Effectiveness of a continuing education program of drugs with fiscalized substance to improve pharmacy staff competencies: A multicenter, cluster-randomized controlled trial

Background: Drugs with fiscalized substances without a correct prescription may lead to undesirable side effects. Pharmacy staff needs to improve their competencies (knowledge, skills, and attitudes) to contribute to providing ambulatory pharmacy services and minimizing medication errors. Continuing education programs (CEP) could favor access to relevant and quality information on health promotion, disease prevention, and the rational use of drugs. Objective: To evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies to enhance the use of drugs with fiscalized substances. Methods: A multicenter, prospective, parallel-group, cluster-randomized, controlled clinical trial was conducted in drugstores and pharmacies in Colombia (ambulatory retail establishments). The intervention group (IG) received a CEP: a web-based social networking site, a virtual course, a dispensing information system, and face-to-face training. The control group (CG) received general written material on the correct use of drugs. We measured pharmacy staff’s skills, attitudes, and knowledge self-reported scores, and the simulated patient technique was used to assess the participant skills and attitudes in real practice. We used a questionnaire designed for this study, which was evaluated by a group of experts and piloted and showed a Cronbach’s alpha of 0.96. Results: Three hundred five drugstores and pharmacies were enrolled in two groups: IG (n = 153) and CG (n = 152). Out of the 750 potential participants, 88% (n=659) agreed to participate. The pharmacy staff’s skills, attitudes, and knowledge self-reported scores post-intervention were higher than baseline in both groups; however, the IG had statistically significantly higher scores than the CG. Post-intervention, the self-efficacy skills and attitudes in the IG improved by 88% (22 of 25) and in six of the seven assessed knowledge components (p<0.001). However, the dispensing criteria evaluated with simulated patient methodology showed no statistically significant differences between groups in the pharmacy staff’s skills and attitudes in real practice. Conclusions: Providing a continuing education program using different educational strategies improved the pharmacy staff’s competencies (assessed knowledge and self-reported skills and attitudes) to enhance the use of drugs with fiscalized substances. However, there were no improvements in skills and attitudes in real practice. These findings could show that pharmacy staff needs additional and continuous training/sustainability.Committee for Development Research and the sustainability of the University of AntioquiaprogramRandox Laboratorie

Graph-Based Approach to the Edit Distance Cryptanalysis of Irregularly Clocked Linear Feedback Shift Registers

This paper proposes a speed-up of a known-plaintext attack on some stream ciphers based on Linear Feedback Shift Registers (LFSRs). The algorithm consists of two basic steps: first, to guess the initial seed value of one of the LFSRs, and then to use the resulting binary sequence in order to deduce useful information about the cipher parameters. In particular, the proposed divide-and-conquer attack is based on a combination of graph-based techniques with edit distance concepts. While the original edit distance attack requires the exhaustive search over the set of all possible initial states of the involved LFSR, this work presents a new heuristic optimization that avoids the evaluation of an important number of initial states through the identification of the most promising branches of the search graph. The strongest aspects of the proposal are the facts that the obtained results from the attack are absolutely deterministic, and that many inconsistent initial states of the target LFSRs are recognized and avoided during search.This work was supported by the Spanish Ministry of Science and Innovation and European FEDER Fund under Project TIN2008-02236/TSI as well as by CDTI (Spain)and the companies INDRA, Unin Fenosa, Tecnobit, Visual Tool, Brainstorm, SAC and Technosafe under Project Cenit-HESPERIA.Peer reviewe

Piloting the Integration of Non-Dispensing Pharmacists in the Australian General Practice Setting: A Process Evaluation

This process evaluation examined the circumstances affecting implementation, intervention design and situational context of the twelve week pilot phase of a project integrating five pharmacists into twelve general practice sites in Western Sydney. The interventional design included three phases, patient recruitment and selection, the pharmacist consultation and the communication and recording of recommendations. A number of barriers and facilitators affecting implementation were identified. Insight into the situational context of the intervention was gained from examining the differences between individual pharmacists and between practice sites. Conducting a process evaluation in the pilot phase of an integrated care project can allow adjustments to be made to the project procedures to improve the effectiveness and reproducibility of the intervention going forward

Evaluation of the effects of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in Colombia drugstores and drugstores/pharmacies: study protocol of a multicenter, clusterrandomized controlled trial

We thank the University of Antioquia, Laproff Laboratories, and all the people who participated in the study and were essential for its successful completion.Background: Health disorders, due to the use of drugs with fiscalized substances, including controlled substances, have become a common problem in Colombia. Multiple reasons can help explain this problem, including selfmedication, since access to these drugs may be easier. Also, there is a lack of knowledge that these drugs are safer than illicit drugs. The use of these drugs without a valid medical prescription and follow-up can have negative consequences such as drug abuse, addiction, and overdose, and eventually, have negative health consequences. Pharmacy staff is essential to both assure the correct drug use and minimize prescription errors to help outpatients have better management of their pharmacotherapy. For this reason, it is necessary to increase key competencies like knowledge, skills, and attitudes in the pharmacy staff of ambulatory (outpatients) pharmacies. Methods: This study is a prospective, cluster-randomized, parallel-group, multicenter trial of drugstores and drugstores/pharmacies (ambulatory pharmacies). The study is designed to determine the effectiveness of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in drugstores and drugstores/pharmacies. Pharmacy staff will be randomly selected and assigned to one of the study groups (intervention or control). The intervention group will receive a continuing education program for over 12 months. The control group will receive only general information about the correct use of complex dosage forms. The primary objective is to evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies (knowledge, skills, and attitudes) to improve the ambulatory (outpatient) pharmacy services: dispensation, health education, and pharmacovigilance of drugs with fiscalized substances. The secondary outcomes include (a) processes associated with the management of drugs with fiscalized substances in drugstores and drugstores/pharmacies, including regulation compliance; (b) degree of implementation of ambulatory (outpatient) pharmacy services targeting these drugs in drugstores and drugstores/pharmacies; (c) patient satisfaction with such services; and (d) pharmacy staff satisfaction with the continuing education program. Discussion: This clinical trial will establish whether providing a continuing education program for the adequate utilization of drugs with fiscalized substances improves pharmacy staff competencies regarding these drugs. Trial registration: ClinicalTrials.gov NCT03388567. Registered on 28 November 2017. First drugstore or drugstore/ pharmacy randomized on December 1, 2018. Protocol version: 0017102017MC Keywords: Dispensation, Health education, Pharmacovigilance, Drugstores, Pharmacies, Pharmacy staff, Fiscalized substances, Controlled drugsCommittee for Development Research (CDR)University of AntioquiaLaproff Laboratorie

Nascent Entrepreneurial Teams (NETs): An Insight into Their Composition and Its Effect on Success

The thesis explored nascent entrepreneurial team (NET) composition and its effect on business success. Drawing on team formation theory (i.e. homophily, similarity- attraction paradigm, rational process model, cognitive resource perspective theory), the thesis addressed the composition, typology and effect on future success in nascent entrepreneurial businesses started by teams. To do so, this thesis addresses three research questions: 1) What types of composition are prevalent in NETs? 2) What different team profiles or types can be identified among NETs, based on their compositional dimensions? 3) What effect does NET composition have on nascent entrepreneurial success? NET composition is studied by calculating the degree of diversity and physical proximity within the team. In line with the current literature, four dimensions of NET composition are examined: Demographic Diversity, Human Capital, Resource Heterogeneity, and Familiarity. The research is conducted by using data from the US Panel Study of Entrepreneurial Dynamics II. The dataset provides information on each team member of the NET and records information about the business over a period of five years. This enables examination of NET composition and its effect on the nascent business success. Thus, the units of analysis considered in this thesis are the team for the predictor variables and the firm for the outcome variables. Overall, the quantitative exploratory study revealed that NET composition has an effect on the probability of success as a nascent business, but has no significant impact on the time taken to achieve success The present thesis makes original contributions to the existing body of knowledge on entrepreneurship in three ways. First, this thesis adds to entrepreneurship literature by exploring to what extent team formation theory can be applied in the nascent entrepreneurial context. Second, this thesis considers the effect of team composition on three dimensions of success, which aims to clarify the current debate regarding success measurement when studying nascent entrepreneurial stage. Third, this thesis introduces an innovative way to study NET composition by considering a typological approach, which at the same time adds to the few methodological efforts to use clustering in entrepreneurial research. Lastly, the findings of this thesis have implications for practitioners, advisory bodies, and policy-makers. For practitioners, the conclusions suggest that attention should be given to identify the potential limitations and advantages related to the team composition/configuration. For advisory or consultant bodies, the present results are helpful in designing better support programmes and training courses for NETs. Finally, while this thesis does not explicitly concern itself with entrepreneurial policy, its findings can suggest a number of implications worth of attention in support to entrepreneurial activity

Lagrangian relaxation of the generic materials and operations planning model

The supply chain management requires increasingly proposals for the production programming planning that brings together its special singularities. Solving coexisting products and alternative processes or by-products must be allowed by the mathematical programming models. The generic materials and operations planning (GMOP) formulation allows operating with different materials and process lists. The paper presents a procedure to solve the versatile GMOP model by the Lagrange Relaxation. The subgradient update method of the lagrangian multiplier is compared with a linear update method. Obtaining lower bound faster compared to the linear method is allowed by the subgradient method, but the linear method provides better solutions after certain iterations

Análisis descriptivo de las familias usuarias de los servicios especializados de atención a la familia e infancia

El Servicio Especializado de Atención a la Familia y a la Infancia (SEAFI), es un Servicio ubicado en la mayor parte de los municipios de la Comunidad Valenciana, que pretende dar una atención integral psicoeducativa o psicosocial a las familias con hijos menores de edad. Esta labor de atención personal se lleva a cabo de forma complementaria y coordinada con el equipo municipal de Servicios Sociales Generales. Los SEAFI’s cuentan con equipos interdisciplinares específicos, con formación en áreas pedagógicas, psicológicas y sociales, y que realizan intervención familiar mediante técnicas de orientación psicosocial, mediación familiar o terapia familiar. Las familias atendidas desde este servicio especializado se encuentran principalmente en dos tipos de situación, de vulnerabilidad o de conflicto. Presentamos un análisis descriptivo de las circunstancias familiares que pueden contribuir a la mayor dificultad de estas familias para abordar las diferentes situaciones de crisis (tipo de familia, edades de los hijos, a quien identifican como paciente identificado…) Los resultados indican principalmente que son las familias con menores preadolescentes o adolescentes las que solicitan en mayor proporción este servicio.The Specialized Family and Childhood Care Service (SEAFI, that stands for Servicio Especializado de Atención a la Familia y a la Infancia), is a service available in most of the municipalities in the Valencian Community, which aims to give comprehensive psycho educational and psychosocial support to families with under aged children in it. This task of providing personal attention is coordinated by the municipal department of General Social Services. The different SEAFIs have specific interdisciplinary teams, with training in the pedagogic, psychological and social fields and perform familiar intervention through a set of techniques of psychosocial orientation, family mediation and family therapy. Families that get such kind of attention and specialized care tend to face, straight away, situations of vulnerability and conflict. We hereby present a descriptive analysis of the family circumstances which can generate bigger difficulties for these families to be able to face critical situations (family structure, age of the children, who is identified as the patient...). Results usually point out that those families who ask for this kind of specialized service are those with preteens or teens in it.peerReviewe

Overall results of the Dader Pharmacotherapeutic Follow-Up Program data base: 2008

Se recogen los resultados globales de la aplicación web desarrollada por el Programa Dáder de Seguimiento Farmacoterapéutico del Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada en el primer año de funcionamiento