Application of a systematic approach to evaluating psychometric properties of a cumulative exit-from-degree objective structured clinical examination (OSCE).

BACKGROUND AND PURPOSE: Objective structured clinical examinations (OSCEs) are considered gold standard performance-based assessments yet comprehensive evaluation data is currently lacking. The objective of this study was to critically evaluate the psychometric properties of a cumulative OSCE for graduating pharmacy students in Qatar for which policies and procedures were adapted from a Canadian context. EDUCATIONAL ACTIVITY AND SETTING: A 10-station OSCE was conducted for graduating students in Qatar. Evaluation included assessment of pass rates, predictive validity, concurrent validity, internal validity, content validity, interrater reliability, and internal consistency. FINDINGS: Twenty-six students completed the OSCE. Three stations achieved pass rates < 80%. Scores from professional skills and case-based learning courses, formative OSCEs, and cumulative grade point averages correlated with OSCE scores (p < 0.05). Average correlation between assessors' analytical and global scoring was moderate (r = 0.52). Average interrater reliability was excellent for analytical scoring (ICC = 0.88) and moderate for global scoring (ICC = 0.61). Excellent internal consistency was demonstrated for overall performance (α = 0.927). Students generally agreed stations represented real practice scenarios (range per station, 30-100%). DISCUSSION AND SUMMARY: The evaluation model identified strengths and weaknesses in assessment and curricular considerations. The OSCE demonstrated acceptable validity and reliability as an adapted assessment.

A literature review of the cardiovascular risk-assessment tools: applicability among Asian population.

BACKGROUND: Cardiovascular diseases, the main causes of hospitalisations and death globally, have put an enormous economic burden on the healthcare system. Several risk factors are associated with the occurrence of cardiovascular events. At the heart of efficient prevention of cardiovascular disease is the concept of risk assessment. This paper aims to review the available cardiovascular risk-assessment tools and its applicability in predicting cardiovascular risk among Asian populations. METHODS: A systematic search was performed using keywords as MeSH and Boolean terms. RESULTS: A total of 25 risk-assessment tools were identified. Of these, only two risk-assessment tools (8%) were derived from an Asian population. These risk-assessment tools differ in various ways, including characteristics of the derivation sample, type of study, time frame of follow-up, end points, statistical analysis and risk factors included. CONCLUSIONS: Very few cardiovascular risk-assessment tools were developed in Asian populations. In order to accurately predict the cardiovascular risk of our population, there is a need to develop a risk-assessment tool based on local epidemiological data.

Effect of privatization of the drug distribution system on drug prices in Malaysia.

BACKGROUND: Previous studies on anti-infective and cardiovascular drugs have shown extraordinary price increases following privatization of the Malaysian drug distribution system. Therefore, it was felt that there was a need to undertake a full-scale study to evaluate the effect of privatization of the Malaysian drug distribution system on drug prices. OBJECTIVES: To compare pre-privatization drug prices with post-privatization drug prices, and to compare the prices with international reference prices (IRPs). METHODS: Five hundred and sixty-four drugs were listed in price lists for 1994, 1995-1996, 1997-2000 and 2001-2003. The 1994 data were taken as the pre-privatization prices, and all other lists were considered to be post-privatization prices. The pre-privatization prices (1994) were compared with those in 1995-1996. The prices in 1995-1996 were compared with those in 1997-2000, and the 1997-2000 prices were compared with those in 2001-2003. Furthermore, the 2001-2003 prices were compared with the median IRPs taken from Management Sciences for Health. RESULTS: The prices increased by 10.42% in 1995-1996, decreased by 3.37% in 1997-2000, and increased by 64.04% in 2001-2003. The increase in prices does not follow any pricing formula but is influenced by free market principles. The commonly used generic drugs showed enormously higher prices compared with the IRPs. CONCLUSION: Some of the prices increased several hundred-fold compared with the previous year, showing that no pricing formula has been followed. Increasing prices over the years may lead to higher expenditures and a hurdle to drug accessibility. A rational pricing structure is needed for transparent pricing, and government involvement and the formation of a medicine pricing policy seems vital.

Irrational fixed dose combinations in Nepal: need for intervention.

A large proportion of drugs available are of little importance in terms of fulfilling primary healthcare needs. Combination drugs increase the risk of side effects, lead to an ineffective dosage and liability to abuse and may also needlessly increase the cost. Drug combinations make it more difficult to find the causative agent responsible for the adverse reactions. In many cases their stability is doubtful, reducing the efficacy of many preparations. The Fifteenth WHO model list of essential medicines (March 2007) contains only 25 approved fixed dose combinations, whereas in Nepal, there are innumerable examples of irrational drug combinations, which are easily available and can be bought even without a prescription. A system of screening the drug combinations that are already licensed and available in the market is implemented in many developed and developing countries. Rational combinations can be of immense help to the health care system. These combinations may improve the quality of life for many and increase compliance. But irrational fixed dose combination products can be equally harmful.

Dialysis for end stage renal disease: a descriptive study in Penang Hospital.

This research was carried out to study the characteristics of ESRD patients and the resources consumed with dialysis treatment as well as to assess the clinical outcomes of ESRD treatment in Penang Hospital. A total of 117 ESRD patients were studied over 30 months. 56.4% of the patients were male and the median age was 40. Diabetic nephropathy was the commonest cause of ESRD (29.9%). Hypertension was the predominant comorbidity (60.6%). A larger proportion started treatment with Continuous Ambulatory Peritoneal Dialysis (59.0%). At the end of the study period, 49.6% of the patients continued their treatment in the same modality and 27.4% died. Average Dialysis Adequacy (Kt/V) achieved was satisfactory, 2.29 in CAPD and 1.50 in Haemodialysis.