Health literacy: Use of the Four Habits Model to improve student pharmacists’ communication

Objective

To assess whether student pharmacists’ communication skills improved using the Four Habits Model (FHM) at the St. Louis College of Pharmacy.

Methods

During the Fall of 2009 and 2010, student pharmacists in the third professional year learned and practiced the FHM. They were given feedback by faculty on three of the four Habits, used the FHM for self and peer assessment, and were formally evaluated on all four Habits during a standardized patient encounter.

Results

Student pharmacist performance significantly improved from baseline during both Fall 2009 and Fall 2010 in the majority of the Habits assessed.

Conclusion

Use of the FHM in pharmacy education can improve a student pharmacists’ ability to display the four Habits of communicating and developing relationships with patients. Tailoring of the FHM to pharmacy encounters will further enhance the utility of this communication framework.

Practice implications

Use of the FHM enhances the measurement and assessment of the relational aspects of student pharmacist–patient communication skills. Consistent use of the FHM over time is likely necessary to fully develop and retain communication skills. The overall goal is to improve patient's health literacy and appropriate medication use by improving communication and the pharmacist–patient relationship.     

Chromosomal Aberrations in Peripheral Lymphocytes of Abstinent Alcoholics

The frequency of structural and/or numerical chromosomal aberrations in human metaphasic cells of lymphocyte cultures from abstinent alcoholics who were abstinent for 1 month up to 32 years was compared with those from controls not selected for alcohol consumption. Cytogenetic analyses revealed a significant increase of the frequencies of cells with structural aberrations in the abstinent alcoholics (7.1 %), compared with controls (2.4%). The frequency of numerical aberrations showed a significant regression on ages in abstinent alcoholics and controls. These results suggest specific action of chronic alcohol consumption impairing biological repair with aging. The increased frequency of chromosome-type aberrations associated with alcohol consumption, even after long withdrawal, could be due to an action of ethanol or its metabolites on primordial leukopoietic cells.     

Hyperhomocysteinemia in healthy young men and elderly men with normal serum folate concentration is not associated with poor vascular reactivity or oxidative stress

The mechanism by which homocysteine (Hcy) causes endothelial dysfunction is probably mediated by oxidative stress. The aim of this study was to evaluate the effect of oxidative stress on endothelial function in young and elderly hyperhomocysteinemic (HHcy) men. A total of 35 HHcy (Hcy > 15 micro mol/L), young (n = 15; 20-40 y) and elderly men (n = 20; > 65 y) and 33 normohomocysteinemic (NHcy; controls) young (n = 14) and elderly (n = 19) men (Hcy < 13 micro mol/L), without classic cardiovascular risk factors were recruited. Serum Hcy, folate, and vitamin B-12, whole-blood glutathione, plasma total antioxidants status, TBARS, and 8-F(2alpha) isoprostanes were determined. Noninvasive ultrasound measurements of endothelium-dependent (EDVR) and -independent dilatation (EIVR) were performed. EDVR, EIVR, and markers of oxidative stress did not differ among the groups. Folate concentrations were higher in elderly than in young men (P < 0.001), independent of Hcy concentrations. Vitamin B-12 concentrations were lower in HHcy than in NHcy elderly men (P < 0.045). EDVR was correlated with folate concentrations in young men (r = 0.40, P = 0.04) and negatively with BMI in elderly men (r = -0.52, P = 0.002). In the present study, HHcy with normal serum folate concentrations was not associated with poor EDVR or oxidative stress in healthy young and elderly men.     

Assessment of sarcopenia: longitudinal versus cross sectional body composition data

BACKGROUND AND AIMS: An accurate diagnosis of sarcopenia is required. The aim of this study is to correlate the results of two methods to define sarcopenia using cross sectional body composition data, with actual loss of fat free mass. METHODS: Healthy older subjects (926 females and 381 males aged 70 years or more) and healthy young adults (425 females and 151 males aged 20 to 40 years) were studied. Body composition was assessed by double beam X ray absorptiometry (DEXA). Among older subjects, a contemporary subsample of 148 females and 45 males had two or more measurements, separated by 4.8+/-1.5 years and loss of fat free mass per year was calculated. In the whole sample, total and appendicular lean body mass index were calculated as total or appendicular lean body mass/height. Using data from young people, sex specific t scores were obtained. In older subjects residuals were derived from a regression equation, using total or appendicular fat free mass as the dependent variable and height, fat free mass and age as independent variables. RESULTS: The concordance between residuals and t scores to define sarcopenia was 68 and 72%, respectively. Among subjects with two or more measurements, men and women lost a mean of 521+/-454 and 221+/-399 g/year of fat free mass, respectively. The odds ratio of losing more than 822 g lean body mass /year among men or 514 g lean body mass /year among women was 2.63 and 2.64 for subjects classified in the two lowest quintiles of sarcopenia, using t scores or residuals, respectively. CONCLUSIONS: Cross sectional body composition data can predict loss of fat free mass among older people.     

Innovations in technology for critical care medicine

SARS (severe acute respiratory syndrome) proved an enormous physical and emotional challenge to frontline health care workers throughout the world in late 2002 through to mid 2003. A large percentage of patients (many being health care workers themselves) became critically ill. Unfortunately, clinicians caring for these individuals did not have the advantage of previous experience or research data on which to base treatment decisions. As a result, at least early in the outbreak, a 'best guess approach' and/or anecdotes drove therapy. In many centres systemic steroids, which carry many potential downsides, became a mainstay of therapy. In this issue of Critical Care, two groups that have frontline experience of SARS debate the role of steroids. Let us hope and pray together that we never have the patient population needed to resolve the questions the two sides raise.     

Acute hepatitis and Brucella melitensis infection: clinicopathological findings

The clinical and pathological findings in a patient who had acute hepatitis caused by Brucella melitensis are described. Antibiotic therapy induced a good clinical and biochemical response, although a relapse occurred. Brucellosis must be considered in the differential diagnosis of pyrexia of unknown origin, particularly if associated hepatic involvement is present. A careful occupational and travel history is essential.