A scoping review of the minority stress processes experienced by sexual and gender minority individuals in pharmacy settings: Implications for health care avoidance.

BACKGROUND: Sexual and gender minority (SGM) people may avoid or delay health care interactions. The minority stress model describes distal (discrimination, violence) and proximal (expectation of rejection, concealment, internalized self-dislike) stress processes as possible contributors to the health disparities and avoidance behaviors observed when encountered in health care settings. Pharmacies are accessible health care settings, yet the extent to which SGM individuals experience minority stress processes while using services at the pharmacies is unknown. OBJECTIVE: This scoping review aimed to identify distal and proximal minority stress processes experienced by SGM individuals and health care avoidance behaviors related to pharmacies or pharmacists. METHODS: An electronic search of PubMed, Embase, and PsycINFO databases was conducted to search for relevant literature up to September 2022. The search was supplemented with a review of reference lists and contact with experts in the field. Articles were included in the review if they described SGM individuals' perceived experiences within pharmacies or with pharmacists and reported an outcome that could be mapped to a distal or proximal minority stress process. RESULTS: Eleven articles met the eligibility criteria and were included in the review. Of these, 6 reported the presence of distal stress processes, such as perceived stigma, negative pharmacy staff attitudes, and a lack of awareness of population needs. For proximal stress processes, 5 articles reported on concealment, 4 reported on expectation of rejection, and 1 reported on internalized transphobia. Developing rapport and increasing competence were identified as ways to help mediate the impact of minority stress processes. CONCLUSION: Minority stress processes and avoidance behaviors are experienced by SGM individuals that relate to pharmacies and pharmacists. Coordinated efforts between professional stakeholders are required to reduce minority stress processes and ensure pharmacy-based services are accessible to all individuals.

Construction of Ideal Remote Assessment Environments and the Impact of Self-Selected Music on Student Performance.

BACKGROUND: Remote online assessments require students to construct their own assessment environments, including selection of strategies (such as the use of music) to reduce stress. This study aimed to determine the impact of self-selected music on student performance during a remote online assessment and to identify factors important for constructing ideal assessment environments. METHODS: Final year students were randomized to complete a voluntary remote online 2-hour care plan test. Those randomized to 'music' were required to play self-selected music during the assessment and those randomized to 'non-music' were asked not to play music. Prior to the assessment, perceived stress and resilience were measured. Performance between groups was compared and associations between stress, resilience, and performance determined. A post-survey identified music preferences/acceptability, and factors identified for ideal remote assessment environments. RESULTS: A total of 79 students completed the study (n=40 music, n=39 non-music). The median assessment score in the music group was 90% (range 58 to 99%) and 88% (range 58 to 99%) in the non-music group (not significant). No associations were found between scores and perceived stress or resilience. The majority of students randomized to music (62.5%) found it helpful. Thirteen categories of factors were identified to contribute to an ideal remote assessment environment with the most common being lighting, location, quietness, distractions, and seating/set-up. CONCLUSION: Findings support the notion that remote online assessment environments should not come as 'one size fits all' and many factors (including self-selected music) may influence a student's ability to perform to a high standard.

Health services for sexually transmitted infections: Where are we at in New Zealand? A narrative literature review.

INTRODUCTION Sexually transmitted infection (STI) rates continue to rise in New Zealand. To effectively prevent, test and diagnose STIs in a timely manner to limit their health effects, health services must be appropriate and accessible for all. AIM The aim of this review was to identify and collate the existing literature and identify gaps in research relating to STI health service delivery in New Zealand. METHODS A critical narrative literature review was conducted. A keyword search of PubMed (2010 to October 2020), EMBASE (2010 to October 2020) and Google Scholar (2010 to October 2020) was conducted. The electronic search was supplemented with manual screening of references from identified articles. Eligible studies reported on STI service delivery in New Zealand. Articles not meeting these criteria were excluded. Articles solely reporting on the human papillomavirus vaccine or condom use statistics or perceptions were also excluded. Data extracted included study year, authors, aim, methods and outcome results. RESULTS A total of 179 articles were identified, including 16 that met study inclusion criteria. Nine studies focused on STI testing, five on health-seeking behaviours and two had other foci. The results reflected substantial gaps in the funding and delivery of best-practice STI management across all New Zealand. DISCUSSION New strategies are needed to improve access to low-cost or free services for sexual health care in general and clinic-wide systems implemented to enable routine delivery of advice about STI prevention and testing by clinicians to patients.

Diversity in health professional education scholarship: a document analysis of international author representation in leading journals.

OBJECTIVES: The global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives. DESIGN: We conducted a document analysis to examine authorship of recent publications to explore current international representation. DATA SOURCES: The table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase. ELIGIBILITY CRITERIA: The journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis. DATA EXTRACTION AND SYNTHESIS: The table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable). RESULTS: A total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time. CONCLUSIONS: Diversity in health professional education scholarship, as marked by nation of authors' professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

Assessment of inhaler technique among fourth-year pharmacy students: Implications for the use of entrustable professional activities.

INTRODUCTION: It is unknown when and how often competency assessments should occur in pharmacy education. Using inhaler technique as an example competency, the study objectives were to measure the proportion of near-graduation students demonstrating correct technique approximately one year after initial training and to measure reliability between assessors. METHODS: A sample of 45 near-graduation pharmacy students with prior education on correct inhaler technique participated in this direct observation study at the University of Otago. Five trained assessors simultaneously rated each participant's inhaler technique demonstration using a checklist. RESULTS: Of 37 participants demonstrating a pressurized metered dose inhaler, 21.62% demonstrated correct technique. No participants among eight volunteers demonstrated proper use of a dry powder inhaler. On average, two steps were performed correctly for each inhaler type. Steps with the highest error rate were "hold the inhaler upright and shake well," "breath out gently, away from the inhaler," and "keep breathing in slowly and deeply". The intraclass correlation coefficient for any inhaler type was excellent (0.91), suggesting assessors had strong reliability. CONCLUSIONS: Students did not retain ability to correctly demonstrate inhaler technique one year after initial instruction. This finding supports the notion that demonstrable tasks may need to be frequently assessed to ensure the task is mastered and becomes a routine part of a student's practice. It also suggests that assessment of milestones and/or entrustable professional activities may need to occur at different time points throughout a program, rather than allowing for "signing off" prematurely.

Exploring the influence of cultural orientations on assessment of communication behaviours during patient-practitioner interactions.

BACKGROUND: Research has shown that patients' and practitioners' cultural orientations affect communication behaviors and interpretations in cross-cultural patient-practitioner interactions. Little is known about the effect of cultural orientations on assessment of communication behaviors in cross-cultural educational settings. The purpose of this study is to explore cultural orientation as a potential source of assessor idiosyncrasy or between-assessor variability in assessment of communication skills. More specifically, we explored if and how (expert) assessors' valuing of communication behaviours aligned with their cultural orientations (power-distance, masculinity-femininity, uncertainty avoidance, and individualism-collectivism). METHODS: Twenty-five pharmacist-assessors watched 3 videotaped scenarios (patient-pharmacist interactions) and ranked each on a 5-point global rating scale. Videotaped scenarios demonstrated combinations of well-portrayed and borderline examples of instrumental and affective communication behaviours. We used stimulated recall and verbal protocol analysis to investigate assessors' interpretations and evaluations of communication behaviours. Uttered assessments of communication behaviours were coded as instrumental (task-oriented) or affective (socioemotional) and either positive or negative. Cultural orientations were measured using the Individual Cultural Values Scale. Correlations between cultural orientations and global scores, and frequencies of positive, negative, and total utterances of instrumental and affective behaviours were determined. RESULTS: Correlations were found to be scenario specific. In videos with poor or good performance, no differences were found across cultural orientations. When borderline performance was demonstrated, high power-distance and masculinity were significantly associated with higher global ratings (r = .445, and .537 respectively, p < 0.05) as well as with fewer negative utterances regarding instrumental (task focused) behaviours (r = -.533 and - .529, respectively). Higher masculinity scores were furthermore associated with positive utterances of affective (socioemotional) behaviours (r = .441). CONCLUSIONS: Our findings thus confirm cultural orientation as a source of assessor idiosyncrasy and meaningful variations in interpretation of communication behaviours. Interestingly, expert assessors generally agreed on scenarios of good or poor performances but borderline performance was influenced by cultural orientation. Contrary to current practices of assessor and assessment instrument standardization, findings support the use of multiple assessors for patient-practitioner interactions and development of qualitative assessment tools to capture these varying, yet valid, interpretations of performance.

Mosquirix (RTS,S): a novel vaccine for the prevention of Plasmodium falciparum malaria.

OBJECTIVE: To summarize and evaluate the literature for Mosquirix (RTS,S) and provide insight into the therapeutic and economic controversies of this novel malaria vaccine candidate. DATA SOURCES: A systematic literature search was performed using the terms Mosquirix; RTS,S; malaria; vaccine; and Plasmodium in MEDLINE (1948-November 2011), EMBASE (1980-November 2011), International Pharmaceutical Abstracts (1970-November 2011), Google, and Google Scholar. STUDY SELECTION AND DATA EXTRACTION: Clinical trials describing vaccine development, pharmacology, pharmacokinetics, efficacy, and safety were reviewed. For efficacy, clinical trials were reviewed that reported acquisition of malarial disease. Information regarding study design, population, study period, baseline characteristics, clinical outcomes, results, and assessors of quality was extracted. DATA SYNTHESIS: Five randomized controlled trials and 4 follow-up extension studies were identified. In Phase 2 trials, vaccine efficacy rates were 33-65% in infants and 30-53% in children for preventing the first episode of clinical disease. In Phase 3 trials, vaccine efficacy was 56% in children aged 5-17 months. RTS,S reduced the number of clinical malaria episodes and prevented severe malaria in several studies. The follow-up period for vaccine efficacy ranged from 6 to 45 months. RTS,S 25 µg is administered intramuscularly as 3 injections given 1 month apart for infants and children. RTS,S appears to be generally well tolerated. A few cases of meningitis and seizures (within 7 days of vaccination) have been reported. CONCLUSIONS: RTS,S has demonstrated efficacy and safety in Phase 1, 2, and 3 trials, and has the potential to decrease morbidity and mortality from malaria worldwide. Major challenges include determination of the duration of immunity, assessment of its cost-effectiveness, its use in special populations, and its dissemination in endemic regions. Pending further studies, RTS,S has the potential to become the benchmark as the first effective vaccine against malaria.