Exploring Hope in Families Affected by Problematic Substance Use: An Interpretive Descriptive Study

The effects of problematic substance use are far-reaching and affect the individuals engaged in problematic substance use, as well as their family members. Hope is a powerful psychosocial tool for these families and caregivers and can reduce their suffering. When utilized in periods of hopelessness and despair, hope helps people to develop resilience. There is limited or no research on the experiences of hope for family members affected by problematic substance use. In this interpretive descriptive study, I explored the experiences of 21 family members concerning hope and hopelessness in their lives. Major themes I found included the manifestation, impacts of, and factors countering hopelessness. Overall, my findings show that family cohesiveness, social structures, and the interplay of hope and hopelessness are significant factors that determine hope for family members of people who experience problematic substance use. Appreciating the families’ challenges gives health care professionals a better understanding of how to assist families in finding hope during uncertain and challenging times. Clinicians can assist families in identifying their strengths, agencies, and pathways of hope, which can support their self-care and enhance their resiliency. My personal and professional experiences as a Registered Nurses both informed and were shaped by this study. Specifically, this study has shaped my understanding of the role of hope in practicing strength-based approached to care

The effectiveness and impact on performance of pharmacy-related competency development frameworks: A systematic review and meta-analysis

BACKGROUND: Competency frameworks for education, training and development are widely used in the health professions, including pharmacy. Published studies suggest that competency frameworks have an impact on professional performance. Professional performance that is consistent with up-to-date knowledge and skills influences health care quality and patient safety. This review assessed the effectiveness of competency frameworks in facilitating improvement in pharmacists' performance. METHOD: PubMed/Medline, CINAHL, Embase, ERIC, PsycINFO and Scopus electronic databases were searched to identify relevant literature. The findings of the included studies were synthesised qualitatively, and via a meta-analysis. The meta-analysis evaluated the odds of improved competency behaviour as a proxy measure of impact on pharmacists' performance. Study quality was assessed using 12 criteria adapted from the EPPI-Centre guidelines v0.9.7. The protocol for this review is registered on PROSPERO with reference number CRD42018096580. RESULTS: In total, nine interventional studies were identified for review. The review findings showed observable and significant improvement in pharmacists' performance when competency frameworks are used to appraise performance, identify knowledge gaps, and tailor learning activities. A meta-analysis that involved a total of 348 pharmacists undergoing repeat peer assessment showed pooled odds for improved competency behaviour of 4.41 (95% CI: 1.89-10.29, I2 = 83%). Subgroup analyses showed pooled odds with corresponding 95% CI of 6.50 (1.77-23.97, I2 = 77%) vs 2.95 (0.59-14.72, I2 = 93%) for the studies that were conducted in countries within or outside Europe, respectively; 10.51 (3.73-29.62, I2 = 24%) vs 2.39 (0.96-5.95, I2 = 87%) for studies with reassessment conducted at ≤6 months from baseline, or more, respectively; 6.68 (1.63-27.45, I2 = 88%) vs 2.80 (0.86-9.07, I2 = 74%) for studies involving hospital or community pharmacists, respectively; and 2.80 (1.22-6.45, I2 = 77%) for studies with low risk of bias. CONCLUSION: These findings suggest competency frameworks facilitate improvement in pharmacists' performance; however, further evaluative studies are needed

The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review

Background: Global reforms in the education of health workers has culminated in the implementation of competency-based education and training (CBET). In line with the CBET model, competency frameworks are now commonplace in the health professions. In pharmacy, these frameworks are used to regulate career entry, benchmark standards of practice and facilitate expertise development. / Objective: This systematic review assessed the development, validity and applicability to practice of pharmacy-related competency frameworks. / Method: PubMed/Medline, CINAHL, Embase, ERIC, Scopus and PsycINFO electronic databases were searched to identify relevant literature. Additional searching included Google Scholar, electronic sources of grey literature, and the Member Organisation websites of the International Pharmaceutical Federation (FIP). The findings of this review were synthesised and reported narratively. The review protocol is registered on PROSPERO with reference number CRD42018096580. / Results: In total, 53 pharmacy-related frameworks were identified. The majority (n=39, 74%) were from high income countries in Europe and the Western Pacific region, with only three each from countries in South East Asia (SEA) and Africa. The identified frameworks were developed through a variety of methods that included expert group consultation used alone, or in combination with a literature review, job/role evaluation, or needs assessment. Profession wide surveys and consensus via a nominal group, Delphi, or modified Delphi technique were the primary methods used in framework validation. The competencies in the respective frameworks were generally ranked relevant to practice, thereby confirming validity and applicability. However, variations in competency-related terminologies and descriptors were observed. Disparities on perception of relevance also existed in relation to area of practice, length of experience, and level of competence. For example, pharmaceutical care competencies were typically ranked high in relevance in the frameworks, compared to others such as the research-related competencies. / Conclusion: The validity and applicability to practice of pharmacy-related frameworks highlights their importance in competency-based education and training (CBET). However, the observed disparities in framework terminologies and development methods suggest the need for harmonisation

Effectiveness of a 6-dose regimen of Artemether-Lumefantrine for unsupervised treatment of uncomplicated childhood malaria in Calabar, Nigeria

Background: The six dose regimen of Artemether- Lumefantrine (AL), has high efficacy in clinical trials and is the first -line drug for treating uncomplicated malaria in Nigeria. The complex dosage schedule could militate against its effectiveness.Objective: To assess the effectiveness of AL prescribed under routineoutpatient conditions in the treatment of uncomplicated malaria.Methods: An open label, noncomparative trial to assess the effectivenessof AL in children 6 to 59 months with uncomplicated P. falciparum and parasite density between 1,000 and 250,000/ìL. Enrolled children received 6-dose course of AL (20/120mg tablets). The first dose was administered in the health facility and caregivers were instructed on how to administerthe remaining five doses at home.Results: Of the 1035 screened, 215 eligible children were enrolled and193 completed the study. Twenty two (22) patients withdrew from thestudy (18 were lost to follow-up, 3 violated protocol and 1 withdrewconsent). Adequate clinical and parasitological response (ACPR) was observed in 90.7%; late clinical failure in 7 (3.6%) and late parasitologicalfailure in 11 (5.7%).Conclusion: This study showed high efficacy of AL in treating uncomplicatedP. falciparum malaria in under-fives in Nigeria. Adherence by caregivers to the treatment regimen was quite good and so, should continue to be used in the home setting.Key words: Artemetherlumefantrine, effectiveness, adherence, uncomplicated malaria

Transnational comparability of advanced pharmacy practice developmental frameworks: A country-level crossover mapping study

BACKGROUND: Previous work by the International Pharmaceutical Federation Education Initiative (FIPEd) demonstrates that even though some country-specific variations occur in pharmacy practice, there exists a set of practice-related competencies that are globally applicable. This study aimed to evaluate the transnational comparability of the Royal Pharmaceutical Society Advanced Pharmacy Framework (RPS-APF, Great Britain) and the Advanced Pharmacy Practice Framework for Australia (APPF). The objective was to obtain preliminary data on the transnational applicability of the developmental competencies contained in the two frameworks. METHOD: A crossover mapping study involving 42 advanced-level pharmacists from four countries was conducted. Qualitative interview (n = 17) was also carried out to explore practitioners’ perception of the frameworks. RESULT: The average postregistration experience of the practitioners in the crossover study was 19 years. Directly observed within-subject agreement per advanced practice competency ranged from 45% to 86%. This agreement was significant for 87% of the competencies evaluated (k ≥ 0.21; P ≤ 0.05). The lowest agreement was in the ‘governance’ competency (k = 0.13; P = 0.21). Wilcoxon sum rank test showed a statistically significant within-subject difference in the ‘collaborative practice’ cluster (P = 0.043). This was not observed in the other five advanced practice clusters. From the qualitative interviews, practitioners generally perceived the two compared advanced-level frameworks as similar in content and indicated they found the described competencies to be useful for clarifying expectations of practice and identifying skills development needs. CONCLUSION: These findings provide preliminary evidence of the comparability and transnational applicability of the advanced pharmacy practice competencies contained in the two national competency development frameworks evaluated

Growth and foliar yield responses of waterleaf (Talinum triangulare Jacq) to complementary application of organic and inorganic fertilizers in a Ultisol

Aims: Growth and foliar yield responses of waterleaf (Talinum triangulare Jacq) to complementary application of organic and inorganic fertilizers were studied in a Ultisol. Study Design: The experiment was laid out in a randomized complete block design with three replicates. Place and Duration of Study: The University of Uyo Teaching and Research Farm, located at Use Offot - Uyo, Akwa Ibom State, Nigeria and was conducted between March, 06 and June, 06 in both 2009 and 2010 cropping seasons. Methodology: Treatments were various combinations of organic and inorganic fertilizers applied to the soil, and these included NPK (15:15:15) at 400 kg ha-1, poultry manure (PM) at 5 t ha-1, PM at 2.5 tha-1 + NPK at 200 kgha-1, PM at 3.75 tha-1 + NPK at 100 kgha-1 , PM at 1.25 tha-1 + NPK at 300 kgha-1 and control (without amendment). Results: There were significant differences (P<0.05) among treatments in height, number of branches, number of leaves, stem girth, leaf area, and total foliage yield of waterleaf in both years. Generally, application of PM alone and complementary use of PM and NPK, irrespective of the ratio, enhanced waterleaf growth and total foliage yield better compared to application of NPK alone and the control treatment. Total foliage yield from 100 kgha-1 NPK + 3.75 tha-1 of PM treatment (56 .03 tha-1 30 and 54 36 tha-1 31 in 2009 and 2010, respectively) superseded other treatments by 38 - 78% in 2009 and 35 -78% in 2010. Conclusion: With the high cost, scarcity, and environmental problems associated with the use of mineral fertilizer in Nigeria; and based on the foliage yield obtained in this study, it is obvious that the use of organic manure in combination with mineral fertilizer (particularly with 100kgha-1 NPK + 3.75tha-1 PM or 200kgha-1 NPK + 2.5tha-1 PM treatment) can sustain waterleaf production. It is also demonstrated that it would be more rewarding to apply 5tha-1 PM alone compared to sole application of 400kgha-1 mineral fertilizer for waterleaf production in a Ultisol. Keywords: Waterleaf; organic inorganic fertilizers; growth; foliar yield; ultisol