Exploring the Role of Item Scenario Features on Situational Judgment Test Response Selections

Objective. To explore pharmacists’ and pharmacy students’ perceptions regarding the significance of changing the features of test item scenario (eg, switching from a health care to a non-health care context) on their situational judgment test (SJT) responses.Methods. Fifteen Doctor of Pharmacy students and 15 pharmacists completed a 12-item SJT intended to measure empathy. The test included six scenarios in a health care context and six scenarios in a non-health care context; participants had to rank potential response options in order of appropriateness and no two items could be of equal rank. Qualitative data were collected individually from participants using think-aloud and cognitive interview techniques. During the cognitive interview, participants were asked how they selected their final responses for each item and whether they would have changed their answer if features of the scenario were switched (eg, changed to a non-health care context if the original item was in a health care context). Interviews were transcribed and a thematic analysis was conducted to identify the features of the scenario for each item that were perceived to impact response selections.Results. Participants stated that they would have changed their responses on average 51.3% of the time (range 20%-100%) if the features of the scenario for an item were changed. Qualitative analysis identified four pertinent scenario features that may influence response selections, which included information about the examinee, the actors in the scenario, the relationship between examinee and actors, and details about the situation. There was no discernible pattern linking scenario features to the component of empathy being measured or participant type.Conclusion. Results from this study suggest that the features of the scenario described in an SJT item could influence response selections. These features should be considered in the SJT design process and require further research to determine the extent of their impact on SJT performance.     

Intratunical versus parenteral administration of methotrexate.

Methotrexate (MXT) distribution in serum, testicle and epididymis after administration into the tunica vaginalis cavity or intravenously was studied in 36 dogs. The dogs were divided into two equal groups: (1) an intratunical group in which 20 mg MXT solution was injected into the tunica vaginalis sac of each dog and (2) a parenteral group in which the same MXT dose was administered intravenously. The MXT concentration in serum, testicle and epididymis was determined 2, 4 and 24 h after MXT administration. Clinical and histologic examination of the tunica vaginalis was performed weekly for four consecutive weeks. The intratunical route, in contrast to the parenteral route, achieves a high MXT level in the testicle and epididymis with a low serum level, resulting in low toxicity and high drug efficacy. This route may therefore be suitable for a more effective treatment of testicular and epididymal lesions, notably malignant tumors.     

签定药品供需质量保证承诺书,强化药品管理

为加强药品流通领域中的质量监管和保证用药安全,公利医院和中国医药集团上海药品公司、上海市医药股份有限公司市郊分公司、浦东新区药材公司等10家药品经营公司于2001年8月签订了<药品供需质量保证承诺书>.通过承诺双方的共同努力及浦东新区药监局对承诺书实施过程的监管,至今未发生一起药品质量问题,为保证广大群众安全、有效地使用药物开了个好头.对此谈几点体会和建议.     

Hypnotic self administration: forced-choice versus single-choice

Twenty-four men and women with insomnia, age 21–50?years, self administered hypnotics under a single-choice with placebo, single-choice with triazolam (0.25?mg), or forced-choice of placebo versus triazolam (0.25?mg) paradigm. Subjects received 4-sampling nights of placebo or triazolam in the single-choice conditions or 2 nights of each in the forced-choice condition. Then on 7 choice nights they could self administer a capsule, or not, in the single-choice conditions, or were required to choose one of two color-coded capsules in the forced-choice condition. In the single-choice conditions, subjects chose placebo 80% of nights and triazolam 77% of nights, while in the forced-choice condition triazolam was chosen on 86% of nights. Thus, the self administration of triazolam did not vary significantly between single or forced choice conditions, but that of placebo did. Placebo rate was high when it was the only alternative, but low when competing with triazolam. On sampling nights, compared to placebo, triazolam produced a significant increase in total sleep time, a reduction in latency to sleep, wake after sleep onset, and percentage stage 1 sleep. Triazolam, relative to placebo, also improved mood in the morning on some sampling nights. For subjects choosing capsules <?100% of opportunities (n?=?14), on nights a capsule was chosen versus nights none was chosen (regardless of whether placebo or triazolam was the choice), self-ratings 30?min before bedtime on the Profile of Mood States vigor scale were significantly higher.     

Patient Education in 20 Dutch Community Pharmacies: Analysis of Audiotaped Patient Contacts

The level of patient education activity in Dutch community pharmacies was examined. A total of 200 hours' audiotapes of pharmacy patient contacts were collected in a selective sample of 20 community pharmacies. All pharmacists involved were selected on the basis of their interest in developing patient education in their pharmacies. The outcome measure was the percentage of patient contacts which included the provision of oral drug information. Both pharmacists and technicians participated in the audiotapes and their behaviour at the counter was compared. The results demonstrated that the provision of oral drug information was concentrated on contacts where patients collected drugs, and the contents of the information mainly concerned drug instructions. The pharmacists provided significantly more frequent oral drug information than the technicians. No differences were found in the frequency of provision of oral drug information to female and to male patients, or to patients and to relatives collecting the drug. Mostly the oral drug information was given without patients' questioning. The effects of these kind of activities on patients' drugs use are questioned because it is known that efforts to increase patient compliance should meet the educational principles of individualisation. Therefore, the development of patient instruction into patient education remains a challenge to pharmacists in the future.     

Pharmacokinetics of once-daily theophylline dose following the morning versus evening administration

The pharmacokinetics of theophylline (Uniphyllin) in blood and saliva was compared after morning and evening administration of a once-daily dose in a randomized cross-over study. Ten bronchial asthma patients received multiple doses of 800 mg theophylline at 8 a.m. and 8 p.m. under controlled food conditions. The precision of the serum concentration prediction from salivary measurements in individual patients was sufficient to obtain identical pharmacokinetic parameters and parallel concentration-time curves. There were no significant differences in the values of mean residence time and area under the concentration-time curves after morning and evening dosing, either in the kinetics of elimination and in the volume of distribution. The fluctuation of concentrations during the dosing intervals was 100% after morning doses and 80% after evening doses. No consistent interference with food was found. Circadian variation in the kinetics of drug disposition after once-daily theophylline administration did not occur. In order to achieve higher therapeutical levels at night and in the morning, the evening dosing seems to be preferable.     

Behavioral effects of oral versus intravenous administration of diazepam

The behavioral effects of oral versus intravenous administration of diazepam were studied in 50 volunteers using a battery of memory, cognitive, mood and psychomotor tests repeated over a 4.5 hr period. Subjects received diazepam 0.2 mg/kg or placebo as capsules, commercial tablets or intravenous solution in a randomized double blind manner. While a quick onset of effects occurred with intravenous administration followed by the capsule and tablet oral administrations in that order, the recovery rate was similar for the 3 methods of administration. Contrary to many claims in the literature the effects of oral administration were substantial. Behavioral impairment was directly related to the magnitude of the memory component of the task. On many of the tasks the pattern of diazepam impairment was one of delayed improvement of performance, a pattern which would only be apparent with repeated testing. Subjects who received diazepam showed a paradoxical enhancement of recall for material learned before the drug.     

Two-hour versus six-hour administration of amphotericin B in the treatment of kala-azar

In a randomised study, 50 parasitologically confirmed cases of kala-azar were allocated to two treatment groups: group A received amphotericin B in 5% glucose infusion for 6 h and group B for 2 h. Amphotericin B was given at an initial dosage of 0.05 mg/kg body weight, increasing to 1 mg/kg body weight on day 5, and this dose was given daily until patients had received a total of 20 mg/kg body weight. Toxicities like rise in serum creatinine, fall in serum potassium levels and diminution in appetite were no different in the two groups. There was no difference in clinical, parasitological and ultimate cures between the two groups. Man-hours spent in treating patients in the 2-h infusion group were one-third of the time with the 6-h infusion group. It was concluded that 2-h infusion of amphotericin B caused fewer infusion-related toxicities (shivering and fever) and saved time spent in treating patients; hence it should be recommended for use.     

Steady-state disposition of diflunisal: once- versus twice-daily administration

To evaluate the steady-state bioequivalence of the nonsteroidal antiinflammatory analgesic agent, diflunisal, administered once versus twice daily, 13 healthy volunteers received diflunisal as follows: 1000 mg at 8:00 AM and 500 mg at 8:00 AM and 8:00 PM, each for 14 days in a randomized crossover study. The mean (+/- SD) steady-state peak plasma concentrations were significantly greater after once-daily dosing (186 +/- 25 micrograms/ml vs 150 +/- 37 micrograms/ml; p less than 0.01). The time to peak concentration was also longer after the single-dose regimen (2.5 +/- 0.8 vs 1.9 +/- 0.9 hr; p less than 0.05). The regimens were similar with respect to the mean 24-hour area under the plasma concentration-time curve at steady state (2839 +/- 612 vs 2782 +/- 778 micrograms.hr.ml-1), steady-state plasma concentrations (118 +/- 25 vs 116 +/- 32 micrograms/ml), trough plasma concentration (85 +/- 27 vs 92 +/- 28 micrograms/ml) as well as 24-hour urinary excretion (776 +/- 79 vs 771 +/- 89 mg) of diflunisal. Based on urinary recoveries, the bioequivalence ratio (once vs twice daily) was 1.01 +/- 0.08. These results indicate that diflunisal administered once daily might offer comparable therapeutic effects but be more convenient than a twice-daily regimen.     

Competency development for pharmacy: Adopting and adapting the Global Competency Framework

BackgroundWith current accelerated changes in the role of the pharmacists across different sectors, evidence-based developmental tools are needed to re-define the scope of practice for early career pharmacists (foundation level) and to support pharmacists’ career development. This study aimed to develop a foundation competency framework for pharmacists in Kuwait using the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) in an adopt and adapt approach.MethodsA 4-phase adopt and adapt approach was followed to develop the Kuwait Foundation Competency Framework (KFCF). Phase one involved translating the FIP GbCF, into Arabic using parallel translation. Phase two utilises 2 consensus panels validation involving pharmacists from public and private sectors. Phase three involved a national survey to all registered pharmacists in Kuwait. The final phase involved focus groups with pharmacists and a consensus panel validation with key policy and decision makers in the pharmacy practice and education sectors in Kuwait. Qualitative data were thematically analysed, while quantitative data were analysed using IBM SPSS Statistics for Windows.ResultsThe translation phase yielded a bilingual framework that could be utilised by pharmacists in Kuwait. The initial validation phase identified 70 behavioural statements (out of the GbCF's 100) as ‘highly relevant’ or ‘relevant’ to pharmacy practice in Kuwait. Findings from the national survey identified a list of behaviours that could be adapted in Kuwait context as well as competencies that were perceived as least relevant to Kuwait practice. The final validation phase generated a list of 98 behavioural statements to be included in the KFCF along with recommendations and an action plan to facilitate the adaptation of the framework.ConclusionThis study presents the first bilingual (Arabic/English) pharmacy foundation competency framework that builds on the FIP GbCF. The KFCF could be utilised as a developmental tool to support pharmacists’ performance at foundation level.     

Enhanced bioavailability of triazolam following sublingual versus oral administration

The rate and extent of the absorption of triazolam following sublingual and oral administration were evaluated in this study. Eight healthy volunteers received triazolam 0.5 mg in a commercially available tablet, by sublingual and oral routes on two occasions in random sequence. Plasma triazolam concentrations during 24 hours after each dose were measured by electron-capture gas-liquid chromatography. The mean total area under the curve for sublingual administration was significantly larger than that following oral dosage (28.9 vs 22.6 ng-hr/mL, P less than .025). The peak plasma concentration after sublingual dosage was also higher than after oral administration (4.7 vs 3.9 ng/mL, P less than .1). No significant differences between sublingual and oral administration were found for the elimination half-life of triazolam (4.1 vs 3.7 hr) and the time of peak concentration (1.22 vs 1.25 hr) after dose. Thus, the bioavailability of triazolam after sublingual administration is increased by an average of 28% compared with oral administration of the same dose, possibly because first-pass extraction is bypassed. Clinical effects of triazolam may likewise be enhanced by sublingual dosage.     

Monkey versus human performance in the NCTR Operant Test Battery

A battery of operant behavioral tasks, designed to monitor complex "cognitive" functions in monkeys, was adapted for use in children. Adaptations were then incorporated into the monkey battery so that monkeys and children performed exactly the same tasks. Food pellets served as reinforcers for monkeys; nickels for children. Correct responding in a task is thought to depend upon relatively specific brain functions including short-term memory and attention, learning, time perception, motivation, and color and position discrimination. Eight 4-year-old rhesus monkeys served as subjects, and groups (n = 10 to 20) of 4- to 8-year-old children were recruited if they were not known to have any neurological, academic or behavioral problems. In performance of only the learning task was there any significant difference between monkeys and children. This difference was in response rate (not accuracy), with the monkeys responding faster than children. This lone difference in operant responding between monkeys and children was likely due to the fact that monkeys generally use all four appendages to respond whereas children generally do not.     

Situational theory of leadership

The situational theory of leadership and the LEAD instruments for determining leadership style are explained, and the application of the situational leadership theory to the process of planning for and implementing organizational change is described. Early studies of leadership style identified two basic leadership styles: the task-oriented autocratic style and the relationship-oriented democratic style. Subsequent research found that most leaders exhibited one of four combinations of task and relationship behaviors. The situational leadership theory holds that the difference between the effectiveness and ineffectiveness of the four leadership styles is the appropriateness of the leader's behavior to the particular situation in which it is used. The task maturity of the individual or group being led must also be accounted for; follower readiness is defined in terms of the capacity to set high but attainable goals, willingness or ability to accept responsibility, and possession of the necessary education or experience for a specific task. A person's leadership style, range, and adaptability can be determined from the LEADSelf and LEADOther questionnaires. By applying the principles of the situational leadership theory and adapting their managerial styles to specific tasks and levels of follower maturity, the authors were successful in implementing 24-hour pharmacokinetic dosing services provided by staff pharmacists with little previous experience in clinical services. The situational leadership model enables a leader to identify a task, set goals, determine the task maturity of the individual or group, select an appropriate leadership style, and modify the style as change occurs. Pharmacy managers can use this model when implementing clinical pharmacy services.     

Effects of daytime administration of zolpidem versus triazolam on memory

To determine whether zolpidem (an imidazopyridine hypnotic) produces amnestic effects which are similar to those produced by triazolam (a benzodiazepine hypnotic), 70 subjects were administered either triazolam (0.125, 0.25, or 0.5 mg), zolpidem (5, 10 or 15 mg) or placebo, then tested on Simulated Escape, Restricted Reminding, and Paired-Associates memory tests at 1.5 hours post-dosing (i.e., near the time of estimated peak blood concentration for both drugs) and again at 6 hours post-dosing. Triazolam 0.5 mg produced the greatest memory impairment at both test times, and also produced the greatest degree of sedation during intervening daytime naps in a non-sleep-conducive environment. Other doses of triazolam and zolpidem produced less memory impairment, but also failed to significantly enhance sleep. The results are consistent with the view that the amnestic and hypnotic effects of these sleep-inducing medications are functionally coupled.     

Comparison of separate versus simultaneous administration of potassium supplement with the diuretic bumetanide

Summary

During an 8-month crossover trial, 20 patients with chronic heart failure were treated foil-monthly periods with either bumetanide plus potassium supplement given simultaneously as a combined tablet, or bumetanide given separately and the potassium supplement then given later in the day. Patients received each regimen twice. Both treatments provided 1?mg bumetanide and approximately 16 mmol potassium daily. Potassium status of patients was followed clinically and by determinations of plasma potassium and blood cell potassium. The combined tablet appeared to avoid potassium depletion as effectively as the regimen using separate tablets. Since the combined tablet also ensures that the potassium supplement is actually taken and reduces the number of tablets a patient has to remember to take, it is concluded that it is to be preferred in patients with chronic heart failure.