Using the patient activation measure during a pharmacist-led rural patient home visit pilot project

BackgroundMany pharmacists use motivational interviewing as a tool to inspire patients to engage in managing their health. Assessing patient engagement and willingness to actively participate in chronic disease management is a necessary component in improving activation and health outcomes. The patient activation measure (PAM) is a validated assessment tool used to give providers insight into a patient’s level of confidence, knowledge, and skills in self-managing their health. In 2017, 2 pharmacists conducted patient home visits using care coordinators to identify patients who would benefit from pharmacist intervention. The PAM-13 was integrated into the pharmacist-led home visits to collect information on patient activation and engagement in addressing their own health problems.ObjectivesTo describe the implementation of the PAM-13 in pharmacist-led patient home visits and to analyze the collected patient PAM-13 scores and levels to determine whether change occurred after meeting with a pharmacist.MethodsThe PAM was used as part of a pilot program involving pharmacist-led patient home visits to assess drug-related problems within a cohort of high-risk rural patients with uncontrolled chronic conditions.ResultsDuring this 6-month study, PAM-13 scores decreased in 3 patients, increased in 9 patients, and did not change in 2 patients whereas PAM-13 levels decreased in 2 patients, increased in 7 patients, and did not change for 5 patients.ConclusionPAM-13 was used as part of a pilot program involving pharmacist-led patient home visits with a cohort of high-risk rural patients with uncontrolled hypertension and diabetes. PAM-13 is a useful tool that could help pharmacists provide targeted motivational interviewing and medication management by assessing and improving patient activation and engagement.     

Chronic morphine and tramadol re‐exposure induced an anti‐anxiety effect in prepubertal rats exposed neonatally to the same drugs

Anxiety disorders are among the most common mental disorders. Drugs that are often administered to manage medical problems cause rebound anxiety. The use of morphine and tramadol has increased in recent decades. In the present study, the effects of morphine and tramadol exposure during the neonatal and prepubertal periods on anxiety‐like behaviours in prepubertal rats were investigated. Male neonate rats were injected subcutaneously with saline, morphine or tramadol (3–21 mg/kg) on a daily basis from postnatal Day (P) 8 to P14. On P22, rats were divided into seven groups (saline/saline, saline/tramadol, saline/morphine, tramadol/saline, tramadol/tramadol, morphine/saline and morphine/morphine) and were injected with saline, tramadol or morphine for seven consecutive days. All rats were tested in an elevated plus maze (EPM) on P24 (acute effects), P27 (chronic effects) and P29. Locomotor activity was increased by the second and third exposure to the EPM. Re‐exposure to chronic morphine and tramadol resulted in increased locomotor activity, whereas acute and chronic administration of these drugs induced no notable difference. Anxiety decreased markedly after re‐exposure to tramadol and this anxiolytic‐like behaviour was more dominant in EPM re‐exposure in rats that had received higher doses of tramadol. Re‐exposure to tramadol elicited a stronger anxiolytic‐like behaviour than re‐exposure to morphine. It can be concluded that repeated morphine and tramadol administration during the neonatal period followed by re‐exposure to these drugs at an immature stage produces considerable anxiolytic‐like behaviour. Exposure to chronic morphine and tramadol during the neonatal period may affect the developing brain, which may induce long‐term changes in the opioid response.     

Internet Access and Nutritional Intake: Evidence from Rural China

Over the past 4 decades, China has experienced a nutritional transition and has developed the largest population of internet users. In this study, we evaluated the impacts of internet access on the nutritional intake in Chinese rural residents. An IV-Probit-based propensity score matching method was used to determine the impact of internet access on nutritional intake. The data were collected from 10,042 rural households in six Chinese provinces. The results reveal that rural residents with internet access have significantly higher energy, protein, and fat intake than those without. Chinese rural residents with internet access consumed 1.35% (28.62 kcal), 5.02% (2.61 g), and 4.33% (3.30 g) more energy, protein, and fat, respectively. There was heterogeneity in regard to the intake of energy, protein, and fat among those in different income groups. Moreover, non-staple food consumption is the main channel through which internet access affects nutritional intake. The results demonstrate that the local population uses the internet to improve their nutritional status. Further studies are required to investigate the impact of internet use on food consumed away from home and micronutrient intake.     

Gender differences among homeless people in Tehran,Iran

Aim

Gender differences among homeless people may affect the frequency of their risky behaviours. This study was conducted to evaluate the behaviour patterns of homeless men and women in Tehran and compare the probable differences.

Subject and methods

In this study, 593 homeless people were recruited from five centres that house homeless people in Tehran, the capital city of Iran. A researcher-designed questionnaire was used to study behavioural patterns.

Results

In this study, homeless people (513 males and 80 females, all Iranian nationals) were enrolled in the study from June to August 2012. Mean age and mean duration of homelessness among women (35.46 and 12.68 months) were lower than those among men (42.74 and 56.85 months) (p?=?0.001). Although lifetime history of incarceration in men was higher than in women (p?=?0.002), mean duration of imprisonment in the last 10 years in men (21.25 months) and women (17.76 months) was not statistically different (p?=?0.07). Accommodation locality in the past 6 months varied between men and women. Women were current drug users more often than men were (61.53 % versus 45.26 %) (p?=?0.02). The type of drug consumption in women (methamphetamine) differed from that of men (opium and heroin). More men had a history of injecting drugs than did women (30.02 % versus 12.30 %) (p?=?0.003). Condom use at the last sexual encounter was reported to be higher in women compared to men (74.60 % versus 26.62 %) (p?=?0.001).

Conclusion

This study showed notable differences in behaviour patterns between homeless men and women and also indicated that homeless people in Tehran exhibit many risky behaviours.     

Most patients are eligible for an alternative to conventional whole breast irradiation for early‐stage breast cancer: A National Cancer Database Analysis

We evaluated the proportion of patients eligible for alternatives to standard whole breast irradiation (WBI) following breast‐conserving surgery using the National Cancer Database (NCDB). Using the 2016 dataset, Stage I‐III patients were identified. Eligibility for hypofractionated WBI (HFRT), accelerated partial breast irradiation (APBI) and endocrine therapy (ET‐alone) was defined using eligibility from large clinical trials as well as consensus guidelines. For patients with pN0 breast cancer, 20.6% and 37.0% were eligible for ET‐alone based on the CALGB 9343/PRIME‐II trials, respectively. In terms of HFRT, 72.5% and 50.4% were eligible based on IMPORT LOW/ASTRO HFRT guidelines, respectively. Based on IMPORT LOW/GEC‐ESTRO trial/ASTRO guidelines/ABS guidelines/GEC‐ESTRO guidelines, 72.5%, 86.1%, 39.0%, 72.5%, 45.7%, respectively, were eligible for APBI. Of those who qualify for HFRT per ASTRO guidelines, approximately 90% were eligible for APBI and 50% for ET‐alone. This analysis shows that a large proportion of patients with node‐negative breast cancer are eligible for HFRT, APBI and/or ET‐alone after breast‐conserving surgery.