the ordinary equation-of-state parameter w(a) and the bulk viscosity zeta(a). Thus, by comparing constraints on r and Omega_gw(f), one can obtain (remarkably tight) constraints in the [w_hat(f), nt_hat(f)] plane. In particular, this is the best way to constrain (or detect) the presence of a ``stiff'' energy component (with w > 1/3) in the early universe, prior to BBN. Finally, although most of our analysis does not assume inflation, we point out that if CMB experiments detect a non-zero value for r, then we will immediately obtain (as a free by-product) a new upper bound w_hat < 0.55 on the logarithmically averaged effective equation-of-state parameter during the ``primordial dark age'' between the end of inflation and the start of BBN.Comment: v1: 12 + 6 pages (main text + appendices), 7 figures; v2: fonts fixed in figure

Collaborative Pharmacy Practice: An Update

Collaborative practice among health professionals is slowly coming of age, given the global focus on efficiency and effectiveness of care to achieve positive patient outcomes and to reduce the economic burden of fragmented care. Collaborative pharmacy practice (CPP) is accordingly evolving within different models including: disease management, medication therapy management, patient centered medical home, and accountable care organizations. Pharmacist roles in these models relate to drug therapy management and include therapy introduction, adjustment, or discontinuation, patient counseling and education, and identification, resolution, and prevention of problems leading to drug interactions and adverse reactions. Most forms of CPP occur with physicians in various settings. Collaborative practice agreements exist in many states in the US and are mentioned in the International Pharmaceutical Federation policy statement. Impetus for CPP comes from health system and economic concerns, as well as from a regulatory push. There are positive examples in community, ambulatory care, and inpatient settings that have well documented protocols, indicators of care, and measurement and reporting of clinical, economic, and patient reported outcomes; however, implementation of the practice is still not widespread. Conceptual and implementation challenges include health professional training, attitudes, confidence and comfort levels, power and communication issues, logistic barriers of time, workload, proximity, resistance to establish and adopt regulations, and importantly, payment models. Some of the attitudinal and perceptual challenges can be mitigated by incorporation of interprofessional concepts and practice in health profession education. Other challenges need to be addressed across health systems, given the inefficiencies and problems that arise from lack of communication and coordination of patient care including medication nonadherence, errors and patient safety, complexity of compounded health problems, and potential liability. The existing evidence needs to be examined to address some challenges and improve infrastructure for CPP

Avaliação do paciente com artrite

Arthritis are clinical manifestations of plenty of diseases. Its etiological classification is many times difficult and depends on careful clinical history and physical examination. Gout and skeptical arthritis presents commonly as acute monoarthritis and reactional arthritis are often polyarticular. Hospitalar admission is a risk factor to the development of reactional arthritis, crisis of gout and septical arthritis.Early diagnosis is imperative to start early treatment, symptom relief and articular function preservation.Synovial fluid aspiration and its analysis are of critical diagnostic importance in cases of acute monoarthritis.Artrites são manifestações clínicas de uma série de doenças. Sua classificação etiológica é muitas vezes difícil e depende de história clínica e exame físico cuidadosos. Artrite séptica e gota se apresentam mais comumente como monoartrite aguda e quadros reacionais são geralmente poliarticulares. A internação hospitalar é fator de risco para o desenvolvimento tanto de artrites reacionais quanto para crises de gota e artrite séptica. O diagnóstico precoce é muito importante a fim de iniciar o tratamento precocemente, alívio dos sintomas e preservação da funcionalidade articular. A punção do líquido sinovial e sua análise são de fundamental importância diagnóstica nos quadros de monoartrite aguda

Thermal history of the plasma and high-frequency gravitons

Possible deviations from a radiation-dominated evolution, occurring prior the synthesis of light nuclei, impacted on the spectral energy density of high-frequency gravitons. For a systematic scrutiny of this situation, the $\Lambda$CDM paradigm must be complemented by (at least two) physical parameters describing, respectively, a threshold frequency and a slope. The supplementary frequency scale sets the lower border of a high-frequency domain where the spectral energy grows with a slope which depends, predominantly, upon the total sound speed of the plasma right after inflation. While the infra-red region of the graviton energy spectrum is nearly scale-invariant, the expected signals for typical frequencies larger than 0.01 nHz are hereby analyzed in a model-independent framework by requiring that the total sound speed of the post-inflationary plasma be smaller than the speed of light. Current (e.g. low-frequency) upper limits on the tensor power spectra (determined from the combined analysis of the three large-scale data sets) are shown to be compatible with a detectable signal in the frequency range of wide-band interferometers. In the present context, the scrutiny of the early evolution of the sound speed of the plasma can then be mapped onto a reliable strategy of parameter extraction including not only the well established cosmological observables but also the forthcoming data from wide band interferometers.Comment: 47 pages, 31 included figures, to appear in Classical and Quantum Gravit

Scalar and Tensor Inhomogeneities from Dimensional Decoupling

We discuss some perturbative techniques suitable for the gauge-invariant treatment of the scalar and tensor inhomogeneities of an anisotropic and homogeneous background geometry whose spatial section naturally decomposes into the direct product of two maximally symmetric Eucledian manifolds, describing a general situation of dimensional decoupling in which $d$ external dimensions evolve (in conformal time) with scale factor $a(\eta)$ and $n$ internal dimensions evolve with scale factor $b(\eta)$. We analyze the growing mode problem which typically arises in contracting backgrounds and we focus our attention on the situation where the amplitude of the fluctuations not only depends on the external space-time but also on the internal spatial coordinates. In order to illustrate the possible relevance of this analysis we compute the gravity waves spectrum produced in some highly simplified model of cosmological evolution and we find that the spectral amplitude, whose magnitude can be constrained by the usual bounds applied to the stochastic gravity waves backgrounds, depends on the curvature scale at which the compactification occurs and also on the typical frequency of the internal excitations.Comment: 31 pages, Latex, DAMTP 96-92, UCM 96-04, to appear in Phys. Rev. D 55 (1997

Spanish validation of Bad Sobernheim Stress Questionnaire (BSSQ (brace).es) for adolescents with braces

<p>Abstract</p> <p>Background</p> <p>As a result of scientific and medical professionals gaining interest in Stress and Health Related Quality of Life (HRQL), the aim of our research is, thus, to validate into Spanish the German questionnaire <b>Bad Sobernheim Stress Questionnaire (BSSQ) (mit Korsett)</b>, for adolescents wearing braces.</p> <p>Methods</p> <p>The methodology used adheres to literature on trans-cultural adaptation by doing a translation and a back translation; it involved 35 adolescents, ages ranging between 10 and 16, with Adolescent Idiopathic Scoliosis (AIS) and wearing the same kind of brace (Rigo System Chêneau Brace). The materials used were a socio-demographics data questionnaire, the SRS-22 and the Spanish version of BSSQ(brace).es. The statistical analysis calculated the reliability (test-retest reliability and internal consistency) and the validity (convergent and construct validity) of the BSSQ (brace).es.</p> <p>Results</p> <p>BSSQ(brace).es is reliable because of its satisfactory internal consistency (Cronbach's alpha coefficient was 0.809, p < 0.001) and temporal stability (test-retest method with a Pearson correlation coefficient of 0.902 (p < 0.01)).</p> <p>It demonstrated convergent validity with SRS-22 since the Pearson correlation coefficient was 0.656 (p < 0.01). By undertaking an Exploratory Principal Components Analysis, a latent structure was found based on two Components which explicate the variance at 60.8%.</p> <p>Conclusions</p> <p>BSSQ (brace).es is reliable and valid and can be used with Spanish adolescents to assess the stress level caused by the brace.</p

"I am nothing": experiences of loss among women suffering from severe birth injuries in Tanzania

\ud Despite the increased attention on maternal mortality during recent decades, which has resulted in maternal health being defined as a Millennium Development Goal (MDG), the disability and suffering from obstetric fistula remains a neglected issue in global health. Continuous leaking of urine and the physical, emotional and social suffering associated with it, has a profound impact on women's quality of life. This study seeks to explore the physical, cultural and psychological dimensions of living with obstetric fistula, and demonstrate how these experiences shape the identities of women affected by the condition. A cross-sectional study with qualitative and quantitative components was used to explore the experiences of Tanzanian women living with obstetric fistula and those of their husbands. The study was conducted at the Comprehensive Community Based Rehabilitation Tanzania hospital in Dar es Salaam, Bugando Medical Centre in Mwanza, and Mpwapwa district, in Dodoma region. Conveniently selected samples of 16 women were interviewed, and 151 additional women responded to a questionnaire. In addition, 12 women affected by obstetric fistula and six husbands of these affected women participated in a focus group discussions. Data were analysed using content data analysis framework and statistical package for the social sciences (SPSS) version 15 for Microsoft windows. The study revealed a deep sense of loss. Loss of body control, loss of the social roles as women and wives, loss of integration in social life, and loss of dignity and self-worth were located at the core of these experiences. The women living with obstetric fistula experience a deep sense of loss that had negative impact on their identity and quality of life. Acknowledging affected women's real-life experiences is important in order to understand the occurrence and management of obstetric fistula, as well as prospects after treatment. This knowledge will help to improve women's sense of self-worth and maintain their identity as women, wives, friends and community members. Educational programmes to empower women socially and economically and counselling of families of women living with obstetric fistula may help these women receive medical and social support that is necessary.\u