Look-alike sound-alike (LASA) medication errors in Thai hospitals / Errores de medicación por sonido similar (LASA) en hospitales tailandeses

Look-alike sound-alike (LASA) drugs cause a high proportion of medication errors in hospitals. Drug lists available in hospitals are diverse and complicated. Presently, each hospital has its own LASA drug list and unique management strategies to minimize and prevent LASA errors. Objective: This study aimed to explore the prevalence of LASA drug lists, types of LASA drugs, and categories of medication errors in hospitals in Thailand. Methods: For this crosssectional study, questionnaires were developed and distributed along with a letter to 500 government hospitals (selected from a total of 1,309 hospitals) in Thailand via mail from April to June 2021. Data were analyzed using descriptive statistics (frequencies and percentages). Results: A total of 128 hospitals participated in this study (response rate: 25.60%), including 12 tertiary hospitals (9.38%), 33 secondary hospitals (25.78%), 24 large primary hospitals (18.75%), 51 small primary hospitals (39.84%), and eight private hospitals (6.25%). A total of 2,510 pairs of LASA drugs were identified, which included 1,674 (66.69%) tablets/capsules (Simvastatin 10-Simvastatin 20 pair had the highest frequency), 427 injections (17.01%) (Ceftriaxone-Ceftazidime pair had the highest frequency), 85 liquid dosage forms (3.39%) (Milk of magnesia-alum milk pair had the highest frequency), 74 special techniques in medicine (2.95%) (Seretide evohaler®-Seretide accuhaler® pair had the highest frequency), 49 external used drugs (1.95%) (Clotrimazole cream-Clobetasol cream pair had the highest frequency), and 28 powder dosage forms (1.12%) (ORS for pediatrics-ORS for adult pair had the highest frequency). Conclusion: Despite relevant awareness among healthcare professionals, LASA medication errors occur in hospitals. The most frequent similarities among LASA drugs were detected in their names/pronunciations, and the most common errors belonged to Category B.(AU)

Enhancing extemporaneous preparations in Thai Hospitals: exploring variation, common formulations, and challenges and needs related to extemporaneous preparations

Objective: This study aimed to assess the diversity of extemporaneous preparations, identify the prevalent formulations, and highlight the challenges and opportunities for standardization and improvement of extemporaneous preparation practices. Methods: A survey was conducted among 88 Thai hospitals representing the public and private sectors. The questionnaire gathered information on general hospital characteristics, detailed aspects of extemporaneous compounding, and the specific extemporaneous formulations used. Results: The survey revealed significant variations in extemporaneous preparations among Thai hospitals, with oral liquids, semisolids, and eye preparations commonly employed. The primary oral liquid formulations used were suspensions, syrups, and solutions. Specific medications frequently used in extemporaneous preparations were also identified. The challenges encompassed space, personnel, skills, raw materials, equipment, standardized formula information, preparation process information, funding, and other factors. Conclusion: A survey among Thai hospitals revealed significant variations in extemporaneous preparations in 88 participating hospitals. Common formulations used in extemporaneous compounding include oral liquid preparations, such as suspensions, syrups, solutions, semisolid preparations, and eye preparations. Stakeholder involvement, implementation of standardized operating procedures, resource allocation, comprehensive training programs, and collaboration among hospitals, pharmaceutical companies, and regulatory agencies are recommended to enhance extemporaneous compounding practices (AU)

Facilitators and barriers of the rational drug use hospital program in Thailand

The Thailand Ministry of Public Health has started a rational drug use (RDU) policy, which includes multifaceted strategies as well as the RDU hospital program to tackle irrational drug use. Objective: To investigate facilitators and barriers related to the CIPP model of the RDU hospital program in Thailand. Methods: This is a qualitative study. Data were collected through semi-structured interviews with regional policymakers who were members of the executive board for RDU management in the 10th health region. The interviews were conducted via telephone using a topic guide informed by the CIPP framework and reviewed for content validity by the research team. Data were transcribed, and thematically analyzed. Results: Fifteen pharmaceutical policymakers were interviewed. The main facilitators related to context, input, and process were the national policy on RDU, RDU awareness/practices among health professionals, particularly prescribers, and multidisciplinary teamwork under the organization’s leadership to use data feedback to improve the program. The main barriers related to context, input, and process were a lack of policy advocacy at the regional and provincial levels, doctor-related reasons such as medicolegal concerns, and a lack of multidisciplinary teamwork. For the product theme, participants were very satisfied and perceived positive impacts at both the individual and organizational levels, such as increased RDU awareness in patients and multidisciplinary teams, as well as RDU prescription. However, negative impacts, such as tensions surrounding professional responsibility and accountability, have been observed. (AU)

Empowerment interventions for pharmacies to comply with the Good Pharmacy Practice (GPP) in Thailand

Good Pharmacy Practices (GPP) is to provide people with quality pharmacy services as well as to promote drug use safety. Objectives: To find out the effect of the process of empowering modern pharmacies to meet the GPP standards and to investigate the problems and obstacles that affect the pharmacy licensees in complying with the GPP. Methods: An action research using the Deming Cycle (PDCA) to design a process, in collaboration with relevant parties, to promote GPP compliance. The process consisted of a group intervention and an individual intervention designed to be consistent with the SOAP assessment. The action plan was implemented over a 9-month period. The GPP outcomes were assessed. Samples were 32 pharmacy licensees in Nakhon Ratchasima Province, which have not yet passed the GPP assessment. They were randomly selected by the stratified sampling method. Results: After participating in the empowerment process, there were 62.50% or 20 pharmacies passed the GPP assessment in all categories. The average GPP compliance score had statistically significantly higher than before the process (p<0.001). For the satisfaction of the participants, the overall score was at the highest level. Conclusion: The process of empowering modern pharmacies to meet GPP standards showed a positive effect. The rate of pharmacies that passed the GPP criteria also increased. In addition, the participants in the process were highly satisfied. Therefore, the PDCA cycle should be used in pharmacy development. Meanwhile, GPP self-assessment is a tool to help pharmacy licensees in systematic problem resolution. (AU)

Pharmacy licensees and their characters that affect Good Pharmacy Practice (GPP) Compliance

Objective: To study the licensee’s factors that affect the GPP compliance, including problems and obstacles in the improvement of pharmacies. Methods: Samples: 90 of the licensees of the modern pharmacies in Nakhon Ratchasima province that did not pass the GPP evaluation. A cross-sectional analytical research with mixed method was done with 2 parts 1) questionnaire survey to assess the attitude, perception, and perceived difficulty of the GPP based on Theory of planned behavior (TPB). The response rate at 68.89%. 2) Focus group discussion to find the problems and obstacles in pharmacy improvement to meet the GPP requirement. Results: the licensees who were a pharmacist have more compliance with the GPP than the non-pharmacist licensees (p=0.001), and the open on daytime period pharmacies (≥8 hours/day) have more compliance with the GPP than pharmacies that are open for certain hours (p=0.001). Attitude, perception and perceived difficulty of GPP from survey and focus group discussion could use as inputs for initiating an empowerment plan for pharmacy licensees. Conclusion: For the reasons that have more tendency to comply with the GPP than others, the pharmacists should be promoted to be the licensees, as well as responsible for operating the pharmacies. The pharmacy should have a pharmacist stationed 8 hours/day to provide the customers with professional standard service. (AU)

Antenatal depressive symptoms are strongly predicted by the severity of pre-menstrual syndrome: results of partial least squares analysis

Background/Objective: Antenatal depression (AD) is the commonest morbidity during pregnancy. There is evidence that premenstrual syndrome (PMS) and AD share common immune-inflammatory and sex hormonal pathways. This study aims to evaluate the association between the severity of depressive PMS and AD in early and late pregnancy. Method: Participants were followed from early (<=16 weeks) to late pregnancy (>=20 weeks). The Premenstrual Symptoms Screening Tool (PSST) was used to assess PMS and AD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results: Up to 57.6% of the variance in the early EPDS score was explained by the regression on the first factor extracted from 10 depression and anxiety PSST items (dubbed the DepAnx PSST), insomnia PSST, relation dissatisfaction, and partner abuse. There were specific indirect effects of DepAnx PSST (p < 0.001), insomnia PSST (p = 0.041), relation dissatisfaction (p = 0.023) and partner abuse (p = 0.007) on the late EPDS which were mediated by the early EPDS score. Conclusion: The affective, but not psychosomatic, symptoms of PMS strongly predict AD symptoms suggesting that the pathophysiology of affective PMS symptoms overlap with those of AD. (AU)

Implementing Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome management system by hospital pharmacists in Samutsakhon Hospital, Thailand

Objectives: To study the process of implementing the DRESS management system by pharmacists and its results, during 2016-2020. Research Method: Operational Research, starting from the process of implementing the DRESS management system by the pharmacy department of Samutsakhon Hospital and reporting the results to the Pharmacy and Therapeutic Committee in patients diagnosed with DRESS according to the RegiSCAR criteria, collecting data from an electronic medical records database. Study Results: The main DRESS management system implementation process is: 1) listing the High alert drugs which may cause an adverse reaction and preparation of pharmacists in DRESS; 2) Using RegiSCAR for patient assessment; 3) Suggesting a genotyping test before the patient receives the drug, starting with carbamazepine and allopurinol; 4) Using a Computerized Decision Support System (CDSS) to facilitate the screening alert. 5) Proposing to the Pharmacy and Therapeutic Committee for approval on gene testing. As a result, a total of 184 patients were sent for genotyping testing, and 92 of the drug allergy genes were identified, making the prevention or monitoring of patients more effectively. 31 patients were diagnosed with DRESS, and 54.84% were male. The 4 drug items with the highest incidence were phenytoin 28.95%, nevirapine 10.53%, rifampicin 7.89%, and pyrazinamide 7.89%. Clinical symptoms were rash 100.00%, fever 90.32%, lymphadenopathy 6.45%, at least one dysfunction in the internal organ system 74.19%, liver dysfunction 80.65%, and eosinophilia 58.65%. Phenytoin had a statistically significant induced eosinophil (p=0.044), which could be used as a factor in the CDSS drug surveillance. (AU)

Evaluation of patient comprehension and quality of consumer medicine information

Background: Consumer medicine information (CMI) is voluntarily produced by pharmaceutical manufacturers in Thailand, but quality assessment of Thai- CMI is not routinely performed. Objective: This study aimed to evaluate the content and design quality of CMI available in Thailand and assess patient understanding of the medicine information provided. Methods: A cross-sectional study that consisted of two phases. Phase 1 was expert assessment of CMI using 15-item content checklists. Phase 2 was patient assessment of CMI by user-testing and the Consumer Information Rating Form. Participants (n=130) were outpatients aged 18 years or older with an educational level of less than grade 12. Self-administered questionnaires were distributed to patients at two university-affiliated hospitals in Thailand. Results: A total of 60 CMI produced by 13 Thai pharmaceutical manufacturers were included in the study. Most of the CMI contained essential information about the medicines, but lacked information about serious adverse effects, maximum dose, warnings, and use in specific patient groups. Of 13 CMI selected for user-testing, none met the passing criteria with only 40.8% – 70.0% of answers found in the correct position and answered correctly. The mean values of patients’ rating the CMI were between 2.5 (SD=0.8) and 3.7 (SD=0.5) for utility on a 4-point scale, and 2.3 (SD=0.7) to 4.0 (SD=0.8) for comprehensibility and 2.0 (SD=1.2) to 4.9 (SD=0.3) for design quality on a 5-point scale. Eight CMI were rated as poor (less than 3.0) for font size. Conclusion: More safety information about medications should be included in Thai CMI and the design quality must be improved. CMI needs to be evaluated before distribution to consumers. (AU)

Moderating Effect of Ethical Climate between the Relationship of Coach Ethical Leadership and Affective Commitment: An Evidence from Thailand Nonprofessional Soccer Player / Efecto moderador del clima ético entre la relación del liderazgo ético del entrenador y el compromiso afectivo: una evidencia de un jugador de fútbol no profesional de Tailandia

A multitude of ethical dilemmas perpetually besets non-professional soccer. It is believed that coaches can be beneficial in preventing unethical behavior. Therefore, this study examines the moderating effect of perceived ethical climate on the relationship between coach ethical leadership and the affective commitment of non-professional soccer players. A convenient sampling technique was utilized to collect data from 300 amateur Thai soccer players for this purpose. The Structural Equation Modeling (SEM) demonstrated that the direct effect of player-perceived coach ethical leadership and player-perceived ethical climate has a significant and positive relationship with affective commitment. The indirect impact of the critical findings indicates that players' perceptions of the ethical environment moderate the relationship between their perceptions of the ethical leadership of their coaches and their affective commitment. These findings suggest that ethical climate is integral because it significantly mediates exogenous and endogenous variables. Therefore, this moderating effect relationship is a significant contribution to the study. This study could assist athletes and clubs in understanding the significance of coaching ethical leadership and ethical climate in enhancing the affective commitment of non-professional athletes.(AU)

The Leadership, Trust, and Openness to Experience as Antecedents of Performance of Sports Manufacturing Firms of Thailand, Exploring the Mediating Role of Team Cohesion / El liderazgo, la confianza y la apertura a la experiencia como antecedentes del desempeño de las empresas de fabricación de deportes de Tailandia, explorando el papel mediador de la cohesión del equipo

The performance of the organizations needs to be measured. This study aimed to determine the relationship between openness, trust, leadership, team cohesion, and organizational performance. This study was cross-sectional, and survey questionnaires were used to collect data from participants. The questionnaire was distributed to employees of Thai organizations that manufacture sports goods. For this purpose, convenience sampling was used, and 75.78 percent of the responses were usable. For data analysis, PLS 3.3.2 was utilized. According to the study's findings, trust does not affect team cohesion. Additionally, team cohesion does not mediate between confidence and performance. However, the remaining relationships were deemed significant. The study's findings are beneficial for policymakers and academics.(AU)

Incidence of oxaliplatin hypersensitivity reaction among colorectal cancer patients: A 5-year retrospective study

Background: Oxaliplatin is a third-generation platinum compound that has efficacy against colorectal cancer. Hypersensitivity reactions during oxaliplatin infusion are a key problem during its use, with the varying incidences and deficiencies of clearly identified risk factors. Objective: To determine the incidence, severity and risk factors of oxaliplatin-related hypersensitivity reaction (HSR). Method: This retrospective study investigated 245 colorectal cancer patients (1,690 treatment cycles) receiving care at King Chulalongkorn Memorial Hospital, Thai Red Cross society between January 1, 2015 and December 31, 2019. The patients’ demographic data, laboratory data and clinical features suggesting hypersensitivity reactions to oxaliplatin were reviewed. The Fisher’s Exact test and unpaired t-test were used to determine the differences among patients with and without oxaliplatin HSR. The potential risk factors for oxaliplatin HSR were analyzed for statistical significance by logistic regression. (AU)

Validación del instrumento: conocimientos, creencias y aceptación de la vacuna del virus del papiloma humano / Validation of the instrument: knowledge, beliefs and acceptance of the human papillomavirus vaccine

Introducción: El virus del papiloma humano es la primera causa de cáncer cervicouterino, contar con un instrumento que mida la aceptación de la vacuna del VPH, así como los factores que intervienen, es una necesidad para la prevención del VPH. El objetivo fue realizar la validación del instrumento conocimientos, creencias y aceptación de la vacuna del virus del papiloma humano.Materiales y Métodos: El proceso de validación se realizó a traves de un estudio descriptivo, transversal y de proceso de dos fases. La población fue de 393 madres de niñas de 9 a 11 años, pertenecientes al Estado de Puebla, con un muestreo no probabilístico por conveniencia, la muestra se consideró por razón de 10:1.Resultados: Se obtuvo un instrumento válido y confiable con un coeficiente de Alfa de Cronbach de .70, un valor de p<.000 para la prueba de esfericidad de Bartlett y la prueba de Kaiser-Meyer Olkin obtuvo un resultado de .82, en este sentido el análisis factorial dio como resultado un total de 40 ítems divididos en seis dimensiones.Discusión:El proceso metodológico permitió contar con un indicador empírico adaptado y valido al contexto mexicano, debido a que es el único dentro del contexto que mide los factores relacionados con la aceptación de la vacuna del virus del papiloma humano.Conclusión: Se concluye que tener un indicador empírico adaptado al idioma español, que mida la aceptación y los factores relacionados, es un aporte de gran importancia para la sociedad y un avance para la ciencia en enfermería (AU)

Introduction: The human papilloma virus (HPV) is the leading cause of cervical cancer. Having aninstrument that measures the acceptance of the HPV vaccine, as well as the factors involved in theacceptance process, is an urgent need for HPV prevention. The objective was to validate theknowledge, beliefs, and acceptance of the human papillomavirus vaccine instrument.Materials and Methods: The validation process was carried out through a descriptive, cross-sectional study and a two-phaseprocess. The population consisted of 393 mothers of girls between the ages of 9 and 11 years,belonging to the State of Puebla, with a non-probabilistic sampling for convenience; the sample wasconsidered at a ratio of 10: 1.Results: A valid and reliable instrument was obtained with a Cronbach's Alpha of .70, a value of p<.000 for Bartlett’s sphericity test, and .82 for the KMO test. In this sense, the factor analysis resulted ina total of 40 items divided into six dimensions.Discussion: The methodological process allowed to have an empirical indicator adapted and validatedfor the Mexican context, since it is the only one within the context that measures the factors related tothe acceptance of the HPV vaccine.Conclusion: We conclude that having an empirical indicator adapted to the Spanish language, whichmeasures acceptance and related factors, is a contribution of great importance to society and anadvance in nursing science (AU)

Potentially inappropriate medications for patients with heart failure and risk of hospitalization from heart failure: A casecontrol study from Thailand

Background: Thailand have developed a list of potentially inappropriate medications for patients with heart failure (PIMHF). However, its association with clinical outcomes has not been evaluated in real-world clinical practice. Objective: To examine the association between the prescription of any PIMHF and hospitalization from heart failure (HF). Methods: A 1:1 matched case-control study was conducted. Data on HF patients visiting the study hospitals during 2017-2019 were obtained from the electronic medical record database. Patients with a history of first hospitalization due to HF and those with a history of outpatient department visits or non-HF hospitalization were defined as cases and controls, respectively. The association of hospitalization from HF with the prescription of any PIMHF was expressed as the adjusted odds ratio (aOR) and 95% confidence interval (95%CI), calculated using a conditional logistic regression (CLR) model. Results: After matching, 1,603 pairs of case and control were generated for the analysis. In total, 21 of 47 PIMHF were found to have been prescribed. Compared with the reference group of patients not prescribed any of the 21 PIMHF, those who had been prescribed a PIMHF had an aOR of 1.47 [95%CI 1.02:2.13]. NSAIDs/COX-2 inhibitors, oral short-acting beta-2 agonists, medications that promote fluid overload, and medications that elevate blood pressure were the four medication classes associated with the increased risk of hospitalization from HF (aOR = 2.64, [95%CI 1.30:5.38], aOR = 4.87, [95%CI 1.17:20.29], aOR = 1.50, [95%CI 1.01:2.22], and aOR = 2.51, [95%CI 1.26:4.99], respectively). Conclusions: The prescription of any of the 21 PIMHF found to have been prescribed in this study may increase the risk of hospitalization from HF. The Thai PIMHF list may be used in pharmacy practice as an assessment tool for the appropriate use of medication in HF patients. (AU)

Effect of drug use calendar on adherence to iron chelation therapy in young thalassemia patients

Background: Regular blood transfusions in thalassemia patients can lead to severe complications and iron chelation therapy is required as a treatment. Thalassemia is common in Thailand and the drugs used in iron chelation therapy are deferoxamine and deferiprone. Adherence to the therapy is a key factor for treatment success. Objective: To assess the impact of a drug use calendar on deferiprone and deferoxamine adherence in young thalassemia patients. Methods: A total of 86 young thalassemia outpatients at a Thai tertiary care hospital were recruited into the study. Patients were stratified into two groups based on self-assessment of adherence using a visual analogue scale. One group (n=41) was given a calendar with the schedule of drug use in addition to counselling as standard pharmaceutical care. The second group (n=45) only received the counselling. Adherence to iron chelation therapy was assessed by deferiprone pill or deferoxamine vial counts on six visits (V1 to V6) and results were compared between visits and groups using a multilevel linear regression model. Change in serum ferritin levels after 6 visits (n = 81) were compared using a linear regression model. Results: Adherence significantly increased in both the calendar and non-calendar groups for deferiprone mono- and combination-therapy and for deferoxamine monotherapy. In the calendar groups, average adherence increased by between 2.05 and 5.66% per visit compared to increases of 0.31 to3.92% per visit in the non-calendar groups. A significant difference in the increase in adherence per visit between the calendar and non-calendar groups was only observed for deferiprone monotherapy (3.03% SEM = 0.49vs 1.42% SEM =0.49, respectively, P-value = 0.0078). The serum ferritin level decreased in the calendar group by 20.25ng/mL (SEM = 23.80) and increased in the non-calendar group by 59.63 ng/mL (SEM = 23.01, P-value = 0.0147). (AU)

Medication Management at Home in Older Patients with Polypharmacy: In-depth Interviews with Home Visits

Background: Older patients with multiple non-communicable diseases (NCDs) usually require ≥5 concurrent medications or polypharmacy. Little is known about how patients manage medications at home. Objectives: This study qualitatively explored how older patients with polypharmacy manage medications at home in a primary care unit (PCU) in Pathum-Thani, Thailand. Methods: We conducted in-depth interviews in 2015 using a semi-structured questionnaire with 19 patients aged ≥60 years with polypharmacy and took photos of medication storage locations. The questionnaires asked about medication storage, sorting, and use. Transcripts were analyzed using thematic content analysis. Results: Of the 19 patients (mean age=69 years), 17 managed medications by themselves. The patients kept medications depending on their lifestyles. Newly received medications were kept separately from the remaining medications. Most patients used the remaining medications; yet, they did not look at the expiration dates. The remaining medications were kept, shared, thrown away, or returned to the PCU. All patients had a good attitude towards medications; yet, misunderstandings about medication administration and their outdoor activities were reasons for medication nonadherence. Conclusion: Older patients developed a system to store and organize medications at home. Management of remaining medications varied from patient to patient. Doctors should ask, not assume, elderly patients, to better understand how they manage medications at home. Future research should focus on if and how medication management at home affects medication adherence and health outcomes. (AU)

Customers’ Satisfaction toward Drugstore Facilities and Services based on the Good Pharmacy Practice Standard in Thailand

Introduction: The Good Pharmacy Practice (GPP) standards in Thailand have been legally implemented for all drugstores since 2014. However, customer satisfaction has not been studied. This research aimed to explore the satisfaction of the customers with the facilities and services received from drugstores under the GPP standards and examine the impact of satisfaction toward each GPP domain on overall satisfaction (OS) and the intention to receive the pharmacy services as the first choice in the case of common and non-serious illnesses (IntR). Methods: This research was a cross-sectional survey study. The Google Forms for data collection was distributed via the online social media between June and August 2021. The satisfaction toward OS, IntR, and the GPP domains; places and equipment (PE), personnel (P), quality control (QC), and pharmacy services (PS) were collected using 5-Likert scales. Descriptive statistics, intra-class correlation, and multiple regression were used in data analysis with statistical significance at p-value<0.05. Results: Three hundred and eighty-eight drugstore’s customers responded to the questionnaires. Most customers rated the OS and the IntR at the highest level. The mean of the OS was 4.4±0.7 and the IntR was 4.6±0.7 points out of five. The OS and the IntR were highly correlated with the ICC of 0.719 (p-value<0.001). The satisfactions toward each GPP criteria were ranged between 3.9±0.9 to 4.6±0.7 indicating high levels of satisfaction. All 4 domains of the GPP standards explained the OS and the IntR with R square at 0.541 and 0.363, respectively. However, only PS and PE impacted the OS and only QC and PS impacted the IntR with statistical significance. (AU)

Bajo la influencia del budismo y el animismo: cuerpo, enfermedad, medicina y cuidados en el cine de Apichatpong Weerasethakul (los ejemplos de Syndromes and a Century, 2006 y Cemetery of Splendour, 2015) / Under the influence of Buddhism and animism: body, disease, medicine and care in the cinema of Apichatpong Weerasethakul (the examples of Syndromes and a Century, 2006 and Cemetery of Splendour, 2015)

El modelo biomédico occidental ha sido ampliamente retratado en el cine y las series televisivas. El artículo busca poner ejemplos de modelos terapéuticos alternativos al biomédico que aún tienen mucha presencia en culturas no occidentales, combinándose a menudo con el modelo biomédico y que no han sido tan reflejados en el cine. Ponemos ejemplos de dos películas del director tailandés Apichatpong Weerasethakul, Syndromes and a Century (Sang Sattawat, 2006) y Cemetery of Splendor (Rak Ti Khon Kaen, 2015). Estas películas nos muestran cómo en la región tailandesa de Isan se combina el modelo biomédico, de origen occidental pero ya plenamente asentado en el país, con técnicas meditativas y prácticas mágicas influidas por el budismo theravada y el animismo de origen laosiano practicados en la región. (AU)

The Western biomedical model has been widely portrayed in film and television series. The article seeks to give examples of alternative therapeutic models to biomedical that still have a strong presence in non-western cultures, often combining with the biomedical model and that have not been so reflected in the cinema. We give examples of two films by the Thai director Apichatpong Weerasethakul, Syndromes and a Century (Sang Sattawat, 2006) and Cemetery of Splendour (Rak Ti Khon Kaen, 2015). These films show us how in the Thai region of Isan the biomedical model of Western origin but already fully established in the country is combined with meditative techniques and magical practices influenced by Theravada Buddhism and animism of Laotian origin practiced in the region. (AU)

Development of pharmacy competency framework for the changing demands of Thailand's pharmaceutical and health services

BACKGROUND: In Thailand, pharmacists are responsible for all activities to ensure access to medicines throughout pharmaceutical supply chain. Competency framework (CF) is an important guidance for professional development and workforce planning. OBJECTIVE: This study aimed to explore needs for pharmacy services in pharmaceutical supply chain and competencies of pharmacists to serve those needs. It was the first step for developing evidence-based pharmacy CF within the context of Thailand in 2026. METHODS: A qualitative method using in-depth interviews to gain rich data from practitioners and leaders in all area of practices. 99 key informants from 56 workplaces in Thailand were interviewed during January and March 2016. Data was transcribed verbatim, and thematic analysis was used. Competencies were extracted, followed by several rounds of group discussion among team members to develop an initial framework. The competencies and CF were presented, and recommendations were gained from professional leaders for refining the findings. RESULTS: The key informants agreed that pharmacist's works and responsibilities have gradually been drifted to support changes in healthcare and pharmaceutical systems. The upcoming pharmaceutical services call for higher standards of practice, larger number of personnel, and skillful pharmacists who have strong foundation in pharmaceutical knowledge as well as an ability to integrate knowledge into practices. Two sets of CFs were established. The general CF comprises five core domains: product focus, patient focus, healthcare system focus, community focus, and personal focus for self-improvement. These general competencies allow practitioners to perform basic professional tasks, including providing information, dispensing, and compounding. The service-specific competency is the integration of general competencies tailored into specific area of practice. CONCLUSIONS: Regarding the professional goal to evolve pharmacists from generalists to specialists for providing higher quality of professional services, the pharmacists are required to demonstrate general competencies and service-specific competencies. The findings serve as the need-based evidence for developing a national CF for pharmacists in Thailand

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Extraña erupción tras viaje a Tailandia / Strange rash after travel to Thailand

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