Pharmacists' perceptions of their practice: a comparison between Alberta and Northern Ireland

Objective To explore how community pharmacists from Alberta, Canada, and Northern Ireland, UK, describe what a pharmacist does and to compare their responses. Methods Two hundred community pharmacists were interviewed using the telephone. The interviewer who introduced himself as a researcher asked two questions about the period over which the participants had been practising pharmacy and the way they describe what a pharmacist does. Responses were categorised into three categories: patient‐centred, product‐focused and ambiguous. Word‐cloud analysis was used to assess the use of patient‐care‐related terms. Key findings Of the responses from community pharmacists in Alberta, 29% were categorised as patient‐centred, 45% as product‐focused and 26% as ambiguous. In Northern Ireland, 40% of the community pharmacists' responses were categorised as patient‐centred, 39% as product‐focused and 21% as ambiguous. Community pharmacists in Northern Ireland provided more patient‐centred responses than community pharmacists in Alberta (P = 0.013). The word‐cloud analysis showed that ‘medicine’ and ‘dispense’ were the most frequently reported terms. It also highlighted a relative lack of patient‐care‐related terms. Conclusions The findings of the present study are suggestive of some movement towards patient‐centredness; however, product‐focused practice still predominates within the pharmacy profession in Alberta and Northern Ireland. The relative lack of patient‐care‐related terms suggests that patient care is still not the first priority for pharmacists in both Alberta and Northern Ireland.     

Plasma Flt-3 ligand concentration correlated with radiation-induced bone marrow damage during local fractionated radiotherapy

PURPOSE: To determine whether variations in the plasma Flt-3 ligand (FL) concentration after radiotherapy (RT) may serve as a biomarker for radiation-induced bone marrow damage. METHODS AND MATERIALS: Twenty-seven patients were followed during RT. The irradiated bone marrow volume was determined. The blood cell counts and plasma FL concentrations were evaluated before and after RT. The expression of membrane-bound FL and mRNA expression were also defined in circulating blood cells. RESULTS: We found a negative correlation between the plasma FL concentration and the number of circulating white blood cells and platelets during RT. Moreover, the overall amount of FL in the blood of patients during RT correlated directly with both the cumulated radiation dose and the proportion of irradiated bone marrow. CONCLUSIONS: We demonstrated that the variations in plasma FL concentration directly reflect the radiation-induced bone marrow damage during fractionated local RT. We suggest a possible use for FL monitoring as a means to predict the occurrence of Grade 3-4 leukopenia or thrombocytopenia during the course of RT.     

Cost-effectiveness of propofol anesthesia using target-controlled infusion compared with a standard regimen using desflurane.

The cost-effectiveness of propofol anesthesia using target-controlled infusion (TCI) versus a standard regimen using desflurane for anesthesia maintenance was analyzed. This observational study consisted of 100 inpatients 18 to 75 years old with an American Society of Anesthesiologists physical status of I or II who were scheduled for otological surgery lasting less than four hours. Patients received one of two treatments. The desflurane-maintenance group received propofol 2-4 mg/kg and sufentanil 0.15-0.30 microg (as the citrate)/kg. A constant fresh gas flow of 1 L/min was used during maintenance of anesthesia. The propofol-maintenance group received TCI propofol and an additional infusion of sufentanil. Anesthesia was induced with 0.15-0.30 microg/kg. One blinded evaluator assessed the postoperative recovery from anesthesia for all patients. The cost of drugs and medical devices used during the intraoperative and postoperative periods was calculated. Effectiveness was defined as the absence of postoperative nausea and vomiting (PONV), while the cost-effectiveness of each procedure was the cost per PONV-free episode. The efficiency of each procedure represented the production of effectiveness per dollar invested. Chi-square and t tests, sensitivity analysis, and logistic regression were also performed. The only intergroup difference detected was the frequency of PONV occurring in the early recovery phase (11 in the desflurane group versus 2 in the propofol group). Of those patients requiring antiemetic rescue, 9 were in the desflurane group and only 2 were in the propofol group (p < 0.05). The TCI propofol regimen was more expensive than the desflurane regimen ($45 versus $28 per patient, respectively) (p < 0.001). The differential cost-effectiveness ratio was $94.7 per PONV-free episode. PONV 24 hours after surgery and patient satisfaction were similar between groups. A standard regimen of desflurane was more cost-effective than TCI propofol for anesthesia maintenance in achieving PONV-free episodes.     

Involvement of sinoaortic afferents in renal sympathoinhibition and vasodilation induced by acute hypernatremia

Despite the abundance of evidence that supports the important role of aortic and carotid afferents to short‐term regulation of blood pressure and detection of variation in the arterial PO₂, PCO₂ and pH, relatively little is known regarding the role of these afferents during changes in the volume and composition of extracellular compartments. The present study sought to determine the involvement of these afferents in the renal vasodilation and sympathoinhibition induced by hypertonic saline (HS) infusion. Sinoaortic‐denervated and sham male Wistar rats were anaesthetised with intravenous (i.v.) urethane (1.2 g/kg body weight (bw)) prior to the measurement of the mean arterial pressure (MAP), renal vascular conductance (RVC) and renal sympathetic nerve activity (RSNA). In the sham group, the HS infusion (3 mol/L NaCl, 1.8 mL/kg bw, i.v.) induced transient hypertension (12 ± 4 mmHg from baseline, peak at 10 min; P < 0.05), an increase in RVC (127 ± 9% and 150 ± 13% from baseline, at 20 and 60 min respectively; P < 0.05) and a decrease in RSNA (?34 ± 10% and ?29 ± 5% from baseline, at 10 and 60 min respectively; P < 0.05). In sinoaortic‐denervated rats, HS infusion promoted a sustained pressor response (30 ± 5 and 17 ± 6 mmHg of baseline values, at 10 and 30 min respectively; P < 0.05) and abolished the increase in RVC (85 ± 8% from baseline, at 10 min) and decrease in RSNA (?4 ± 3% from baseline, at 10 min). These results suggest that aortic and carotid afferents are involved in cardiovascular and renal sympathoinhibition responses induced by acute hypernatremia.     

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands

Background  

In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands.     

Evaluation of Visual Acuity,Macular Thickness,and Level of Proteinuria in Children with Nephrotic Syndrome

PurposeMacular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria.MethodsThe comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map.ResultsThe mean foveal thickness was 238.15 ± 22.98 μm for children with nephrotic syndrome and 237.01 ± 22.60 μm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = − 0.41, p = 0.019), the nasal outer macula (r = −0.41, p = 0.019), and the inferior outer macula (r = −0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness.ConclusionsThe mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.     

1 282名驾驶员焦虑水平与危险驾驶关系研究

[摘要] 目的 探讨驾驶员焦虑水平对危险驾驶行为的关系。方法 采用问卷调查法,分别使用贝克焦虑量表与 Dula危险驾驶行为量表( DDDI-Dula Dangerous Driving Index)对1285名驾驶员的焦虑水平与危险驾驶行为进行了评价。此外,研究分析两者之间的相关性,对不同焦虑水平驾驶员的危险行为进行方差分析。 结果 （1）焦虑总分与危险驾驶量表总分呈显著性正相关（p<.01）,焦虑总分与危险驾驶量表的三个子量表分数均呈显著性正相关（p<.01）。（2）由F检验知,处于不同焦虑水平的驾驶员其危险驾驶行为在以下方面存在不同（p<.05）：DDDI总分,过去6个月的驾驶肇事次数,过去两个周 "尾随"行为的次数,过去两周内超速的次数,过去两周内超速驶入应停车减速的区域的次数,过去四周影响下驾驶行为的次数。结论 驾驶员的焦虑水平可以影响危险驾驶行为,高的焦虑水平与更多的危险驾驶行为显著相关。     

Effects of Sintering Temperature Variation on Synthesis of Glass-Ceramic Phosphor Using Rice Husk Ash as Silica Source

In this study, the authors attempted to propose the very first study on fabrication and characterization of zinc-boro-silicate (ZBS) glass-ceramics derived from the ternary zinc-boro-silicate (ZnO)_0.65(B₂O₃)_0.15(RHA)_0.2 glass system through a conventional melt-quenching method by incorporating rice husk ash (RHA) as the silica (SiO₂) source, followed by a sintering process. Optimization of sintering condition has densified the sintered samples while embedded beta willemite (β-Zn₂SiO₄) and alpha willemite (α-Zn₂SiO₄) were proven in X-ray diffraction (XRD) analysis. Field emission scanning electron microscopy (FESEM) has shown the distribution of willemite crystals in rhombohedral shape crystals and successfully form closely-packed grains due to intense crystallization. The photoluminescence (PL) spectra of all sintered ZBS glasses presented various emission peaks at 425, 463, 487, 531, and 643 nm corresponded to violet, blue, green, and red emission, respectively. The correlation between the densification, phase transformation, microstructure, and photoluminescence of Zn₂SiO₄ glass-ceramic phosphor is discussed in detail.