Evaluation of Hypertensive Patients after Care Provided by Community Pharmacists in a Rural Setting

We evaluated blood pressure control, quality of life, quality of care, and satisfaction of patients who were monitored by specially trained community pharmacists in a group medical practice. After participating in an intensive skill development program, pharmacists performed in an interdisciplinary team in a rural clinic. The primary objective was assessed by evaluating outcome variables at 6 months compared with baseline in 25 patients randomly assigned to a study group. A control group of 26 patients was also evaluated to determine if outcome variables remained constant from baseline to 6 months. Systolic blood pressure was reduced in the study group (151 mm Hg baseline, 140 mm Hg at 6 mo, p<0.001) and diastolic blood pressure was significantly lower at 2, 4, and 5 months compared with baseline. Ratings from a blinded peer review panel indicated significant improvement in the appropriateness of the blood pressure regimen, going from 8.7 ± 4.7 to 10.9 ± 4.5 in the study group (p<0.01), but they did not change in the control group. Several quality of life scores improved significantly in the study group after 6 months (p<0.05). These included physical functioning (61.6 vs 70.7), physical role limitations (56.8 vs 72.8), and bodily pain (60.0 vs 71.7) at baseline and 6 months, respectively. There were no significant changes in the control group. Patient satisfaction scores were consistently higher in the study group at the end of the study. Our results indicate that when community pharmacists in a clinic setting are trained and included as members of the primary care team, significant improvements in blood pressure control, quality of life, and patient satisfaction can be achieved.     

Cognitive consequences of early phase of literacy.

The effect of the degree of illiteracy (complete or incomplete) on phonological skills, verbal and visual memory and visuospatial skills is examined in 97 normal Brazilian adults who considered themselves illiterate, and 41 Brazilian school children aged 7 to 8 years, either nonreaders or beginning readers. Similar literacy effects were observed in children and in adults. Tasks involving phonological awareness and visual recognition memory of nonsense figures distinguish the best nonreaders and beginning readers. Children performed better than adults at oral repetition of short items and figure recall, and adults better than children at semantic verbal fluency, digit span, and word list recall. A principal component analysis of the correlations between tasks showed that phonological awareness/reading, phonological memory/oral repetition, and semantic verbal memory/fluency tasks, generated different components. The respective role of culturally based preschool activities and literacy on the cognitive functions that are explored in this study is discussed.     

Pregnant Adolescents With Addictions

Adolescence is the most formative time in the lives of women. During this time girls are making choices that have implications for the rest of their lives. Adolescence also can be a time when the negative impact of sexual and physical abuse from childhood begins to take its toll, contributing to adolescent pregnancy and substance abuse. In the last decade the incidences of pregnancy and drug use in the adolescent population have increased, with 80% of teenagers reported being sexually active by the age of 19 years and 80% of high school seniors reporting use of alcohol; 64% reporting smoking; and 41 % reporting marijuana use in 1995. Nurses working with pregnant adolescents must screen for substance abuse problems and physical abuse. If problems are identified, the nurse should refer the adolescent for counseling.     

TREATMENT OF PSEUDALLESCHERIA BOYDII INFECTION WITH ORAL KETOCONAZOLE AND TOPICAL MICONAZOLE

Skin infection in a man immunosuppressed by corticosteroid treatment was found to be due to Pseudallescheria boydii. Although treatment is often unsatisfactory, infection in this patient responded well to oral ketoconazole and topical miconazole.