Global Is Local: Interprofessional Experiential Learning for Migrant Farmworker Health Equity.

Purpose: Medical educators recognize the importance of addressing social determinants of health and providing opportunities for learners to work with diverse populations. Still, social, geographic, resource, and language barriers prevent institutions from connecting with globally diverse populations within their own communities. In this article, we describe the migrant farmworker health course at the University of Minnesota, the importance of longitudinal partnership with community-based organizations, and ways to increase access to care and educate health professional learners in health equity. Methods: The migrant farmworker health course is a clinical rotation that combines didactic learning on social determinants of health with hands-on clinical experience. Learners work with community organizations to provide mobile health care while learning about a diverse and underserved rural population. Twenty-eight learners who participated in the course between 2015 and 2019 were surveyed about their experience, knowledge, and skills gained, and recommendations for improvement. Results: Over 90% of participants rated their overall experience in the course as "good" or "outstanding." Most learners increased confidence in the subjects that were covered during didactic sessions. Qualitative feedback provided insight on how the migrant farmworker health course shaped learners' understanding of social determinants of health and influenced their career trajectories. Conclusion: The migrant farmworker health course has educated interprofessional learners and is expanding to include more opportunities for mobile health care. The feedback from this survey helped improve didactic teaching and will help deepen relationships with community partners. Learning through service with global populations locally in a "global is local" rotation is a rewarding way to engage in and learn about health equity.

Costs and Cost-Effectiveness of the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers.

BACKGROUND: The patient-centered HIV care model (PCHCM) is an evidence-informed structural intervention that integrates community-based pharmacists with primary medical providers to improve rates of HIV viral suppression. This report assesses the costs and cost-effectiveness of the PCHCM. SETTING: Patient-centered HIV care model. METHODS: Three project sites, each composed of a medical clinic and 1 or 2 community-based HIV-specialized pharmacies, were included in the analyses. PCHCM required patient data sharing between medical providers and pharmacists and collaborative therapy-related decision making. Intervention effectiveness was measured as the incremental number of patients virally suppressed (HIV RNA <200 copies/mL at the last test in a 12-month measurement period). Microcosting direct measurement methods were used to estimate intervention costs. The cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were calculated from the health care providers' perspective. Additionally, the number of HIV transmissions averted, lifetime HIV treatment cost saved, quality-adjusted life years (QALYs) saved, and cost per QALY saved were calculated from the societal perspective, using standard methods and reported values from the published literature. RESULTS: Overall, the PCHCM annual intervention cost for the 3 project sites was $226,741. The average cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were $813, $48, and $5,039, respectively. The intervention averted 2.75 HIV transmissions and saved 12.22 QALYs and nearly $1.28 million in lifetime HIV treatment costs. The intervention was cost saving overall and at each project site. CONCLUSIONS: The PCHCM can be delivered at a relatively low cost and is a cost-saving intervention to assist patients in achieving viral suppression and preventing HIV transmission.

Work System and Process Designs for Community Pharmacy-Medical Clinic Partnerships to Improve Retention in Care, Antiretroviral Adherence, and Viral Suppression in Persons with HIV.

The objective of this project was to collect and analyze information about work systems and processes that community pharmacy-medical clinic partnerships used for implementing the Patient-Centered HIV Care Model (PCHCM). Paired collaborations of 10 Walgreens community pharmacies and 10 medical clinics were formed in 10 cities located throughout the United States that had relatively high HIV prevalence rates and existing Walgreens HIV Centers of Excellence. Patient service provision data and most significant change stories were collected from key informants at each of the clinic and pharmacy sites over an 8 week period in 2016 and through in-depth phone interviews. Written notes were reviewed by two authors (J.C.S. and O.W.G.) and analyzed using the most significant change technique. The findings showed that half of the partnerships (n = 5) were unable to fully engage in service implementation due to external factors or severe staff turnover during the project period. The other half of the partnerships (n = 5) were able to engage in service implementation, with the most impactful changes being related to strong patient care systems, having a point person at the clinic who served as a connector between sites, and having pharmacists integrated fully into the health care team.

Using a multisite and multi-health system pharmacy resident program model for care documentation quality improvement.

OBJECTIVES: To implement and evaluate a pharmacy resident documentation peer review process. SETTING: The University of Minnesota Postgraduate Year One Pharmacy Residency Program is a multisite program with 25 residents across 16 different health care organizations. PRACTICE DESCRIPTION: Sites within the program provide comprehensive medication management (CMM) services to patients in ambulatory care settings, including participation in the full patient care process of assessment, care plan development, follow-up, and appropriate documentation. PRACTICE INNOVATION: In this innovative peer review process model, residents undergo a deidentified CMM documentation review process with residents from other practice sites, exposing them to different documentation templates and perspectives. EVALUATION: A workgroup of residency preceptors led by a research team developed a peer review process, which evolved through 3 phases over 2 years in response to resident, preceptor, and administration team feedback. Resident feedback was compiled and analyzed. RESULTS: Forty-two residents responded to the survey (67% response rate); 71% found the review process to be helpful. Residents reported that the process improved their understanding of how to improve patient care documentation (74%), how to provide peer feedback (90%), and the importance of effective interprofessional communication in clinical decision making (81%). DISCUSSION: The core perceived benefit of the peer review process was exposure to how other health systems and practitioners document CMM. Some residents participate in a peer review process at their home institutions, which may explain some of the lack of perceived benefit. Generalizability of this study is limited by being within a single residency program with a relatively small number of participants. CONCLUSION: Pharmacy residents found a peer review process of documentation to be helpful during their residency education. The process exposed residents to different documentation practices at various health care systems, which led to ideas of how to improve documentation and provided a foundation for how to provide peer feedback in practice.

Leadership and Management Are One and the Same.

Defining the attributes of change catalysts within high functioning organizations, including the academic enterprise, is desirable. An understanding of these attributes within our academy may foster faculty interest and engagement in seeking administrative roles and serve to bolster succession planning within our schools. On one hand, there have been numerous publications teasing out the purported differences between leadership and management. On the other hand, does segregating these important characteristics based upon arbitrary distinctions do more harm than good? This commentary represents the work of a group of academic leaders participating in the 2015-2016 AACP Academic Leadership Fellowship Program. This work was presented as a debate at the 2016 AACP Interim Meeting in Tampa, Florida, in February 2016.

Partners in Public Health: Public Health Collaborations With Schools of Pharmacy, 2015.

To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.

Experience with technology-supported transitions of care to improve medication use.

OBJECTIVE: To describe an innovative community pharmacy-based pilot program using technology to support transitions of care for patients living in rural areas. SETTING: This service occurred through a partnership between 1 independent community pharmacy organization with 5 locations in Ohio and Indiana and one 92-bed general medical and surgical county hospital during May 2014 to May 2015. PRACTICE DESCRIPTION AND INNOVATION: Community pharmacists worked with patients immediately following discharge to reconcile their medications and make recommendations to optimize therapy. The pharmacy packaged their new medication regimen in clear, individual dose adherence packaging. Medications were delivered by a staff driver to the patient's home within 72 hours of discharge. Patients consulted with the pharmacist by videoconference using a computer tablet device. Patients received telephone follow-up shortly before their medication supply was to run out, and additionally as needed on an individual basis. EVALUATION: Self-reported hospital readmissions were collected at 30 and 180 days after enrollment. Patient satisfaction data were also collected at 30 and 180 days using a tool modified from the 5-item Transition Measure (15-item Care Transitions Measure). RESULTS: Eighteen patients participated in the evaluation of the pilot. Three patients were readmitted within 30 days (17%), and 2 additional patients were readmitted within 180 days (11%). Patient satisfaction results were positive overall. Lessons learned relate to establishing partnerships, logistics, and patient engagement. These lessons will assist future community pharmacies in implementing a transition of care service. CONCLUSION: This pharmacist care model may offer a solution to increase access to pharmacy services for patients in rural areas during a critical transition in care.

A leadership elective course developed and taught by graduate students.

OBJECTIVE: To develop and implement a flexible-credit elective course to empower student pharmacists to develop lifelong leadership skills and provide teaching practice opportunities for graduate students. DESIGN: An elective course focusing on leadership development for second- and third-year doctor of pharmacy (PharmD) students was designed and taught by 4 graduate students under the mentorship of 2 faculty members. Student pharmacists could enroll in a 1-, 2-, or 3-credit-hour version of the course. ASSESSMENT: Attainment of course objectives was measured using student pharmacist reflection papers and continuing professional development portfolios. Additionally, self-assessments of graduate students and faculty members delivering the course were conducted. In their responses on course evaluations, student pharmacists indicated they found the course a valuable learning experience. Graduate students found course development to be challenging but useful in developing faculty skills. CONCLUSION: This flexible-credit elective course taught by graduate students was an innovative way to offer formal leadership instruction using limited college resources.

Pilot evaluation of a continuing professional development tool for developing leadership skills.

BACKGROUND: Strategies are needed to assure essential nonclinical competencies, such as leadership, can be gained using a continuing professional development (CPD) framework. OBJECTIVE: The objective of this study was to explore student pharmacists' utilization and perceived effectiveness of a CPD tool for leadership development in an elective course. METHODS: Students completed 2 CPD cycles during a semester-long leadership elective using a CPD tool. A questionnaire was used to measure students' perceptions of utility, self-efficacy, and satisfaction in completing CPD cycles when using a tool to aid in this process. RESULTS: The CPD tool was completed twice by 7 students. On average, students spent nearly 5 hours per CPD cycle. More than half (57.1%) scored themselves as successful or very successful in achieving their learning plans, and most (71.4%) found the tool somewhat useful in developing their leadership skills. Some perceived that the tool provided a systematic way to engage in leadership development, whereas others found it difficult to use. CONCLUSIONS: In this pilot study, most student pharmacists successfully achieved a leadership development plan and found the CPD tool useful. Providing students with more guidance may help facilitate use and effectiveness of CPD tools. There is a need to continue to develop and refine tools that assist in the CPD of pharmacy practitioners at all levels.

[Treatment of femoro-acetabular impingement by a minimally invasive approach. Results at 2 years follow-up]. / Tratamiento del pinzamiento femoro-acetabular mediante abordaje mínimo invasivo. Resultados con 2 años de seguimiento.

INTRODUCTION: Surgical treatment of femoroacetabular impingement (FAI) is becoming a worldwide current practice. In this work we describe our developed minimal-invasive anterior technique as well as the results obtained in our first 117 patients. MATERIAL AND METHODS: We evaluated our first 117 operated hips in 115 patients, who underwent to femoroacetabular osteoplasty through minimally invasive anterior approach with a minimal follow up of 2 years. Hips were divided into 3 groups according to radiological Tönnis classification: 32 cases were included in group A (stage 0), 61 cases in group B (stage 1), 24 cases in group C (stage 2). A combined score method (Dexeus Combined Score) was used to compare these groups at 3 months, 6 months and 1 year and each subsequent year. RESULTS: In 30 cases (93.7%) group A, 56 (91.8%) group B and 14 (58.3%) group C satisfactory result was obtained at 6 months, without significant changes over the year (96.8%, 91.8%, 54.1% respectively). After 2 years same behaviour was observed in groups A and B, exception made with group C (96.8%, 93.4%, 45.8% respectively). Differences between groups A and B when compared to group C were statistically significant (p < 0.01). No statistical difference was observed between groups A and B (p > 0.05). CONCLUSIONS: Patients improve in their clinical and functional scores. However these results differed in patients with Tönnis stage 0 and 1 when compared to Tönnis 2. Thus, it seems reasonable to recommend to symptomatic patients surgical treatment of FAI as early as it appears.

[Alteplase in acute coronary syndromes]. / Registro de Alteplasa en Síndromes Coronarios Agudos con elevación del ST (REALSICA).

OBJECTIVE: The registry intends to establish the safety and security of one-hour 100 mg alteplase infusion and 50 mg in 30 minutes to facilitate percutaneous coronary intervention (PCI) in a cardiology hospital with primary angioplasty program (24 hours 365 days a year) with current doses of unfractionated heparin and enoxaparin. METHODS AND RESULTS: REALSICA II is a prospective registry that included 103 patients with final diagnosis of ST elevation myocardial infarction in which Alpert's quality criteria were used. Seventy two patients were under one-hour 100 mg alteplase infusion and thirty one under 30 minutes 50 mg alteplase infusion to facilitate PCI. Patients were young and predominantly males. In both groups > 50% had extensive ST elevation myocardial infarction and 68% were Killip & Kimball I. The majority received reperfusion > 3 hours after the onset of symptoms. In-hospital and follow-up treatment were compliant with Mexican Cardiology Society guidelines. ECG reperfusion was observed in 59% and TIMI III flow in 19% of PCI group. Any intracranial hemorrhage was observed. Global cardiovascular mortality was 11%. Patients under PCI had low incidence of recurrent ischemia and reinfarction. CONCLUSION: REALSICA registry showed in non-complicate acute myocardial infarction ST elevation safety and security of one-hour 100 mg alteplase infusion with current recommended unfractionated heparin and enoxaparin doses in ST elevation myocardial infarction. In complicated patients the regimen to facilitate PCI was associated with increased hemorrhagic complications and requires further research.

Comparison of a novel distillation method versus a traditional distillation method in a model gin system using liquid/liquid extraction.

This research studied a novel form of distillation (high vacuum distillation) as a method for preserving volatile aroma chemicals important to the organoleptic attributes of a four botanical model gin as well as the degradation products generated during the heating required in traditional methods of gin distillation. A 2 (5) factorial experiment was conducted in a partially confounded incomplete block design and analyzed using the PROC MIXED procedure from SAS. A model gin was made of dried juniper berries (Juniperus communis), coriander seed (Coriandrum sativum), angelica root (Angelica archangelica), and dry lemon peel (Citrus limonum). This was distilled on a traditional still utilizing atmospheric pressure and a heating mantel to initiate phase separation as well as a novel still (high vacuum) utilizing high vacuum pressures below 0.1 mmHg and temperatures below -15 degrees C to initiate phase separation. The degradation products (alpha-pinene, alpha-phellandrene, E-caryophyllene, and beta-myrcene) were present at greater levels (approximately 10 times) in the traditional still-made gin as compared to the novel gin.

Registro de Alteplasa en Síndromes Coronarios Agudos con elevación del ST (REALSICA) / Alteplase in acute coronary syndromes

OBJECTIVE: The registry intends to establish the safety and security of one-hour 100 mg alteplase infusion and 50 mg in 30 minutes to facilitate percutaneous coronary intervention (PCI) in a cardiology hospital with primary angioplasty program (24 hours 365 days a year) with current doses of unfractionated heparin and enoxaparin. METHODS AND RESULTS: REALSICA II is a prospective registry that included 103 patients with final diagnosis of ST elevation myocardial infarction in which Alpert's quality criteria were used. Seventy two patients were under one-hour 100 mg alteplase infusion and thirty one under 30 minutes 50 mg alteplase infusion to facilitate PCI. Patients were young and predominantly males. In both groups > 50% had extensive ST elevation myocardial infarction and 68% were Killip & Kimball I. The majority received reperfusion > 3 hours after the onset of symptoms. In-hospital and follow-up treatment were compliant with Mexican Cardiology Society guidelines. ECG reperfusion was observed in 59% and TIMI III flow in 19% of PCI group. Any intracranial hemorrhage was observed. Global cardiovascular mortality was 11%. Patients under PCI had low incidence of recurrent ischemia and reinfarction. CONCLUSION: REALSICA registry showed in non-complicate acute myocardial infarction ST elevation safety and security of one-hour 100 mg alteplase infusion with current recommended unfractionated heparin and enoxaparin doses in ST elevation myocardial infarction. In complicated patients the regimen to facilitate PCI was associated with increased hemorrhagic complications and requires further research.

The arterial blood supply for the synovial tendon sheaths of the hand.

The blood supply for the synovial tendon sheaths of the hand was carefully investigated. We show that the origin of those arteries, supplying the synovial tendon-sheaths of the Mm. flexor pollicis longus, flexor digitorum superficialis and profundus, lies in the Canalis carpi. We also describe that the branches of the Aa. digitales palmares propriae arise independently. We emphasize that the terminal branches of the A. interossea posterior and the Rete carpi dorsalis form an arterial network on the synovial tendon sheaths of the Dorsum manus. The synovial membranes of the proximal joints of the fingers receive an ample blood supply from the Rami ascendentes of the Aa. metacarpeae palmares and the Aa. digitales palmares propriae (Aa. recurrentes).

Transition State Structure for the Water-Catalyzed Hydrolysis of p-Nitrophenyl Trifluoroacetate in Acetonitrile.

The neutral hydrolysis of p-nitrophenyl trifluoroacetate in acetonitrile solvent has been studied by varying the molarities of water from 1.0 to 5.0 at 25 degrees C. The reaction is found to be third order in water. The reaction is also third order in D(2)O and in methanol when D(2)O and methanol replace water as the solvent. The kinetic solvent isotope effect is (kH(2)O/kD(2)O) = 2.90 +/- 0.12. Proton inventories at each molarity of water studied are consistent with an eight-membered cyclic transition state model. In this model, three protons undergo bonding changes. Such an eight-membered transition state model can easily accommodate linear hydrogen bonds for the three transferred protons. These results are consistent with the experimental findings of Bell and Critchlow(1) on the reversible addition of water to 1,3-dichloroacetone in dioxane and the theoretical findings of Wolfe and co-workers(2) on the hydration of formaldehyde.

Detección de diabetes mellitus no insulinodependiente en adultos asintomáticos / Screening for non-insulin dependent diabetes mellitus in asymptomatic adults

Se estudio un grupo de 1,011 adultos clínicamente sanos mayores de 20 años que asistieron por algún motivo a las unidades de medicina familiar del IMSS. Se interrogaron antecedentes de biabetes mellitus en familiares directos, se midieron la estatura, el peso y los perímetros de la cintura y de la cadera, con los cuales se calcularon los índices de masa corporal (IMC) y la relación cintura/cadera; se tomó una muestra de sangre capilar para la determinación de glucosa empleando un refractómetro. El 35.6 por ciento del grupo refirió antecedentes de diabetes en familiares directos y 26 por ciento tuvieron un IMC > 30. Las personas con cifras de glucosa arriba de 160 mg/dL (17/1011) fueron evaluados con glucemias de ayuno: se diagnóstico diabetes mellitus en 12/17 (1.2 por ciento del total de la muestra). No se encontró ninguna persona menor de 30 años con diabetes mellitus, pero se encontraron 3/237 en los de 30-39 años (1.3 por ciento en este subgrupo) y se identificaron nueve personas en el grupo de mayores de 40 años. La obesidad centrípeta predominó en los varones obesos, 74/74, mientras que sólo se identificó en 61/189 (32.3 por ciento) de las mujeres obesas