Burnout among Hospital Pharmacists in Canada: A Cross-Sectional Analysis.

Background: Burnout is a growing problem among health care professionals, with consequences for patient safety and personal satisfaction. The prevalence of burnout among hospital pharmacists in Canada is unknown; however, it has been documented at over 60% in other countries. Objectives: To assess the prevalence of burnout and variables associated with burnout among hospital pharmacists in Canada. Methods: This cross-sectional cohort study was based on a survey made available to more than 2600 Canadian hospital pharmacists from February 10 to April 2, 2020, through the Canadian Society of Hospital Pharmacists QID platform. The questionnaire collected data for the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSSMP), demographic data, employment characteristics, and workplace factors; it also included an open-ended question about burnout. Results: A total of 171 respondents provided data suitable for analysis. Of these, only 13 (7.6%) met the criteria for burnout on all 3 subscales of the burnout inventory; however, 105 respondents (61.4%) surpassed the threshold for burnout on the emotional exhaustion subscale. In univariate analyses, not working to one's full scope of practice was associated with meeting the criteria for burnout on all 3 scales. Linear regression highlighted associations between scores on the emotional exhaustion subscale and gender identity, perceived excessive on-call duties, area of practice, and positivity of workplace culture. Content analysis of the open-ended question supported the quantitative findings and pointed to 3 major themes: workload quantity, workload quality, and workplace culture. Conclusions: Results on the emotional exhaustion subscale of the MBI-HSSMP and responses to the open-ended question suggested a relatively high prevalence of burnout among Canadian hospital pharmacists, and indicated potential links between burnout and certain workplace characteristics.

Contexte: L'épuisement professionnel est un problème croissant chez les professionnels de la santé qui entraîne des conséquences sur la sécurité des patients et la satisfaction personnelle des professionnels. La prévalence de l'épuisement professionnel chez les pharmaciens d'hôpitaux au Canada est inconnue; cependant, il a été documenté à plus de 60 % dans d'autres pays. Objectifs: Évaluer la prévalence de l'épuisement professionnel et les variables associées à celui-ci chez les pharmaciens d'hôpitaux au Canada. Méthodes: Cette étude de cohorte transversale se basait sur un sondage distribué à plus de 2600 pharmaciens d'hôpitaux canadiens entre le 10 février et le 2 avril 2020 via la plateforme QID de la Société canadienne des pharmaciens d'hôpitaux. Le questionnaire a permis de recueillir des données pour le Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSSMP; un inventaire de l'épuisement professionnel chez les professionnels de la santé), des données démographiques, des caractéristiques professionnelles et des facteurs liés au lieu de travail; il comprenait également une question ouverte sur l'épuisement professionnel. Résultats: Au total, 171 répondants ont fourni des données se prêtant à l'analyse. Parmi ceux-ci, seuls 13 (7,6 %) répondaient aux critères de l'épuisement professionnel des 3 sous-échelles de l'inventaire de l'épuisement professionnel; cependant, 105 répondants (61,4 %) ont dépassé le seuil d'épuisement professionnel de la sous-échelle d'épuisement émotionnel. Dans les analyses univariées, le fait de ne pas travailler dans l'ensemble de son champ d'exercice était associé au respect des critères d'épuisement professionnel sur les 3 sous-échelles. La régression linéaire a mis en évidence des associations entre les scores sur la sous-échelle d'épuisement émotionnel et l'identité de genre, les tâches de garde excessives perçues, le domaine de pratique et la positivité de la culture sur le lieu de travail. L'analyse du contenu de la question ouverte étayait les résultats quantitatifs et a souligné 3 thèmes principaux : la quantité et la qualité de la charge de travail, ainsi que la culture sur le lieu de travail. Conclusions: Les résultats relatifs à la sous-échelle d'épuisement émotionnel du MBI-HSSMP et les réponses à la question ouverte suggèrent une prévalence relativement élevée d'épuisement professionnel chez les pharmaciens d'hôpitaux canadiens et indiquent des liens potentiels entre l'épuisement professionnel et certaines caractéristiques du milieu de travail.

Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction.

The COVID-19 pandemic required pharmacists in a provincial Home Dialysis Clinic to adapt from in-person to telephone-based medication reviews. Studies have shown that in-person pharmacist interventions in patients with chronic kidney disease (CKD) lead to a reduction of drug therapy problems (DTPs), however, it's unknown if telephone interventions provide similar outcomes. The purpose of this study was to evaluate whether differences in quality of care exist between in-person vs. telephone medication reviews in home dialysis patients and to evaluate patient satisfaction with telephone medication reviews. Data from the two most recent in-person medication reviews was compared with the two most recent telephone medication reviews for each patient (n = 46). There were no statistically significant differences in DTPs identified between in-person and telephone medication reviews (p = 0.431). Physician acceptance of pharmacist recommendations was higher for in-person medication reviews (p = 0.009). Patients were satisfied with the care they received with pharmacist-led telephone medication reviews, however, 29% (n = 7) would prefer an in-person medication review once per year with telephone medication reviews the rest of the time. Overall, patients were satisfied with the care they received from telephone medication reviews.

Novice Nurses' Experiences Caring for Acutely Ill Patients during a Pandemic.

The Coronavirus pandemic erupted in 2020 and new graduate registered nurses (RNs) found themselves caring for those with devastating illness as they were transitioning into nursing practice. The purpose of this study was to describe the experience of novice nurses working in acute care settings during a pandemic. This qualitative phenomenological study of novice nurses working in facilities providing acute care for COVID-19 patients was conducted in Phoenix, Arizona, USA. Purposive sampling identified 13 participants for interviews. Data were analyzed using thematic analysis. Eight themes emerged: Dealing with death, Which personal protective equipment (PPE) will keep us safe?, Caring for high acuity patients with limited training, Difficulties working short-staffed, Everything is not okay, Support from the healthcare team, Nursing school preparation for a pandemic, I would still choose nursing. Novice nurses felt challenged by the experience and were at times overwhelmed and struggling to cope. Support from peers and coping skills learned during nursing school helped them continue to work during a critical time. Data from this study suggest that some participants may have been experiencing symptoms of anxiety, depression, or post-traumatic stress disorder, and findings provide foundational insights for nursing education and psychological interventions to support the nursing workforce.

Assessment of Canadian Hospital Pharmacists' Job Satisfaction and Impact of Clinical Pharmacy Key Performance Indicators.

BACKGROUND: The clinical pharmacy key performance indicators (cpKPIs) are quantifiable measures of quality to advance clinical pharmacy practice and improve patient care. Although when delivered in combination they have been linked to important patient outcomes, no data are available relating to their impact on hospital pharmacists' job satisfaction. OBJECTIVES: To determine the level of job satisfaction among Canadian hospital pharmacists and whether participation in cpKPI activities contributes to hospital pharmacists' job satisfaction. METHODS: A mixed-methods study was conducted. An electronic survey, consisting of 36 questions, was developed using a validated pharmacist job satisfaction tool and was then distributed nationally to hospital pharmacists between January 30 and March 14, 2019. Focus groups were conducted with pharmacists at Horizon Health Network in New Brunswick to further explore activities that contribute to their job satisfaction. RESULTS: Overall, 284 pharmacists from 9 provinces completed the electronic survey. The mean job satisfaction score among hospital pharmacists was 3.93 (standard deviation 0.85) out of 5. Job satisfaction scores increased with increases in self-identified time spent performing cpKPI activities (r = 0.148, p = 0.014). Pharmacist satisfaction increased with time spent performing medication reconciliation on admission (ß = 0.140, p = 0.032) and decreased with time spent identifying and resolving drug therapy problems (ß = -0.153, p = 0.030). Three focus groups, comprising a total of 13 pharmacists, were conducted; during these sessions, some cpKPIs were highlighted favourably, although pharmacists described some ambivalence toward patient education. The importance of having an impact and receiving appreciation was highlighted. CONCLUSIONS: Canadian hospital pharmacists are generally satisfied with their jobs, and participation in cpKPI activities was found to be positively associated with hospital pharmacists' job satisfaction.

CONTEXTE: Les indicateurs clés de performance de la pharmacie clinique (ICPpc) sont des mesures quantifiables de la qualité qui permettent de faire avancer la pratique en pharmacie et d'améliorer les soins du patient. Bien qu'ils aient été associés à des résultats importants pour les patients lorsqu'ils sont utilisés conjointement, aucune donnée concernant leur impact sur la satisfaction professionnelle des pharmaciens d'hôpitaux n'est disponible. OBJECTIFS: Déterminer le degré de satisfaction professionnelle des pharmaciens d'hôpitaux canadiens et noter si la participation aux activités liées aux ICPpc y contribue. MÉTHODES: Une étude à méthodologie mixte a été menée. À l'aide d'un outil validé mesurant la satisfaction professionnelle du pharmacien, les investigateurs ont préparé une enquête électronique comprenant 36 questions, qui a été distribuée à l'échelle nationale aux pharmaciens d'hôpitaux entre le 30 janvier et le 14 mars 2019. Des groupes de travail comprenant des pharmaciens au Réseau de santé Horizon au Nouveau-Brunswick ont exploré plus en profondeur les activités qui contribuaient à leur satisfaction professionnelle. RÉSULTATS: Globalement, 284 pharmaciens de neuf provinces ont répondu à l'enquête électronique. Le score moyen de satisfaction des pharmaciens d'hôpitaux était de 3,93 (écart type 0,85) sur 5. Les scores relatifs à la satisfaction professionnelle augmentaient lorsque le temps passé à faire des activités liées aux ICPpc augmentait (r = 0,148, p = 0,014). La satisfaction du pharmacien augmentait quand il passait du temps à faire le bilan comparatif des médicaments au moment de l'admission (ß = 0,140, p = 0,032) et diminuait quand il devait déterminer et résoudre des problèmes de pharmacothérapie (ß = −0,153, p = 0,030). Trois groupes de discussion comprenant 13 pharmaciens au total se sont penchés sur la question. Pendant leurs séances, ils ont mis en valeur certains ICPpc, bien que les pharmaciens aient décrit des ambivalences concernant les instructions données au patient. Ils ont aussi souligné l'importance d'avoir un effet positif et d'être apprécié. CONCLUSIONS: Les pharmaciens d'hôpitaux canadiens sont généralement satisfaits de leur travail et la participation à des activités liées aux ICPpc est associée à leur satisfaction professionnelle.

Escape the Pharmacy: An Active Learning Strategy for the Nursing Pharmacology Classroom.

ABSTRACT: Escape the Pharmacy is a fast-moving collaborative challenge for students in nursing and other health professions programs requiring coursework in pharmacology. Teams of students compete to solve a series of puzzles that reinforce knowledge of safe analgesic administration. Information regarding maximum dosing and adverse effects of opioids, nonsteroidal anti-inflammatories, and acetaminophen is included, as well as content on types of pain receptors. Recognition of opioid toxicity and symptoms of oversedation are all part of the challenge of escaping the pharmacy.

Evaluation of a Pharmacist-Dietician-Led Patient-Centered Approach to Managing CKD-MBD: A Mixed-Method Study.

Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication in end-stage renal disease (ESRD). To improve prescribing consistency and patient outcomes, a patient-centered, pharmacist-dietician-led approach to managing CKD-MBD was developed. The purpose of this study was to evaluate if the new approach impacted serum markers of CKD-MBD and medication burden, and to evaluate patient satisfaction. A single-arm, pre-post, mixed-methods study was conducted. Serum markers of CKD-MBD and medication data were collected pre- and post-intervention, and a patient survey administered post-intervention. Focus groups were conducted, transcribed, and analyzed thematically. No statistically significant differences in serum markers of CKD-MBD or medication burden were found. Eighty-seven percent of patients were satisfied with their care, however, 31% were very dissatisfied with medical explanations provided to them and 48% felt their allotted time with healthcare professionals was too short. Four major themes identified from focus groups included lack of privacy, knowledge and perceptions of blood work rounds, issues with taking phosphate binders, and areas for increased patient education. Patients would prefer more information regarding their blood work results and more time with the healthcare team. Areas for expanded education include renal diet, phosphate binders, and consequences of abnormal bloodwork.

Feasibility of hybrid off pump artery bypass grafting and transaortic transcatheter aortic valve implantation: A case series.

INTRODUCTION: Patients with complex coronary artery disease and severe aortic stenosis unsuitable for conventional cardiac surgery pose a significant treatment challenge. This is especially difficult for patients where percutaneous revascularization is technically very challenging and/or would not offer as complete revascularisation compared to surgical revascularisation. In addition, patients who are unsuitable for transfemoral transcatheter aortic valve implantation (TAVI) pose an additional technical challenge, particularly with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). As a potential solution we describe the first case series of hybrid off-pump coronary artery bypass grafting (CABG) combined with transaortic TAVI. METHODS AND RESULTS: Over a ten-month-period, four patients underwent hybrid off-pump CABG combined with transaortic TAVI. A full sternotomy allowed off-pump arterial and vein graft anastomosis to significantly stenosed coronaries. The first three patients had severe aorto-iliac disease precluding femoral access; the fourth patient was deemed unsuitable for PCI. Transaortic TAVI using Edwards Sapien 3 valves were performed without complication in all four patients. CONCLUSION: The hybrid off-pump CABG and transaortic TAVI procedure allows for more complete coronary revascularization, negates the need for DAPT, and minimizes treatment delay of a TAVI procedure, particularly in patients unsuitable for transfemoral access. We propose this as an important treatment option for the heart team to consider. © 2016 Wiley Periodicals, Inc.

Beliefs about excessive exercise in eating disorders: the role of obsessions and compulsions.

OBJECTIVE: This study aimed to develop an understanding of excessive exercise in eating disorders by exploring the role of exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours. METHOD: Sixty-four women were recruited from eating disorder services and 75 non-clinical women were recruited from a university. Exercise beliefs and behaviours, obsessive beliefs and behaviours and eating disorder psychopathology were assessed using self-report questionnaires. RESULTS: There was an association between exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours in the eating-disordered group, but not in the non-eating-disordered group. In the eating-disordered group obsessive beliefs and obsessive-compulsive behaviours were associated with a significant proportion of variance in exercise beliefs after controlling for eating disorder psychopathology and BMI. In the non-eating-disordered group obsessive beliefs and behaviours were associated with beliefs about exercise as a method of affect regulation after controlling for BMI. CONCLUSION: The results are compatible with a model in which obsessive beliefs and exercise beliefs could maintain exercise in eating disorders. This has implications for the assessment and treatment of excessive exercise. Further research is necessary to determine the causality of these relationships.

Retrospective audit of medication order turnaround time after implementation of standardized definitions.

BACKGROUND: Standardizing the interpretation of "stat", "emergent", "urgent", and "now" medication orders can improve patient safety. However, the effect of implementing standardized definitions on the turnaround time for medication orders in hospital pharmacy dispensaries has not been studied. OBJECTIVES: To examine the effects of using formal definitions for "stat", "emergent", "urgent", and "now" on turnaround time for medication orders within a pharmacy dispensary. METHODS: Definitions for "stat", "emergent", "urgent", and "now" orders, as well as for "turnaround time", were developed from the formal literature and the grey literature. The definitions were implemented by educating all pharmacy staff. Retrospective audits of turnaround time were conducted at baseline (for all orders over a 1-month period) and after implementation of the definitions (for a total of 28 days over a 3-month period). Health records and medication orders were used to calculate time from prescribing to administration (total turnaround time) and time from prescribing to departure from the dispensary (dispensary turnaround time). Differences between total and dispensary turnaround times were compared with nonparametric statistics. RESULTS: During the baseline audit period, 84 (1.1%) of 7787 orders were identified as "stat", "emergent", "urgent", or "now". After implementation of the formal definitions, 142 (2.6%) of 5365 orders were identified by one of these terms. The percentage of orders meeting the target dispensary turnaround time of less than 15 min was at least 90% both at baseline (76/84 [90%]) and after implementation (129/142 [91%]) (p = 0.80). Median dispensary turnaround time for stat and emergent medication orders combined (10 versus 9 min, p = 0.27) and for urgent and now medication orders combined (10 versus 12 min, p = 0.09) did not change after implementation of formal definitions. Similarly, median total turnaround time did not change for stat and emergent medication orders combined (30 versus 45 min, p = 0.32), but it increased for urgent and now orders combined (35 versus 45 min, p = 0.041). CONCLUSIONS: Implementing standardized definitions for "stat", "emergent", "urgent", and "now" had no significant effect on dispensary turnaround time. However, the majority of orders with these designations met the expected target for dispensary turnaround time. Further interventions aimed at other health care professionals may be needed to reduce total turnaround time. This research supports the concept of interdisciplinary interventions for reducing total turnaround time.

Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review.

BACKGROUND: As many women experiencing symptoms of premenstrual syndrome (PMS) seek relief from natural products (NP), health care providers should have quality information available to aid women in making evidence-based decisions regarding use of these products. OBJECTIVE: To identify herbs, vitamins and minerals advocated for the treatment of PMS and/or PMDD and to systematically review evidence from randomized controlled trials (RCTs) to determine their efficacy in reducing severity of PMS/PMDD symptoms. METHODS: Searches were conducted from inception to April 2008 in Clinical Evidence, The Cochrane Library, Embase, IBID, IPA, Mayoclinic, Medscape, MEDLINE Plus, Natural Medicines Comprehensive Database and the Internet to identify RCTs of herbs, vitamins or minerals advocated for PMS. Bibliographies of articles were also examined. Included studies were published in English or French. Studies were excluded if patient satisfaction was the sole outcome measure or if the comparator was not placebo or recognized therapy. RESULTS: Sixty-two herbs, vitamins and minerals were identified for which claims of benefit for PMS were made, with RCT evidence found for only 10. Heterogeneity of length of trials, specific products and doses, and outcome measures precluded meta-analysis for any NP. Data supports the use of calcium for PMS, and suggests that chasteberry and vitamin B6 may be effective. Preliminary data shows some benefit with ginkgo, magnesium pyrrolidone, saffron, St. John's Wort, soy and vitamin E. No evidence of benefit with evening primrose oil or magnesium oxide was found. CONCLUSION: Only calcium had good quality evidence to support its use in PMS. Further research is needed, using RCTs of adequate length, sufficient sample size, well-characterized products and measuring the effect on severity of individual PMS symptoms.

Capacity strengthening in malaria research: the Gates Malaria Partnership.

The Gates Malaria Partnership (GMP) includes five African and four European partner institutions. Its research programme has five priority areas involving an extensive range of field-based studies. GMP research has contributed significantly to the development of new research consortia investigating strategies for improving means of malaria control, and has already had an impact on policy and practice. A substantial investment in innovative training activities in malaria has enhanced knowledge and practice of malaria control at all levels from policy making to local community involvement. Capacity development, notably through a PhD programme, has been an underlying feature of all aspects of the programme.

Creatine monohydrate supplementation does not increase muscle strength, lean body mass, or muscle phosphocreatine in patients with myotonic dystrophy type 1.

Creatine monohydrate (CrM) supplementation may increase strength in some types of muscular dystrophy. A recent study in myotonic muscular dystrophy type 1 (DM1) did not find a significant treatment effect, but measurements of muscle phosphocreatine (PCr) were not performed. We completed a randomized, double-blind, cross-over trial using 34 genetically confirmed adult DM1 patients without significant cognitive impairment. Participants received CrM (5 g, approximately 0.074 g/kg daily) and a placebo for each 4-month phase with a 6-week wash-out. Spirometry, manual muscle testing, quantitative isometric strength testing of handgrip, foot dorsiflexion, and knee extension, handgrip and foot dorsiflexion endurance, functional tasks, activity of daily living scales, body composition (total, bone, and fat-free mass), serum creatine kinase activity, serum creatinine concentration and clearance, and liver function tests were completed before and after each intervention, and muscle PCr/beta-adenosine triphosphate (ATP) ratios of the forearm flexor muscles were completed at the end of each phase. CrM supplementation did not increase any of the outcome measurements except for plasma creatinine concentration (but not creatinine clearance). Thus, CrM supplementation at 5 g daily does not have any effects on muscle strength, body composition, or activities of daily living in patients with DM1, perhaps because of a failure of the supplementation to increase muscle PCr/beta-ATP content.