Practice of pharmacy and language competency: delivery of an integrated cross-cultural care

Student pharmacists in countries where English is used for on-campus instruction but is not the national language may face difficulties when it comes to effectual communication with patients during experiential learning in clinical settings. Having effective communication skills is one of the traits of professionalism,1 and is not only one of the core competencies in becoming a better practicing pharmacist, but also an integral part of effective pharmaceutical care planning.2 Seemingly, on the view on cultural competency as one of the traits of professionalism in pharmacy education;3 most of the articles have mentioned the predestined importance of language and the knowledge of language as integral components to cultural competency.4-6 Some even have looked at cultural competency as a defense against healthcare disparities,4 as speaking the same language minimizes the possibilities of “otherizing” and stigmatization in the delivery of cross-cultural care

Pediatric pharmacotherapy and its unique challenges: amalgamation of professionalism and Emotional Quotient (EQ).

Pharmacotherapeutics in children follows the same principles as pharmacotherapy for adults (1); and focuses primarily on the physiology of the children as well as the pharmacology of the medications. Children react to medications differently i.e., incomplete absorption, distribution, metabolism and excretion, causing increased or decreased efficacy or safety (2)

Assessing professional development and professionalism: peer review, reflection and appraisal

Background: Identity formation is one of the frameworks to address professional development amongst healthcare students (Irby and Hamstra, 2016). Professional development is a continuous nurturing process. Healthcare students gradually develop their professional identity to mirror the values and dispositions of their profession; and to become the very best they could be, professionally. There is a significant association between professional development and reflective ability; although the causality of the association needs further investigations (Hoffman et al., 2016). There is a need to move from theoretical frameworks to interventions that foster professionalization among future healthcare professionals. Description of the work To help students of pharmacy and nursing form their professional identity, we introduce them to a series of simulation and experiential interventions. Interprofessional education (IPE) is a key catalyst intervention for formation of professional identity. Students' attitudes towards IPE are evaluated; their interactions with their peers and their engagement with the activities are observed by a multidisciplinary team of healthcare teacher-practitioners. We also collect teacher-practitioners’ views on the key strengths and key development areas of each student. During a formative appraisal session students self-assess their key strengths and key development areas. After which, we share with them the views of their teachers. Then, students have to come up with an action plan to showcase their plans and strategies to address the key development areas. Proposed evaluation We apply a multi-pronged evaluation plan to assess the interventions. Firstly, we collect feedback from students, by survey about their appraisal session immediately. Secondly, we will continue monitoring students' professional identity formation post appraisal to graduation. We will look for changes in students' attitudes and behaviour post-appraisal. For instance, pre- and post-evaluation of attitudes towards engagement with the IPE activities. We will also evaluate the year over year (YOY) comparison of the students’ behaviour in the context of time management, punctuality and communication skills.. Finally, we will assess the overall experience of students on their professional development using standard social science methodology, including questionnaires and focus groups

Historien om medikamentell behandling av sykdom hos barn

Medikamentell behandling av barn må følge samme prinsipper og retningslinjer som hos voksne. Pinlig nøyaktighet er påkrevet når det administreres medikamenter til barn fordi effekten av legemidler i forhold til barnets fysiologi, biokjemi, og vekst er annerledes enn hos voksne. Legens ansvar til å forskrive medikamenter til barn må alltid ses i sammenheng med plikten til å utøve forsvarlig legevirksomhet (Lov om helsepersonell). Et godt eksempel for de mange utfordringene er risikoen for etseskader ved bruk av klorheksidin til huddesinfeksjon til premature barn

Machining Chatter in Flank Milling and Investigation of Process Damping in Surface Generation

Although a considerable amount of research exists on geometrical aspects of 5-axis flank milling, the dynamics of this efficient milling operation have not yet been given proper attention. In particular, investigating machining chatter in 5-axis flank milling remains as an open problem in the literature. The axial depth of cut in this operation is typically quite large, which makes it prone to machining chatter. In this thesis, chatter in 5-axis flank milling is studied by developing analytical methods of examining vibration stability, generating numerical simulations of the process, and conducting experimental investigations. The typical application of 5-axis milling includes the machining of thermal resistant steel alloys at low cutting speeds, where the process damping dominates the machining vibration. The results of experimental study in this thesis showed that the effect of process damping is even stronger in flank milling due to the long axial engagement. Accordingly, the first part of the thesis is devoted to studying process damping, and in the second part, the modeling of chatter in flank milling is presented. Linear and nonlinear models have been reported in the literature that account for process damping. Although linear models are easier to implement in predicting stability limits, they could lead to misinterpretation of the actual status of the cut. On the other hand, nonlinear damping models are difficult to implement for stability estimation analytically, yet they allow the prediction of “finite amplitude stability” from time domain simulations. This phenomenon of “finite amplitude stability” has been demonstrated in the literature using numerical simulations. In this thesis, that phenomenon is investigated experimentally. The experimental work focuses on uninterrupted cutting, in particular plunge turning, to avoid unduly complications associated with transient vibration. The experiments confirm that, because of the nonlinearity of the process damping, the transition from fully stable to fully unstable cutting occurs gradually over a range of width of cut. The experimental investigation is followed by developing a new formulation for process damping based on the indentation force model. Then, the presented formulation is used to compute the stability lobes in plunge turning, taking into account the effect of nonlinear process damping. The developed lobes could be established for different amplitudes of vibration. This is a departure from the traditional notion that the stability lobes represent a single boundary between fully stable and fully unstable cutting conditions. Moreover, the process damping model is integrated into the Multi-Frequency Solution and the Semi Discretization Method to establish the stability lobes in milling. The basic formulations are presented along with comparisons between the two approaches, using examples from the literature. A non-shallow cut is employed in the comparisons. Assessing the performance of the two methods is conducted using time domain simulations. It is shown that the Semi Discretization Method provides accurate results over the whole tested range of cutting speed, whereas higher harmonics are required to achieve the same accuracy when applying the Multi Frequency Solution at low speeds. Semi Discretization method is modified further to calculate the stability lobes in flank milling with tools with helical teeth. In addition to the tool helix angle and long axial immersion, the effect of instantaneous chip thickness on the cutting force coefficients is considered in the modified formulation of Semi Discretization as well. Considering the effect of chip thickness variation on the cutting force coefficients is even more important in the modeling of 5-axis flank milling, where the feedrate, and consequently the chip thickness, varies at each cutter location. It also varies along the tool axis due to the additional rotary and tilt axis. In addition to the feedrate, the tool and workpiece engagement geometry varies at each cutter location as well. The actual feedrate at each cutter location is calculated by the dynamic processing of the toolpath. The tool and workpiece engagement geometry is calculated analytically using the parametric formulation of grazing surface at the previous and current passes. After calculating the instantaneous chip thickness and tool/workpiece engagement geometry, they are integrated into the Semi Discretization Method in 5-axis flank milling to examine the stability of vibration at each cutter location. While the presented chatter analysis results in establishing stability lobes in 3-axis flank milling, it results in developing a novel approach in presenting the stability of the cut in 5-axis flank milling. The new approach, namely “stability maps”, determines the unstable cutter locations of the toolpath at each spindle speed. The accuracy of established 3-axis flank milling stability lobes and 5-axis stability maps is verified by conducting a set of cutting experiments and numerical simulations

Development of professionalism: case study of HIV/AIDS-related stigma among healthcare students

A healthcare workforce that is responsive and fair in its treatment of patients is one of the central pillars of a modern health system (1). It is for this reason, among others, that healthcare workers are ethically bound to treat patients according to their need, and not according to their gender, religious beliefs, sexual orientation, skin color, or other socially (de)valued attribute. Within a modern healthcare program, there is also a focus on professional ethics and professional practice – often implicit rather than explicit probably increasing with the shift from pre-clinical to clinical years in a program. Hence, the years of training become a reasonable indicator of professionalization. A professional, however, is not simply brought into being. They are developed over time. When a student starts healthcare professional course, they would not be steeped in the ideas of the profession. By the time they have finished their university training, they may not be a fully-fledged professional, but they will, we would anticipate, be more professional. There is some anecdotal evidence, and preliminary empirical evidence to suggest that professionalization will affect attitudes in a healthcare setting, but will have a weaker effect on attitudes associated with the private, social sphere of a healthcare workers life (2). The conception and compilation of the code of professional conducts could be an explanation for the bifurcation of social attitudes. What one feels personally, should not affect the professional performance of that individual which subsequently should not affect the equality of the service provided. The Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a highly stigmatized condition(3–14). People with HIV have been divorced, thrown out of their homes and driven from their villages and lost their jobs (5); all because of that discrediting attribute. People with HIV have also been denied access to treatment and care by health professionals for the same reason (15),which has challenged the equitable delivery of services (3,16,17). There is some evidence to suggest, however, that there has been a bifurcation of social attitudes. One recent study suggested that health professionals may mentally ‘juggle’ two dissonant attitudes towards people living with HIV/AIDS (PLWHA), a professional attitude of fair treatment without regard to HIV status of the patient, and a social attitude of antipathy (18). In a lay, social sphere, HIV/AIDS remains a stigmatized condition(19–23). An interesting and important question arises from the bifurcation of social attitude. As healthcare professionals progress through their training, and acquire the norms of the profession including appropriate ethical practice and behavior, do their stigmatizing attitudes about HIV/AIDS reduce globally? Or, do their attitudes change within the limited sphere of the healthcare setting, leaving the attitudes they hold about the disease outside the healthcare untouched? Crudely, you might be prepared to treat the person, but would you want them as a friend? There is some anecdotal evidence, and preliminary empirical evidence to suggest that professionalization will affect attitudes in a healthcare setting, but will have a weaker effect on attitudes associated with the private, social sphere of a healthcare workers life (2). This question is important because it provides insight into the process of professionalization within healthcare professionals, and it provides insights into the process of managing disease related stigma in healthcare and non-healthcare settings. We hypothesized the following in our attempt to answer the question of what is the relationship between the professional development and changes in HIV/AIDS-related stigmatizing attitudes. The hypotheses were: 1. Healthcare students will demonstrate significant levels of disease related stigma. 2. The levels of disease related stigma among healthcare students will decrease significantly with increasing levels of professionalization. 3. On average, healthcare students will evaluate disease in healthcare situation in a less stigmatizing fashion than disease in social/private situation. 4. The rate of decreasing disease related stigma associated with increasing levels of professionalization will be greater for evaluations of disease in healthcare situations than for evaluations of disease in social/private situations. We created and validated a measurement tool to measure the levels of HIV/AIDS-related stigmatizing attitudes in two domains. That is a professional domain and a personal domain. Each domain represented the type of stigmatizing attitudes in each participant. We chose a novel non-parametric item response theory approach i.e., Mokken Scale Analysis (MSA) technique to develop and validate a brief unidimensional measure of personal domain of HIV/AIDS-related stigmatizing attitudes. We applied the Principal Component Analysis (PCA) technique to validate the measure of professional stigma scale. The initial items of the professional stigma scale were developed using modified Delphi technique. We administered the validated questionnaire to undergraduate medical and pharmacy students of Monash University in Australia and Malaysia in a two point-in-time fashion. The first round of data was collected during the first 2 months of the first semester of the Monash academic year i.e., March and April. The second round of data was collected during the ‘study vacation’ of the second semester i.e., October. The study vacation is the period in which students prepare for their exams – prior to the end of semester exams – when there are no teaching activities. There was, on average a 6-month time gap between the two data collections points. We also administered the validated questionnaire to undergraduate pharmacy students of Universiti Sains Malaysia (USM) in the month of October. At USM, academic calendar starts in the month of September. The ideal design for this research would be a 4-year to 5-year longitudinal study of healthcare students measuring changes in attitude over their professional course; however, an alternative approach was proposed to limit the resource expenditure while providing a good indication of the idea’s merit. Instead of a longitudinal design, a serial cross-sectional design (to examine differences between cohorts in different years of study) – please refer to Study I and Study II – was combined with a two-point in time longitudinal design (to examine differences between the beginning and the end of a single year of study) – please refer to Study III. Levels of stigma were measured once at the beginning of a single year of study and once at the end of the same year, and this was conducted across year cohorts. Study I was a cross-sectional survey of undergraduate pharmacy and medical students of Monash University in Australia and Malaysia. The fundamental finding of Study I was the ‘bifurcation’ of HIV/AIDS-related stigmatizing attitudes amongst healthcare students. As healthcare students became more professionalized their HIV/AIDS-related stigmatizing attitudes diverge across two domains: 1- The professional domain in which the behavioral intentions towards PLWHA are work related in a health working environment. 2- The personal domain in which the behavioral intentions towards PLWHA are at personal levels and in private situations. The HIV/AIDS-related stigmatizing attitudes, showed a significant –although small – decline for every year spent in the health programs i.e., pharmacy and medicine. The decline in the HIV/AIDS-related stigmatizing attitudes indicates the professionalization of HIV/AIDS stigmatizing attitudes amongst [future] healthcare professionals. Study II was a cross-sectional survey of undergraduate pharmacy students of Monash University Malaysia and USM. The two main findings were: 1) there were differences in HIV/AIDS-related stigmatizing attitudes between universities; 2) overall, the older cohorts did not show lower levels of HIV/AIDS-related stigmatizing attitudes. Although, Monash University pharmacy students showed a decline in the personal and professional HIV/AIDS-related stigmatizing attitudes, USM pharmacy students did not show significant decline in their stigmatizing attitudes. Moreover, there was no bifurcation of HIV/AIDS-related stigmatizing attitudes. We discussed the absence of bifurcation of stigmatizing attitudes and differences in professionalization of stigmatizing attitudes among Monash University and USM students by further exploring the differences in their curricula and teaching and learning activities. In Study III we collected the data in two points in time from undergraduate pharmacy and medical students of Monash University in Australia and Malaysia. There was an average a 6-month time period between the two data collection. The bifurcation of HIV/AIDS-related stigmatizing attitudes was present at the first point of data collection; however, the bifurcation was absent at the end of the 6-month period. We attempted to identify the reason(s) why the hypothesized relationship between professionalization and changes in stigmatizing attitudes did not hold

Antimicrobial Resistance, Pharmacists, and Appreciative Inquiry: Development of a Novel Measurement Tool

Antimicrobial resistance (AMR) is a threat to achieving the United Nation’s (UN) sustainable development goals (SDGs). The behavior of stakeholders has directly influenced the extent of AMR and understanding underpinning knowledge and attitudes is an important step towards understanding these behaviors. The aim of this study was to develop and validate a novel questionnaire, utilizing the theory of Appreciative Inquiry, to measure knowledge and attitudes around antibiotic resistance amongst community pharmacists throughout Thailand. A survey tool was developed using the Appreciative Inquiry theory, and was piloted in a non-probability sample of practicing community pharmacists. Descriptive and inferential statistics were applied and the tool validated, using a three-step psychometric validation process. A total of 373 community pharmacists participated in the study. The survey tool was found to be valid and reliable. The “Knowledge” domain of the survey tool showed an acceptable level of reliability (Cronbach’s alpha 0.64); while the “Attitude” domain showed an excellent reliability level (Cronbach’s alpha 0.84). This new survey tool has been designed to measure attitudes and knowledge of antibiotic resistance by utilizing the Discovery phase of Appreciative Inquiry theory amongst community pharmacists in Thailand. This survey tool has the potential to be used by other researchers across different settings

A novel nonparametric item response theory approach to measuring socioeconomic position: a comparison using household expenditure data from a Vietnam health survey, 2003

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background Measures of household socio-economic position (SEP) are widely used in health research. There exist a number of approaches to their measurement, with Principal Components Analysis (PCA) applied to a basket of household assets being one of the most common. PCA, however, carries a number of assumptions about the distribution of the data which may be untenable, and alternative, non-parametric, approaches may be preferred. Mokken scale analysis is a non-parametric, item response theory approach to scale development which appears never to have been applied to household asset data. A Mokken scale can be used to rank order items (measures of wealth) as well as households. Using data on household asset ownership from a national sample of 4,154 consenting households in the World Health Survey from Vietnam, 2003, we construct two measures of household SEP. Seventeen items asking about assets, and utility and infrastructure use were used. Mokken Scaling and PCA were applied to the data. A single item measure of total household expenditure is used as a point of contrast. Results An 11 item scale, out of the 17 items, was identified that conformed to the assumptions of a Mokken Scale. All the items in the scale were identified as strong items (Hi > .5). Two PCA measures of SEP were developed as a point of contrast. One PCA measure was developed using all 17 available asset items, the other used the reduced set of 11 items identified in the Mokken scale analaysis. The Mokken Scale measure of SEP and the 17 item PCA measure had a very high correlation (r = .98), and they both correlated moderately with total household expenditure: r = .59 and r = .57 respectively. In contrast the 11 item PCA measure correlated moderately with the Mokken scale (r = .68), and weakly with the total household expenditure (r = .18). Conclusion The Mokken scale measure of household SEP performed at least as well as PCA, and outperformed the PCA measure developed with the 11 items used in the Mokken scale. Unlike PCA, Mokken scaling carries no assumptions about the underlying shape of the distribution of the data, and can be used simultaneous to order household SEP and items. The approach, however, has not been tested with data from other countries and remains an interesting, but under researched approach.https://doi.org/10.1186/1742-7622-11-911pubpub

The Effect Paraoxonase-1, Hydrogen Peroxide and Adiponectin Changes on Systolic and Diastolic Blood Pressure of Men’s with High Blood Pressure Fallowing to 12 Week Moderate Aerobic exercise

چکیده: زمینه و هدف: پاراکسوناز-1، آدیپونکتین و پراکسید هیدروژن از جمله شاخص هایی هستند که تحت تأثیر کم تحرکی قرار می گیرند و این احتمال وجود دارد که بر فشار خون موثر باشند. با این حال ارتباط بین تغییرات آن ها با فشار خون در اثر شرکت در فعالیت های منظم ورزشی مشخص نشده است، لذا هدف از تحقیق حاضر بررسی اثر 12 هفته فعالیت هوازی شدت متوسط بر ارتباط بین تغییرات پاراکسوناز-1، پراکسید هیدروژن و آدیپونکتین پلاسمایی با فشار خون سیستولی و دیاستولی مردان دارای فشار خون بالا می باشد. روش بررسی: تحقیق حاضر از نوع نیمه تجربی با اندازه گیری مکرر می باشد که در آن 10 مرد (در دامنه سنی 68/2±9/37) دارای فشارخون بالا (فشار خون سیستولی 23/0±531/140 و فشار خون دیاستولی 05/0±71/90) پس از اخذ رضایت نامه در 12 هفته برنامه فعالیت هوازی شدت متوسط (70-55 درصد حداکثر ضربان قلب بیشینه) شرکت کردند. سطح شاخص های فیزیولوژیک و همچنین سطح پاراکسوناز-1 Paraoxonase-1= PON-1)) و هیدروژن پراکسید (Hydrogen Peroxide= H2O2) و آدیپونکتین در مرحله پایه، هفته چهارم، هشتم و دوزادهم اندازه گیری شد و از آزمون مدل خطی آمیخته (Liner Mixed Model) جهت بررسی ارتباط بین شاخص ها استفاده شد. یافته ها: بررسی های آماری ارتباط معنی داری بین آدیپونکتین با فشار خون سیستولی و دیاستولی (به ترتیب: 150/0P= و 561/0P=) نشان نداد. ارتباط بین پاراکسوناز-1 با فشار خون سیستولی و دیاستولی (به ترتیب: 165/0P= و 520/0P=) نیز معنی دار نشد. با این حال ارتباط بین پراکسید هیدروژن با فشار خون سیستولی و دیاستولی معنی دار گزارش شد (به ترتیب: 020/0P= و 048/0P=). نتیجه گیری: به نظر می رسد 12 هفته فعالیت هوازی شدت متوسط از طریق کاهش ROS ها و فشار اکسایشی منجر به کاهش فشار خون مردان دارای فشار خون بالا می گردد

Smoking Cessation Amid the Coronavirus 2019 Pandemic: Making Every Contact Count

Recently, YouGov and the campaign group, Action on Smoking and Health, published the results of their survey on the impact of coronavirus disease 2019 (COVID-19) on the smoking behavior of current adult smokers.1 The study, which interviewed over 1000 adult participants residing in the United Kingdom during April 2020, revealed some positive findings with regards to smoking behavior in association with the COVID-19 pandemic. Specifically, 36% of smokers had reduced the amount of tobacco or cigarettes smoked while 8% of smokers had tried to quit smoking. Collectively, the proportion of smokers who had reduced or tried to quit smoking was more than the proportion of smokers (20%) who had purchased tobacco or cigarettes in larger quantities—bulk-buying or stockpiling—because of COVID-19 associated lockdowns. Though lesser in proportion, it is also encouraging to observe that 2% of smokers had quit smoking in the last 4 months, solely or partly due to COVID-19. These positive findings may be due to media coverage in which smokers have been predicted to have a higher risk of COVID-19 acquisition than non-smokers. Though no studies as yet have proven such an association, it has been suggested that smokers could be more vulnerable to acquiring COVID-19, as their fingers (and possibly contaminated tobacco or cigarettes) are often in contact with their lips, which increases the likelihood of the transmission of severe acute respiratory syndrome coronavirus 2, (SARS-CoV-2), the causative pathogen of COVID-19, from hand to mouth