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Exploring the Multiplicity of Embodied Agency in Colombian Assisted Reproduction
No full textAnalyses of assisted reproductive technologies have demonstrated how objectification and agency can coexist in infertility centres. How objectification creates opportunities for empowerment, however, has not yet been explored. In analysing women’s narratives of assisted conception in Colombian infertility clinics, I demonstrate the complexity in women’s embodied experiences of various objectifying stages of assisted conception and argue that their experiences produced multiple forms of embodied agency. Women used diagnostic procedures to learn about their bodies and infertility complications, which augmented their authority over their bodies and treatment. They drew upon their embodied knowledge to reduce treatment anxieties, while sensations such as pain were made purposeful, and hence meaningful, as women strove to reconfigure the significance of the embodied sensations of conception in a context of medicalized reproduction. In these narratives, we see that lived bodies are productive agents of social change, generating meanings and working to reshape dominant social understandings
What\u27s new in academic medicine? Focus on evolving models of competence in Graduate Medical Education
No full textComparative risk of musculoskeletal adverse reactions among new users of dipeptidyl peptidase-4 inhibitors: A retrospective cohort study
No full textBackground: The effects of dipeptidyl peptidase-4 inhibitors (DPP4Is) on joint pain have been controversial. Objective: To assess the comparative musculoskeletal (MSk) risk of DPP4Is vs. non-DPP4Is. Methods: This study used a national claims database from January 2007 to December 2014. Exposure included the initiation of DPP4Is against the initiation of non-DPP4Is: metformin, sulfonylureas, thiazolidinediones, meglitinides, and glucagonlike peptide-1 receptor agonists (GLP-1 RAs). Insulin was not included in this study. Outcomes were newly diagnosed MSk conditions (arthralgia, arthropathy, and rheumatoid arthritis or other inflammatory polyarthropathies). Individuals exposed to DPP4Is were matched to those exposed to non-DPP4Is using a propensity score (PS). Balance between the DPP4I\u27s group and the non-DPP4I\u27s group was assessed using standardized differences for both continuous and categorical variables. Cox regressions were used to estimate hazard ratios (HRs) for MSk conditions. Results: Among PS-matched cohorts, incidence rates (IRs) for MSk conditions did not differ between DPP4I initiators and non-DPP4I initiators (HR = 1.01, 95% CI: 0.97–1.05). After stratifying non-DPP4Is by drug class, the results still showed that DPP4I initiators had similar MSk risk when compared to initiators of metformin, sulfonylureas, meglitinides, and GLP-1 RAs. However, thiazolidinedione initiators had higher risk of MSk conditions than DPP4I initiators (HR = 1.05, 95% CI: 1.00–1.10). Conclusions: This head-to-head comparison study estimated comparative MSk risks among different antidiabetic drugs. The risk of MSk conditions among DPP4I initiators were not significantly higher than non-DPP4I initiators
Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features
No full textPreexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present
What does experiential education look like in a global pandemic? Reflecting back and looking forward
No full textPurpose: The purpose of this reflection or wisdom of experience article is to describe and reflect on the impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on experiential education (EE) leadership and teams. Additionally, this reflection will shift the focus from the spring 2020 environment of SARS-CoV-2 to what EE teams and college administration can learn from those experiences. Moving forward, EE teams and administrators can be better equipped to proactively plan for future emergencies. Description: Using the “What? So What? Now What?” model of reflection, this manuscript will broadly describe the experiences of three EE administrators and their teams during the SARS-CoV-2 pandemic. Proposed lessons learned as well as future planning strategies will be presented. Analysis/Interpretation: The world of education was unprepared for the SARS-CoV-2 pandemic, and most sectors were left scrambling to adjust to new models very quickly with no planning or preparation. In the realm of pharmacy education, SARS-CoV-2 caused complete disruption for pharmacy students on rotations, clinical sites, preceptors, and EE teams. In reflecting on spring 2020, much can be gained and applied to future planning efforts so that institutions can be better prepared for future crises. Conclusions/Implications: While still in the pandemic, schools must plan for the coming year. EE teams can work together to prepare for emergencies, craft contingency plans, and build additional capacity into their teams and available rotation offerings
Evaluating the role and value of a clinical pharmacist in a concierge primary care clinic
No full textObjective: To understand the perceived role and value of the clinical pharmacist in a southern Arizona concierge primary care practice (CPCP) by employees. Methods: Semistructured face-to-face interviews were conducted with health care team members employed by the CPCP site in December 2019 and January 2020 for this study. The interviews were audio recorded, transcribed, and thematically analyzed using an inductive approach with ATLAS.ti (version 7). A qualitative assessment was performed by 2 independent reviewers to identify the themes, which included clinical, economic, and humanistic outcomes. Results: Eleven CPCP employees were interviewed: physicians (n = 2), a nurse practitioner (n = 1), medical assistants (n = 4), and administrative staff (n = 4). The perceived role and value of the clinical pharmacist in this CPCP varied by employee position; yet, all expressed the pharmacist\u27s positive impact on patient care. Five themes were identified. The most common pharmacist roles identified included providing medication knowledge to providers, preventing abuse of controlled substances, monitoring clinical response to medications and adverse drug events, aiding in prior authorizations, educating patients, and providing patient-centered care. Conclusion: These results demonstrate that the integration of a clinical pharmacist into a CPCP can be valuable. This study highlights that the pharmacist was positively received by the physicians and staff. This further supports the value of the pharmacist as a key interprofessional health care team member. Further study is warranted to assess the longitudinal impact of pharmacists’ services in a CPCP
Validity and Reliability of the Student Refractive Error and Eyeglasses Questionnaire - Revised Version in Myopic Children
No full textSIGNIFICANCE Multiple vision-related quality of life (VRQol) instruments exist, but questionnaires designed specifically for myopic children that are appropriate for assessing the impact of refractive error are rare. PURPOSE This study aimed to assess the validity and reliability of the Student Refractive Error and Eyeglasses Questionnaire - Revised (SREEQ-R) in school-aged children with myopia in the United Kingdom. METHODS Community optometrists in the United Kingdom invited children up to the age of 18 years presenting for an eye examination with current or previous reported use of eyeglasses for myopia to complete the SREEQ-R, which consists of 20 specific items divided into two sections each with three response categories. The without glasses section relates to perceptions of uncorrected vision/not wearing glasses, and the with glasses relates to corrected vision/wearing glasses. Rasch analysis was used to explore the psychometric performance (content, construct validity, and reliability) of the questionnaire items and scale using Winsteps software (Winsteps.com. Portland, OR). RESULTS A total of 125 eligible children with a mean ± standard deviation age of 12.7 ± 2.9 years completed the SREEQ-R. All items fit the Rasch model and were retained, and the scale was found to be unidimensional. All children and item infit and outfit mean square statistics fell within the recommended fit criteria. As per the Rasch analysis, the person reliability coefficients were 0.84 and 0.91, whereas item reliabilities were 0.99 and 0.80 for the without glasses and with glasses sections, respectively. The internal consistency for the SREEQ-R was good; Cronbach α values were 0.84 for without glasses and 0.91 for with glasses. CONCLUSIONS The SREEQ-R had satisfactory validity and reliability evidence. Construct validity of the scale was supported to measure the impact of uncorrected and corrected refractive error on vision-related quality of life in myopic school-aged children in the United Kingdom. The SREEQ-R could be used in future studies to evaluate vision-related quality of life in children with myopia
Timing of antibiotic therapy in the ICU
No full textSevere or life threatening infections are common among patients in the intensive care unit (ICU). Most infections in the ICU are bacterial or fungal in origin and require antimicrobial therapy for clinical resolution. Antibiotics are the cornerstone of therapy for infected critically ill patients. However, antibiotics are often not optimally administered resulting in less favorable patient outcomes including greater mortality. The timing of antibiotics in patients with life threatening infections including sepsis and septic shock is now recognized as one of the most important determinants of survival for this population. Individuals who have a delay in the administration of antibiotic therapy for serious infections can have a doubling or more in their mortality. Additionally, the timing of an appropriate antibiotic regimen, one that is active against the offending pathogens based on in vitro susceptibility, also influences survival. Thus not only is early empiric antibiotic administration important but the selection of those agents is crucial as well. The duration of antibiotic infusions, especially for β-lactams, can also influence antibiotic efficacy by increasing antimicrobial drug exposure for the offending pathogen. However, due to mounting antibiotic resistance, aggressive antimicrobial de-escalation based on microbiology results is necessary to counterbalance the pressures of early broad-spectrum antibiotic therapy. In this review, we examine time related variables impacting antibiotic optimization as it relates to the treatment of life threatening infections in the ICU. In addition to highlighting the importance of antibiotic timing in the ICU we hope to provide an approach to antimicrobials that also minimizes the unnecessary use of these agents. Such approaches will increasingly be linked to advances in molecular microbiology testing and artificial intelligence/machine learning. Such advances should help identify patients needing empiric antibiotic therapy at an earlier time point as well as the specific antibiotics required in order to avoid unnecessary administration of broad-spectrum antibiotics
Pharmacist led vaccination rates in opioid addicted obstetric patients
No full textObjective: To evaluate whether patients seen at the Women\u27s and Infants Substance Help Center (WISH) are in compliance with the 2016 Advisory Committee on Immunization Practices (ACIP) recommendations for influenza, tetanus/diphtheria/pertussis (Tdap), pneumococcal-23, hepatitis A, hepatitis B, and human papillomavirus (HPV) vaccines. Methods: In a retrospective cross-section chart review, all patients with at least two WISH visits from September 1, 2014 to January 22, 2017 were included in the analysis. The primary objective evaluated compliance with ACIP recommendations. Data extraction included baseline demographics, patient-specific vaccine indications, and vaccine history. Results: Ninety-nine patients receiving buprenorphine (n = 80), methadone (n = 14), or no therapy (n = 5) from September 1, 2014 to January 22, 2017 were included. On average, patients were 28 years old and had the first visit at 19 gestational weeks (range 6-35). Overall, WISH vaccination compliance was high for influenza (66%) and Tdap (86%) as well as the initial doses of hepatitis A (80%), hepatitis B (77%), and HPV (46%) vaccines. No difference was found between patients receiving buprenorphine and methadone. Patients who had at least 1 pharmacist consultation (n = 90) had significantly higher compliance with the initial doses of hepatitis A (92.1% vs 22.2%, P \u3c.0001) and hepatitis B (86.4% vs 11.1%, P \u3c.0001), and influenza vaccines (71.6% vs 33.3%, P \u3c.0001) compared to those who did not (n = 9). Common reasons for vaccine non-compliance were patient refusal, did not return to the clinic, or missed opportunity by the non-pharmacist healthcare professional. Conclusions: Overall clinic vaccination rates were high and implies that pharmacy intervention significantly increased administration rates for hepatitis A, hepatitis B, and influenza vaccines. Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT 03039725
Validation of a pre-/post-survey to measure change in student social justice attitudes and empathy
No full textIntroduction: Despite endorsement by the Center for the Advancement of Pharmacy Education (CAPE), doctor of pharmacy (PharmD) students are infrequently taught concepts related to social justice and empathy in a formal capacity. In addition, no validated measure exists to examine changes in these attitudes. Therefore, we tested the ability of a survey to predict changes in social justice and professional empathy attitudes in PharmD students. Methods: Retrospective pre-/post-data collected from PharmD students who completed a population health course at two schools of pharmacy were used to assess validity and reliability of the Social Justice and Empathy Assessment (SJEA) survey. A partial-credit Rasch model was used to test for uni-dimensionality, person and item fit, and rating scale functioning, as well as construct and content validity. Multiple linear regression was used to assess the effect of demographic covariates on the extent of pre-/post-change. Results: Of 396 participating students, 60% were non-Hispanic White and 57% were male. The scale demonstrated evidence of uni-dimensionality of a construct designated “social justice self-efficacy.” The rating scale functioned best as a three-option scale. Four items were removed to optimize person-item distribution, though few items were difficult to endorse. Attending the private school was significantly associated with increased pre-/post-change. Conclusions: The SJEA is functional as a criterion-referenced assessment to determine whether minimum competency in social justice self-efficacy is experienced before or after participation in a CAPE-informed educational program. Further research should explore contextual predictors of change in social justice self-efficacy