Impact of pharmacist interventions during transition of care in older adults to reduce the use of healthcare services: A scoping review

BackgroundCurrent literature has shown increasing risk of error in transition of care between different healthcare settings, especially in the older population. Moreover, drug-related hospital readmission has been reported due to lack of appropriate communication. However, the literature is not clear about the impact of pharmacist interventions during transition of care of older adults on the reduction in use of healthcare services.ObjectiveThe goal of the scoping review was to describe the impact of pharmacist interventions during transitions of care for older adults on the use of healthcare services.MethodsMEDLINE was searched for randomized controlled trials and controlled studies that analyzed pharmacist interventions during transition of care of older adults with regard to use of healthcare services. Four reviewers, grouped in pairs, independently screened all references published from 1990 to 2019 and extracted and analyzed the data. A pharmaceutical model of 8 pharmacist-led interventions was adapted from literature to compare the included studies.ResultsThere were 1527 publications screened, 17 of which met inclusion criteria. Pharmacist-led interventions decreased the use of healthcare services in 11 of these studies. The majority of studies were of very good or good quality based on Mixed Methods Appraisal Tool. Pharmacist were implicated at all times during the transition of care process (i.e. admission/during stay, discharge and post-discharge) in 4 of the effective studies, whereas none did in the not effective studies. More interventions were accomplished by pharmacists in studies with positive outcomes.ConclusionBy diversifying their interventions at different moments throughout transition of care, pharmacists can reduce the use of healthcare services for older adults during transition of care. This scoping review also shows the need to better understand key components of post-discharge interventions and to have a dynamic pharmaceutical model accepted by the scientific community.     

Systematic review of the health benefits of physical activity and fitness in school-aged children and youth

Background  

The purpose was to: 1) perform a systematic review of studies examining the relation between physical activity, fitness, and health in school-aged children and youth, and 2) make recommendations based on the findings.     

Using reflective learning to improve the impact of continuing education in the context of work rehabilitation

Reflective learning has been described as a promising approach for ameliorating the impact of continuing education (CE) programs. However, there are still very few studies that have investigated how occupational therapists use reflection to improve the integration of CE program content in their decision-making processes. The study objectives were to describe how these professionals, working in the sector of work rehabilitation, used reflective learning to integrate research evidence into their clinical decision-making process and to identify the factors that influenced the reflective learning process. A collaborative research study was conducted. Eight occupational therapists were recruited to participate to the group that was convened for 12 meetings and held during a 15-month period. The strategies used were critical analysis of ill-structured and authentic clinical situations, peer support, reflective journal writing and complementary reading. The group facilitator acted as a research evidence mentor and guided the group process. The data collected was analyzed using the grounded theory method. The reflective learning process, used by the participants, enabled them to change their perspective at six different stages in their decision-making process. The participants developed their ability to use different types of reflective thinking: introspection, concept attainment, self-attribution, problem solving, action planning and reorganization. The factors that most influenced learning were: ease in sharing experience, normative beliefs, coping with negative emotions, perceived self-efficacy, social support and risk taking. Results led to the development of the Model of Research Utilization Grounded in Critical Reflection.     

Risk prediction using genome‐wide association studies

Over the last few years, many new genetic associations have been identified by genome‐wide association studies (GWAS). There are potentially many uses of these identified variants: a better understanding of disease etiology, personalized medicine, new leads for studying underlying biology, and risk prediction. Recently, there has been some skepticism regarding the prospects of risk prediction using GWAS, primarily motivated by the fact that individual effect sizes of variants associated with the phenotype are mostly small. However, there have also been arguments that many disease‐associated variants have not yet been identified; hence, prospects for risk prediction may improve if more variants are included. From a risk prediction perspective, it is reasonable to average a larger number of predictors, of which some may have (limited) predictive power, and some actually may be noise. The idea being that when added together, the combined small signals results in a signal that is stronger than the noise from the unrelated predictors. We examine various aspects of the construction of models for the estimation of disease probability. We compare different methods to construct such models, to examine how implementation of cross‐validation may influence results, and to examine which single nucleotide polymorphisms (SNPs) are most useful for prediction. We carry out our investigation on GWAS of the Welcome Trust Case Control Consortium. For Crohn's disease, we confirm our results on another GWAS. Our results suggest that utilizing a larger number of SNPs than those which reach genome‐wide significance, for example using the lasso, improves the construction of risk prediction models. Genet. Epidemiol. 34: 643‐652, 2010. © 2010 Wiley‐Liss, Inc.     

Sensory Impairment Among Older US Workers

We used 1997–2004 National Health Interview Survey data to evaluate the prevalence of sensory impairment among US workers 65 years and older. Hearing impairment prevalence was 3 times that of visual impairment (33.4% vs 10.2%), and 38% of older workers reported experiencing either impairment. Farm operators, mechanics, and motor vehicle operators had the highest prevalence of sensory impairment. Workplace screening and accommodations, including sensory protection devices for older workers, are warranted given the greater risk for injuries among the sensory impaired.Americans are living longer and are delaying retirement. As a result, the number of older US workers is increasing rapidly, with more than 40 million American workers 65 years and older projected to be in the workforce by 2012.¹ Older age is associated with a higher prevalence of sensory impairment,^2,3 which in turn is associated with an increased risk of occupational injury.^4–6 One public health implication of an increasingly older workforce is a continued rise in workplace injuries. An estimated 3.9 million cases of workplace injuries were reported in 2006,⁷ a disproportionate amount of which were among older employed men.⁸ Research on the prevalence of sensory impairment by occupational and industrial worker groups is needed to identify older US workers in greatest need of workplace accommodations. We examined the prevalence of vision and hearing impairment among older workers with data from a nationally representative sample of US worker groups.     

N-tosyl-L-phenylalanyl-chloromethyl ketone eliminates the increase in caspase-3 and bcl-2 caused by brain injury in the newborn rat

N-Tosyl-L-phenylalanyl-chloromethyl ketone (TPCK) is neuroprotective in rat pups. We measured bcl-2, Bax and caspase-3 to determine the mechanisms. Seven-day-old rats had the right carotid artery ligated and were subjected to 2.5 h of 8% oxygen. Ten mg/kg of PTCK or vehicle was given intraperitoneally 15 min prior to hypoxia. At 24 h after hypoxia the brains were removed. Bcl-2 in the hippocampus increased from 0.149 +/- (SE) 0.023 in the shams to 0.289 +/- 0.037 with injury and vehicle (p < 0.05 vs. shams), which was reduced to 0.177 +/- 0.030 by TPCK ( p < 0.05 vs. vehicle). Bcl-2 in the cortex increased from 0.180 +/- 0.037 in the shams to 0.655 +/- 0.078 with injury and vehicle (p < 0.01 vs. shams), which was reduced to 0.354 +/- 0.035 by TPCK (p < 0.01 vs. vehicle). Bax, measured only in the mitochondrial enriched fraction of the cortex, was unchanged. Caspase-3 activity increased with injury to 245 +/- 38% of baseline in the hippocampus (p < 0.01) and to 261 +/- 69% in the cortex (p < 0.01). Treatment with TPCK reduced this to 132 +/- 16% in the hippocampus (p < 0.01 vs. vehicle) and 140 +/- 14% in the cortex (p < 0.05 vs. vehicle). In this experiment TPCK reduces bcl-2 and caspase-3 concentration in animals who have been shown in our previous studies to be protected by TPCK from hypoxic ischemic brain injury. This is consistent with the hypothesis that TPCK produces neuroprotection by blocking the apoptotic cascade between bcl-2 and caspase-3.     

E-learning optimization: the relative and combined effects of mental practice and modeling on enhanced podcast-based learning—a randomized controlled trial

Enhanced podcasts increase learning, but evidence is lacking on how they should be designed to optimize their effectiveness. This study assessed the impact two learning instructional design methods (mental practice and modeling), either on their own or in combination, for teaching complex cognitive medical content when incorporated into enhanced podcasts. Sixty-three medical students were randomised to one of four versions of an airway management enhanced podcast: (1) control: narrated presentation; (2) modeling: narration with video demonstration of skills; (3) mental practice: narrated presentation with guided mental practice; (4) combined: modeling and mental practice. One week later, students managed a manikin-based simulated airway crisis. Knowledge acquisition was assessed by baseline and retention multiple-choice quizzes. Two blinded raters assessed all videos obtained from simulated crises to measure the students’ skills using a key-elements scale, critical error checklist, and the Ottawa global rating scale (GRS). Baseline knowledge was not different between all four groups (p = 0.65). One week later, knowledge retention was significantly higher for (1) both the mental practice and modeling group than the control group (p = 0.01; p = 0.01, respectively) and (2) the combined mental practice and modeling group compared to all other groups (all ps = 0.01). Regarding skills acquisition, the control group significantly under-performed in comparison to all other groups on the key-events scale (all ps ≤ 0.05), the critical error checklist (all ps ≤ 0.05), and the Ottawa GRS (all ps ≤ 0.05). The combination of mental practice and modeling led to greater improvement on the key events checklist (p = 0.01) compared to either strategy alone. However, the combination of the two strategies did not result in any further learning gains on the two other measures of clinical performance (all ps > 0.05). The effectiveness of enhanced podcasts for knowledge retention and clinical skill acquisition is increased with either mental practice or modeling. The combination of mental practice and modeling had synergistic effects on knowledge retention, but conveyed less clear advantages in its application through clinical skills.     

Exposure of Adult Mice to Environmental Tobacco Smoke Fails to Enhance the Immune Response to Inhaled Antigen

Epidemiologic evidence supports a role for environmental tobacco smoke (ETS) in the occurrence and severity of allergies/asthma. However, neither the precise combination of ETS and allergen exposure nor the mechanism (or mechanisms) by which these factors interact and contribute to asthma induction is known. Animal model studies have failed to establish a convincing relationship between ETS exposure and asthma induction, perhaps because of methodological inadequacies. Here, we tested the hypothesis that ETS inhalation would provoke an asthmatic response by overcoming normal airway tolerance to inhaled antigens. Our protocol combined daily ETS exposure with nose-only sensitization to ovalbumin. Three strains of mice were tested, each with a different level of susceptibility to airway hypersensitivity. Immunological responses were assessed by immunoglobulin production. Airway inflammation was assessed by bronchoalveolar lavage differentials and lung histopathology. Airway hyperresponsiveness was determined by methacholine challenge. The mice produced ovalbumin-specific antibodies following ovalbumin exposure in a strain-dependent manner. Only the A/J mice produced detectable levels of ovalbumin-specific immunoglobulin (Ig) E. Both A/J and BALB/c mice produced ovalbumin-specific IgG1 antibodies. The C57Bl/6 mice did not produce detectable levels of antibodies. The A/J mice also exhibited airway inflammation following ovalbumin exposure. Neither the C57Bl/6 nor the BALB/c mice exhibited signs of airway inflammation. Exposure to ETS failed to enhance ovalbumin-specific antibody production, airway inflammation, or hyperresponsiveness. Together these results indicate that ETS exposure accompanied by nose-only allergen sensitization fails to overcome aerosol tolerance in adult mice.