Information Technology Development Needs in Community Pharmacies : A Strategic Approach

In the context of health care, information technology (IT) has an important role in the operational infrastructure, ranging from business management to patient care. An essential part of the system is medication management in inpatient and outpatient care. Community pharmacists strategy has been to extend practice responsibilities beyond dispensing towards patient care services. Few studies have evaluated the strategic development of IT systems to support this vision. The objectives of this study were to assess and compare independent Finnish community pharmacy owners and staff pharmacists priorities concerning the content and structure of the next generation of community pharmacy IT systems, to explore international experts visions and strategic views on IT development needs in relation to services provided in community pharmacies, to identify IT innovations facilitating patient care services and to evaluate their development and implementation processes, and to assess community pharmacists readiness to adopt innovations. This study applied both qualitative and quantitative methods. A qualitative personal interview of 14 experts in community pharmacy services and related IT from eight countries and a national survey of Finnish community pharmacy owners (mail survey, response rate 53%, n=308), and of a representative sample of staff pharmacists (online survey, response rate 22%, n=373) were conducted. Finnish independent community pharmacy owners gave priority to logistical functions but also to those related to medication information and patient care. The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies. A majority of the international experts shared the vision of community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Community pharmacy IT innovations were rare, which is paradoxical because owners and staff pharmacists perception of their innovativeness was seen as being high. Community pharmacy IT systems development processes usually had not undergone systematic needs assessment research beforehand or evaluation after the implementation and were most often coordinated by national governments without subsequent commercialization. Specifically, community pharmacy IT developments lack research, organization, leadership and user involvement in the process. Those responsible for IT development in the community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies. This could provide systematic guidance for future projects to ensure that potential innovations are based on a sufficient understanding of pharmacy practice problems that they are intended to solve, and to encourage strong leadership in research, development of innovations so that community pharmacists potential innovativeness is used, and that professional needs and strategic priorities will be considered even if the development process is led by those outside the profession.

Smoking patterns and lung function : A longitudinal twin study

In many countries, the prevalence of smoking and smokers average cigarette consumption have decreased, with occasional smoking and daily light smoking (1-4 cigarettes per day, CPD) becoming more common. Despite these changes in smoking patterns, the prevalence of chronic obstructive pulmonary disease (COPD), a disorder characterized by a progressive decline in lung function, continues to rise globally. Smoking is the most important factor causing COPD, however, not all smokers develop the disease. Genetic factors partly explain the inter-individual differences in lung function and susceptibility of some smokers to COPD. No earlier research on the genetic and environmental determinants of lung function or on the phenomenon of light smoking exists in the Finnish population. Further, the association between low-rate smoking patterns and COPD remains partly unknown. This thesis aimed to study the prevalence and consistency of light smoking longitudinally in the Finnish population, to assess the characteristics of light smokers, and to examine the risks of chronic bronchitis and COPD associated with changing smoking patterns over time. A further aim was to estimate longitudinally the proportions of genetic and environmental factors that explain the inter-individual variances in lung function. Data from the Older Finnish Twin Cohort, including same-sex twin pairs born in Finland before 1958, were used. Smoking patterns and chronic bronchitis symptoms were consistently assessed in surveys conducted in 1975, 1981, and 1990. National registry data on reimbursement eligibilities and medication purchases were used to define COPD. Lung function data were obtained from a subsample of the cohort, 217 female twin pairs, who attended spirometry in 2000 and 2003 as part of the Finnish Twin Study on Ageing. The genetic and environmental influences on lung function were estimated by using genetic modeling. This thesis found that light smokers are more often female, well-educated, and exhibit a healthier lifestyle than heavy smokers. At individual level, light smoking is rarely a constant pattern. Light smoking, reducing from heavier smoking to light smoking, and relapsing to light smoking after quitting, are among patterns associated with an increased risk of chronic bronchitis and COPD. Constant light smoking is associated with an increased use of inhaled anticholinergics, a medication for CODP. In addition to smoking, other environmental factors influence lung function in the older age. During a three-year follow-up, new environmental effects influencing spirometry values were observed, whereas the genes affecting lung function remained mostly the same. In conclusion, no safe level of daily smoking exists with regard to pulmonary diseases. Even daily light smoking in middle-age is associated with increased respiratory morbidity later in life. Smoking reduction does not decrease the risk of COPD, and should not be recommended as an alternative to quitting smoking. In elderly people, attention should also be drawn to other factors that can prevent poor lung function.

The decline of malaria in Finland – the impact of the vector and social variables

Background: Malaria was prevalent in Finland in the 18th century. It declined slowly without deliberate counter-measures and the last indigenous case was reported in 1954. In the present analysis of indigenous malaria in Finland, an effort was made to construct a data set on annual malaria cases of maximum temporal length to be able to evaluate the significance of different factors assumed to affect malaria trends. Methods: To analyse the long-term trend malaria statistics were collected from 1750–2008. During that time, malaria frequency decreased from about 20,000 – 50,000 per 1,000,000 people to less than 1 per 1,000,000 people. To assess the cause of the decline, a correlation analysis was performed between malaria frequency per million people and temperature data, animal husbandry, consolidation of land by redistribution and household size. Results: Anopheles messeae and Anopheles beklemishevi exist only as larvae in June and most of July. The females seek an overwintering place in August. Those that overwinter together with humans may act as vectors. They have to stay in their overwintering place from September to May because of the cold climate. The temperatures between June and July determine the number of malaria cases during the following transmission season. This did not, however, have an impact on the longterm trend of malaria. The change in animal husbandry and reclamation of wetlands may also be excluded as a possible cause for the decline of malaria. The long-term social changes, such as land consolidation and decreasing household size, showed a strong correlation with the decline of Plasmodium. Conclusion: The indigenous malaria in Finland faded out evenly in the whole country during 200 years with limited or no counter-measures or medication. It appears that malaria in Finland was basically a social disease and that malaria trends were strongly linked to changes in human behaviour. Decreasing household size caused fewer interactions between families and accordingly decreasing recolonization possibilities for Plasmodium. The permanent drop of the household size was the precondition for a permanent eradication of malaria.

Optimal blood glucose regulation of diabetic patients using single network adaptive critics

Diabetes is a long-term disease during which the body's production and use of insulin are impaired, causing glucose concentration level to increase in the bloodstream. Regulating blood glucose levels as close to normal as possible leads to a substantial decrease in long-term complications of diabetes. In this paper, an intelligent online feedback-treatment strategy is presented for the control of blood glucose levels in diabetic patients using single network adaptive critic (SNAC) neural networks (which is based on nonlinear optimal control theory). A recently developed mathematical model of the nonlinear dynamics of glucose and insulin interaction in the blood system has been revised and considered for synthesizing the neural network for feedback control. The idea is to replicate the function of pancreatic insulin, i.e. to have a fairly continuous measurement of blood glucose and a situation-dependent insulin injection to the body using an external device. Detailed studies are carried out to analyze the effectiveness of this adaptive critic-based feedback medication strategy. A comparison study with linear quadratic regulator (LQR) theory shows that the proposed nonlinear approach offers some important advantages such as quicker response, avoidance of hypoglycemia problems, etc. Robustness of the proposed approach is also demonstrated from a large number of simulations considering random initial conditions and parametric uncertainties. Copyright (C) 2009 John Wiley & Sons, Ltd.

Post-seizure EEG fractal dimension of first ECT predicts antidepressant response at two weeks

Background: Duration of seizure by itself is an insufficient criterion for a therapeutically adequate seizure in ECT. Therefore, measures of seizure EEG other than its duration need to be explored as indices of seizure adequacy and predictors of treatment response. We measured the EEG seizure using a geometrical method-fractal dimension (FD) and examined if this measure predicted remission. Methods: Data from an efficacy study on melancholic depressives (n = 40) is used for the present exploration. They received thrice or once weekly ECTs, each schedule at two energy levels - high or low energy level. FD was computed for early-, mid- and post-seizure phases of the ictal EEG. Average of the two channels was used for analysis. Results: Two-thirds of the patients (n = 25) were remitted at the end of 2 weeks. As expected, a significantly higher proportion of patients receiving thrice weekly ECT remitted than in patients receiving once weekly ECT. Smaller post-seizure FD at first ECT is the only variable which predicted remission status after six ECTs. within the once weekly ECT group too, smaller post-seizure FD was associated with remission status. Conclusions: Post-seizure FD is proposed as a novel measure of seizure adequacy and predictor of treatment response. Clinical implications: Seizure measures at first ECT may guide selection of ECT schedule to optimize ECT. Limitations: The study examined short term antidepressant effects only. The results may not be generalized to medication-resistant depressives. (C) 1999 Elsevier Science B.V. All rights reserved.

Reconciling transactional conflicts with compiler's help

Software transactional memory(STM) is a promising programming paradigm for shared memory multithreaded programs. While STM offers the promise of being less error-prone and more programmer friendly compared to traditional lock-based synchronization, it also needs to be competitive in performance in order for it to be adopted in mainstream software. A major source of performance overheads in STM is transactional aborts. Conflict resolution and aborting a transaction typically happens at the transaction level which has the advantage that it is automatic and application agnostic. However it has a substantial disadvantage in that STM declares the entire transaction as conflicting and hence aborts it and re-executes it fully, instead of partially re-executing only those part(s) of the transaction, which have been affected due to the conflict. This "Re-execute Everything" approach has a significant adverse impact on STM performance. In order to mitigate the abort overheads, we propose a compiler aided Selective Reconciliation STM (SR-STM) scheme, wherein certain transactional conflicts can be reconciled by performing partial re-execution of the transaction. Ours is a selective hybrid approach which uses compiler analysis to identify those data accesses which are legal and profitable candidates for reconciliation and applies partial re-execution only to these candidates selectively while other conflicting data accesses are handled by the default STM approach of abort and full re-execution. We describe the compiler analysis and code transformations required for supporting selective reconciliation. We find that SR-STM is effective in reducing the transactional abort overheads by improving the performance for a set of five STAMP benchmarks by 12.58% on an average and up to 22.34%.

Deficits in sensory prediction are related to delusional ideation in healthy individuals.

Motor control strongly relies on neural processes that predict the sensory consequences of self-generated actions. Previous research has demonstrated deficits in such sensory-predictive processes in schizophrenic patients and these low-level deficits are thought to contribute to the emergence of delusions of control. Here, we examined the extent to which individual differences in sensory prediction are associated with a tendency towards delusional ideation in healthy participants. We used a force-matching task to quantify sensory-predictive processes, and administered questionnaires to assess schizotypy and delusion-like thinking. Individuals with higher levels of delusional ideation showed more accurate force matching suggesting that such thinking is associated with a reduced tendency to predict and attenuate the sensory consequences of self-generated actions. These results suggest that deficits in sensory prediction in schizophrenia are not simply consequences of the deluded state and are not related to neuroleptic medication. Rather they appear to be stable, trait-like characteristics of an individual, a finding that has important implications for our understanding of the neurocognitive basis of delusions.

La paz como un signo de estos tiempos : la Iglesia latinoamericana ante la violencia y el aporte de las mujeres a la paz

Resumen: Esta ponencia forma parte del primer Panel Inaugural del II Congreso de Teólogas latinoamericanas y alemanas “Espacios de Paz”, realizado del 28 al 31 de marzo de 2016. Se aborda el tema de la paz como signo de estos tiempos desde tres claves: el contexto latinoamericano, la centralidad de la violencia en los estudios sobre la paz y su relación con las mujeres como constructoras de paz y víctimas de violencia. La reflexión se organiza en dos partes: primero, se analiza el discernimiento teológicopastoral sobre la paz realizado por la Conferencia de Medellín, en un contexto de subdesarrollo e injusticia caracterizados como violencia institucional y pecado estructural; además, se mencionan en forma breve los desafíos de reconciliación que plantearon los procesos de transición que siguieron a los gobiernos militares y a los conflictos armados internos. En la segunda parte, se enfocan algunos valores y esferas de la paz y la violencia –personal, estructural y cultural–, para considerar el concepto secular y cristiano de “pacificación” (peacebuilding) y los aportes teóricos y prácticos de las mujeres en la construcción de la paz en contextos de violencia.

Liberalismo, neutralidad estatal y perfeccionismo : Rawls y su crítica

Resumen: Este artículo expone ciertos ejes del debate contemporáneo en torno al liberalismo político y la neutralidad estatal para intentar una recapitulación crítica que permita arrojar luz sobre la posibilidad de una posición que concilie el respeto a la pluralidad contemporánea y a ciertos principios constitucionales con la no abdicación del rol que la política debe tener en el fomento de la “vida buena” (lo que en la tradición de la filosofía política anglosajona se ha designado como “perfeccionismo”). El artículo explora, al menos preliminarmente, sobre qué premisas se asentaría dicha conciliación, a través del análisis de la justificación del “perfeccionismo” y del tratamiento del tema del paternalismo estatal, la coerción y el fomento. Se analizan las ideas de Rawls así como las de algunos de sus críticos, en especial de Sandel y – sobre todo– de Raz, dado que es un autor que abre las puertas a la posibilidad de un liberalismo “perfeccionista”, fiel a los principios del liberalismo político clásico, pero que abandona la exigencia de “neutralidad” ante distintas concepciones del bien.

Algunas similitudes en el pensamiento de Lev S. Vygotsky y Humberto Maturana

Resumen: Este trabajo presenta información en torno a algunos puntos de encuentro en ciertos aspectos de las teorías del psicólogo ruso Lev S. Vygotsky y las del biólogo chileno Humberto Maturana. Específicamente, muestra sus similitudes en relación a los siguientes temas: la construcción del conocimiento como idea central, la perspectiva genética en sus trabajos, la reconciliación de acciones biológicas y sociales, y la aplicación de sus teorías al campo de la educación. Las posturas de ambos autores desdibujan las líneas que tradicionalmente dividen sus campos de estudio, por lo cual han podido aportar mucho a la teoría y práctica de la educación.

Farmacogenómica : aspectos éticos de la medicina personalizada

Las diferencias genéticas entre individuos (polimorfismos) condicionan los efectos de un fármaco en cuanto a la toxicología (efectos adversos) y farmacoterapia. Nuevas técnicas analíticas permiten estudiar el perfil genético de los individuos. Surge así una nueva disciplina, la Farmacogenómica, que es el estudio del total de genes farmacológicamente relevantes, así como la forma en que dichos genes manifiestan sus variaciones, y de qué manera estas variaciones pueden interaccionar para configurar el fenotipo de cada individuo, en lo que afecta a su respuesta a los medicamentos. La Bioética personalista ofrece un camino de reflexión que acompaña el quehacer científico en la búsqueda de fines verdaderos. En este sentido es fundamental acercar nuevas y mejores curas, así como disminuir el dolor de enfermedades crónicas y terminales, siempre y cuando se eviten nuevas clasificaciones de seres humanos e injusticias a la hora de distribuir los recursos.

Aspectos de la cultura popular en la cultura urbana

El autor nos presenta como desafíos para los tiempos del bicentenario emprender un difícil camino de reconciliación cultural que exige experiencias de historias compartidas y solidaridades vividas. Analiza, en este texto, los fenómenos de colisión y encuentro de la cultura popular y la cultura urbana en el escenario de nuestras ciudades.

Impact of depressive symptoms on subjective well-being: the importance of patient-reported outcomes in schizophrenia

Objective: The subjective experience of psychotic patients toward treatment is a key factor in medication adherence, quality of life, and clinical outcome. The aim of this study was to assess the subjective well-being in patients with schizophrenia and to examine its relationship with the presence and severity of depressive symptoms. Methods: A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. The Subjective Well-Being under Neuroleptic Scale - short version (SWN-K) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to gather information on well-being and the presence and severity of depressive symptoms, respectively. Spearman's rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the CDSS total score. Discriminative validity was evaluated against that criterion by analysing the area under the curve (AUC). Results: Ninety-seven patients were included in the study. Mean age was 35 years (standard deviation = 10) and 72% were male. Both the total SWN-K scale and its five subscales correlated inversely and significantly with the CDSS total score (P < 0.0001). The highest correlation was observed for the total SWN-K (Spearman's rank order correlation [ rho] = -0.59), being the other correlations: mental functioning (-0.47), social integration (-0.46), emotional regulation (-0.51), physical functioning (-0.48), and self-control (-0.41). A total of 33 patients (34%) were classified as depressed. Total SWN-K showed the highest AUC when discriminating between depressive severity levels (0.84), followed by emotional regulation (0.80), social integration (0.78), physical functioning and self-control (0.77), and mental functioning (0.73). Total SWN-K and its five subscales showed a significant linear trend against CDSS severity levels (P < 0.001). Conclusion: The presence of moderate to severe depressive symptoms was relatively high, and correlated inversely with patients' subjective well-being. Routine assessment of patient-reported measures in patients with schizophrenia might reduce potential discrepancy between patient and physician assessment, increase therapeutic alliance, and improve outcome.

Applying Habermas's critical theory to public administration and policy: A case study of Florida Everglades restoration program

The foundation of Habermas's argument, a leading critical theorist, lies in the unequal distribution of wealth across society. He states that in an advanced capitalist society, the possibility of a crisis has shifted from the economic and political spheres to the legitimation system. Legitimation crises increase the more government intervenes into the economy (market) and the "simultaneous political enfranchisement of almost the entire adult population" (Holub, 1991, p. 88). The reason for this increase is because policymakers in advanced capitalist democracies are caught between conflicting imperatives: they are expected to serve the interests of their nation as a whole, but they must prop up an economic system that benefits the wealthy at the expense of most workers and the environment. Habermas argues that the driving force in history is an expectation, built into the nature of language, that norms, laws, and institutions will serve the interests of the entire population and not just those of a special group. In his view, policy makers in capitalist societies are having to fend off this expectation by simultaneously correcting some of the inequities of the market, denying that they have control over people's economic circumstances, and defending the market as an equitable allocator of income. (deHaven-Smith, 1988, p. 14). Critical theory suggests that this contradiction will be reflected in Everglades policy by communicative narratives that suppress and conceal tensions between environmental and economic priorities. Habermas’ Legitimation Crisis states that political actors use various symbols, ideologies, narratives, and language to engage the public and avoid a legitimation crisis. These influences not only manipulate the general population into desiring what has been manufactured for them, but also leave them feeling unfulfilled and alienated. Also known as false reconciliation, the public's view of society as rational, and "conductive to human freedom and happiness" is altered to become deeply irrational and an obstacle to the desired freedom and happiness (Finlayson, 2005, p. 5). These obstacles and irrationalities give rise to potential crises in the society. Government's increasing involvement in Everglades under advanced capitalism leads to Habermas's four crises: economic/environmental, rationality, legitimation, and motivation. These crises are occurring simultaneously, work in conjunction with each other, and arise when a principle of organization is challenged by increased production needs (deHaven-Smith, 1988). Habermas states that governments use narratives in an attempt to rationalize, legitimize, obscure, and conceal its actions under advanced capitalism. Although there have been many narratives told throughout the history of the Everglades (such as the Everglades was a wilderness that was valued as a wasteland in its natural state), the most recent narrative, “Everglades Restoration”, is the focus of this paper.(PDF contains 4 pages)

Preparo e administração de medicamentos por sondas em pacientes que recebem nutrição enteral

O objeto de estudo foi o preparo e a administração de medicamentos por cateter pela enfermagem em pacientes que recebem nutrição enteral. O objetivo geral foi investigar o padrão de preparo e administração dos medicamentos por cateter em pacientes que recebem nutrição enteral concomitante. Os objetivos específicos foram apresentar o perfil dos medicamentos preparados e administrados de acordo com a possibilidade de serem administrados por cateter enteral e avaliar o tipo e a freqüência de erros que ocorrem no preparo e administração de medicamentos por cateter. Tratou-se de uma pesquisa com desenho transversal de natureza observacional, sem modelo de intervenção. Foi desenvolvida em um hospital do Rio de Janeiro onde foram observados técnicos de enfermagem preparando e administrando medicamentos por cateter na Unidade de Terapia Intensiva. Foram observadas 350 doses de medicamentos sendo preparados e administrados. Os grupos de medicamentos prevalentes foram os que agem no Sistema Cardiovascular Renal com 164 doses (46,80%), seguido pelos que agem no Sistema Respiratório e Sangue com 12,85% e 12,56% respectivamente. Foram encontrados 19 medicamentos diferentes do primeiro grupo, dois no segundo e cinco no terceiro. As categorias de erro no preparo foram trituração, diluição e misturas. Encontrou-se uma taxa média de 67,71% no preparo de medicamentos. Comprimidos simples foram preparados errados em 72,54% das doses, e todos os comprimidos revestidos e de liberação prolongada foram triturados indevidamente entre sólidos a categoria de erro prevalente foi trituração com 45,47%, preparar misturando medicamentos foi um erro encontrado em quase 40% das doses de medicamentos sólidos. A trituração insuficiente ocorreu em 73,33% das doses de ácido fólico, do cloridrato de amiodarona (58,97%) e bromoprida (50,00%). A mistura com outros medicamentos ocorreu em 66,66% das doses de bromoprida, de besilato de anlodipina (53,33%), bamifilina (43,47%), ácido fólico (40,00%) e ácido acetilsalicílico (33,33%). Os erros na administração foram ausência de pausa e manejo indevido do cateter. A taxa média de erros na administração foi de 32,64%, distribuídas entre 17,14% para pausa e 48,14% para manejo do cateter. A ausência de lavagem do cateter antes foi o erro mais comum e o mais incomum foi não lavar o cateter após a administração. Os medicamentos mais envolvidos em erros na administração foram: cloridrato de amiodarona (n=39), captopril (n=33), cloridrato de hidralazina (n=7), levotiroxina sódica (n=7). Com relação à lavagem dos cateteres antes, ela não ocorreu em 330 doses de medicamentos. O preparo e administração inadequados de medicamentos podem levar à perdas na biodisponibilidade, diminuição do nível sérico e riscos de intoxicações para o paciente. Preparar e administrar medicamentos são procedimentos comuns, porém apresentou altas taxas de erros, o que talvez reflita pouco conhecimento desses profissionais sobre as boas práticas da terapia medicamentosa. Constata-se a necessidade de maior investimento de todos os profissionais envolvidos, médicos, enfermeiros e farmacêuticos nas questões que envolvam a segurança com medicamentos assim como repensar o processo de trabalho da enfermagem.