Dynamic posturography after computerized vestibular retraining for stable unilateral vestibular deficits.

BACKGROUND: Balance deficits increase the risk of falls and compromise quality of life. Current treatment modalities do not resolve symptoms for many patients. AIMS/OBJECTIVES: To measure changes in objective posturography after a computerized vestibular retraining therapy protocol. MATERIALS AND METHODS: This was a single-arm interventional study of individuals with a stable unilateral vestibular deficit present for greater than six months. Participants underwent 12 twice-weekly sessions of computerized vestibular retraining therapy. Objective response was measured by the Sensory Organization Test and questionnaires were administered to measure subjective changes. RESULTS: We enrolled 13 participants (5 females and 8 males) with a median age of 51 years (range 18 to 67). After retraining, the Sensory Organization Test composite score improved by 8.8 (95% CI 0.6 to 19.1) and this correlated with improvement in the Falls Efficacy Scale-International questionnaire (rs -0.6472; 95% CI -0.8872 to - 0.1316). Participants with moderate-to-severe disability at baseline (n = 7) demonstrated greater improvement in the composite score (14.6; 95% CI 7.0 to 36.9). CONCLUSIONS AND SIGNIFICANCE: Computerized vestibular retraining therapy for stable unilateral vestibular deficits is associated with improvement in dynamic balance performance. Posturography improvements correlated with a reduction in perceived fall risk. Trial Registration Information Clinicaltrials.gov registration NCT04875013; 04/27/2021.

An Integrative Review of Approaches Used to Assess Course Interventions.

Objective. The objectives of this review are to describe the utility of approaches used for the assessment of course interventions in pharmacy education and to provide recommendations that may guide faculty members in their scholarship of teaching and learning (SoTL) efforts that encompass assessment of course interventions.Findings. Thirty-four articles that included educational interventions published between 2016 and 2020 in the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were selected for analysis. Those articles used various approaches for the assessment of course interventions. In the order of decreasing frequency of use, those methods were surveys, student academic performance, student evaluations, mixed quantitative and qualitative methods, pre- and posttest, and learning analytics.Summary. The use of more than one assessment approach, ie, triangulation, and multiple student cohorts are advantageous. When multiple cohorts are used, it is beneficial to present the students' demographic information. Student academic performance should be part of an assessment of course interventions whenever relevant. Surveys about student perceptions and confidence may contribute to the assessment of course interventions. However, since the information collected is subjective and is usually unrelated to student learning, such an approach should be coupled with other assessment approaches that reflect student learning, such as academic performance and/or a pre- and a posttest. Depending on the research question, qualitative methods and learning analytics may also be a part of the assessment of course interventions.

Durable improvement in participant-reported measures of disability and objective posturography after computerized vestibular retraining.

BACKGROUND: Unilateral vestibular deficits are associated with postural instability and loss of quality of life. Common treatments frequently fail to achieve satisfactory outcomes. OBJECTIVE: To assess the durability of changes in participant-reported disability and objective posturography after computerized vestibular retraining. METHODS: This was a single-group study. Individuals with persistent symptoms of an objectively determined unilateral vestibular deficit completed questionnaires and posturography assessments before and after twelve sessions of computerized retraining, and 4-6 months and 10-12 months after treatment. RESULTS: 13 participants completed the post-treatment assessments; 9 completed the follow up. Mean improvements in perceived disability at 4-6 months after retraining were: DHI 14.3 points (95% confidence interval 4.0 to 24.5), ABC scale 14.9 points (4.3 to 25.6), FES-I 11.6 points (-3.2 to 26.5).The SOT composite score increased by 11.4 points (95% CI 1.9 to 20.9; p = 0.0175) immediately after treatment, 8.9 points (-2.9 to 20.7; p = 0.1528) at 4-6 months, and 10.6 points (2.2 to 19.0; p = 0.0162) after 10-12 months. At the 10-12 month time point, the areas of the functional stability region increased significantly for both endpoint excursion (p = 0.0086) and maximum excursion (p = 0.0025). CONCLUSION: Computerized vestibular retraining was associated with improved participant reported disability and objective measures of postural stability.

In-class Exercises Regarding the Roles of Excipients in a Pharmaceutics Course.

Objective: To assess student perceptions regarding: 1) exercises designed to enhance student comprehension of the roles of pharmaceutical excipients in dosage forms and 2) the use of resources to identify the roles of excipients. Description: In-class exercises regarding the roles of excipients were implemented in a foundational pharmaceutics course. The exercises covered the topics of liquid single-phase systems, liquid multiphase systems, drug delivery to the skin, and parenteral, ophthalmic, and nasal dosage forms. Students were introduced to resources to identify the roles of excipients. The exercises included the presentation of pharmaceutical preparations with various fundamental excipients, followed by student polling and class discussion. A survey was administered to evaluate student perceptions regarding the exercises about the roles of excipients and the use of resources to identify the roles of excipients. Findings: Eighty students participated in the study (response rate = 99%). Student perceptions indicated that the exercises helped them understand the material better and enhanced their performance in the non-sterile compounding course taught concurrently with the pharmaceutics course. Students indicated that the resources they used during the exercises were lecture notes from the course (95%), lists with excipients that the instructor provided (24%), a Web search, e.g., Google, Bing (20%), the sixth edition of the Handbook of Pharmaceutical Excipients (18%), Micromedex/Martindale (16%), and the International Journal of Pharmaceutical Compounding (6%). Conclusion. Targeted excipient exercises are a practical approach to enhance student understanding and can be utilized in pharmaceutics and non-sterile compounding courses across various pharmacy curricula.

Lead/Drug Discovery from Natural Resources.

Natural products and their derivatives have been shown to be effective drug candidates against various diseases for many years. Over a long period of time, nature has produced an abundant and prosperous source pool for novel therapeutic agents with distinctive structures. Major natural-product-based drugs approved for clinical use include anti-infectives and anticancer agents. This paper will review some natural-product-related potent anticancer, anti-HIV, antibacterial and antimalarial drugs or lead compounds mainly discovered from 2016 to 2022. Structurally typical marine bioactive products are also included. Molecular modeling, machine learning, bioinformatics and other computer-assisted techniques that are very important in narrowing down bioactive core structural scaffolds and helping to design new structures to fight against key disease-associated molecular targets based on available natural products are considered and briefly reviewed.

The use of ratio and proportion, dimensional analysis, and equations to solve pharmacy calculations problems.

INTRODUCTION: To evaluate the effects of using different problem-solving approaches on the success rates of student pharmacists in solving problems throughout a pharmacy calculations course. METHODS: A survey was administered to first-year students (N = 96, response rate 100%) near the completion of a pharmacy calculations course. The survey assessed whether students used the approaches of ratio and proportion (RP) or equations vs. dimensional analysis (DA) to solve calculation problems involving conversions, weight-based doses, flow rates, electrolyte solutions, and expressions of concentration. Questions used on course exams were tagged according to topics. Mean success rates in solving tagged questions were correlated with the problem-solving approaches that students used. RESULTS: Approximately 60% of students used RP/equations, 30% used DA, and 10% used both approaches equally. The success rate of students solving conversions was 74% ± 24% for RP, 84% ± 14% for DA (P < .05 vs. RP), and 91% ± 12% for the use of both approaches equally (P < .05 vs. RP). Success rates in solving calculation problems of weight-based doses, flow rates, electrolyte solutions, and expressions of concentration were similar across all approaches. CONCLUSIONS: The use of DA, or the combination of RP and DA equally, may be advantageous for solving conversions but not for the other types of calculation problems studied. Therefore, for most topics, pharmacy calculations instructors can demonstrate the method of their choice. Since a considerable number of students use each of the approaches, the demonstration of both approaches in class may be advantageous.

Course design, delivery, and assessment strategies for pharmaceutical calculations course in a doctor of pharmacy program: A review.

BACKGROUND: Pharmaceutical calculations is a fundamental course taken by doctor of pharmacy students in United States schools and colleges of pharmacy. To minimize medical errors and increase the accuracy with which future pharmacists perform calculations, a comprehensive training during the program is deemed. This review attempts to summarize research outcomes of interventions described thus far in the literature concerning the improvement of course design, delivery, and assessment strategies. METHODS: A detailed literature review of various educational resources was conducted using pharmaceutical calculations and related terms. RESULTS: The literature review outcomes were divided into three major categories: educational interventions in design, delivery, and assessment of pharmaceutical calculations courses. The research findings of course design describe a standalone course vs. an integrated course, a computer-aided course, use of compact disc read-only memory, and implementation of Gagne's Nine Events of Instructions. Findings in course delivery include the use of self-paced vs. integrated courses, flipped classroom vs. traditional lecture, Keller's Personalized System of Instruction, condensed videos, and podcasts. Finally, different types of assessments are presented such as those based on selected- vs. constructed-response questions, collaborative quizzes, the approach of repeated testing, and the use of technology. IMPLICATIONS: While the review intends to present educational interventions available to construct and/or modify an existing pharmaceutical calculations course, the choice of design, delivery, and assessment approaches depends upon various factors such as the purpose of course modification, resources available, and the number of students in class.

Patient-Reported Disability After Computerized Posturographic Vestibular Retraining for Stable Unilateral Vestibular Deficit.

Importance: Individuals with persistent unilateral vestibular deficits experience loss of quality of life and increased risk of falling, and they have few well-supported options for effective treatment. Objectives: To evaluate whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit and to assess the feasibility of conducting a randomized clinical trial of vestibular retraining using computerized dynamic posturography. Design, Setting, and Participants: This single-group cohort study was conducted from April 29 to July 23, 2021, in a tertiary neurotology clinic among 13 individuals with a stable unilateral vestibular deficit present for more than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing. Statistical analysis was performed from July 7, 2021, to January 25, 2022. Interventions: Twelve twice-weekly sessions of posturography-assisted vestibular retraining with prescribed weight shifting tasks guided by an interactive display. Main Outcomes and Measures: Change in scores on the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence (ABC) Scale, and the Falls Efficacy Scale-International (FES-I), which participants completed before and after retraining to measure their perception of their disability. They also completed posturography measurements. Secondary outcomes included tolerability of the intervention and rate of completion of the full protocol. Results: A total of 13 participants (8 men [62%]; median age, 51 years [range, 18-67 years]) were enrolled. All 13 participants completed the intervention and all follow-up. After treatment, the median changes in scores were -16 points (95% CI, -20 to 2) for the DHI, -9 (95% CI, -14 to 1) for the FES-I, and 11.9 (95% CI, 0-17.3) for the ABC Scale. Eight participants (62%) improved by greater than the minimum clinically important difference (MCID) for the DHI, whereas 4 (31%) exceeded the MCID for the ABC Scale, and 3 (23%) exceeded the MCID for the FES-I. Participants with moderate to severe disability at baseline (n = 7) had a larger magnitude of improvement in DHI scores than those with mild disability (n = 6) (-18 [95% CI, -78 to 2] vs -1 [95% CI, -8 to 16]). Six of the 7 patients (86%) with moderate to severe disability improved by greater than the MCID for DHI, wherease 4 of 7 patients (57%) improved by greater than the MCID for the ABC Scale, and 3 of 7 patients (43%) improved by greater than the MCID for the FES-I. Conclusions and Relevance: This cohort study suggests that computerized, dynamic posturography-assisted retraining was associated with clinically meaningful improvements in participant-reported disability among those with stable unilateral vestibular deficit and moderate to severe disability. Further studies should compare posturography-assisted vestibular retraining with conventional physical therapy rehabilitation techniques. Trial Registration: ClinicalTrials.gov Identifier: NCT04875013.

Evaluating the effects of a mindfulness mobile application on student pharmacists' stress, burnout, and mindfulness.

PURPOSE: Pharmacists report high levels of burnout. Mindfulness approaches have been demonstrated to have positive results in the general population and in other healthcare professions. However, limited studies have been performed evaluating mindfulness approaches in student pharmacists. The aim of this study was to evaluate the effectiveness of daily use of a mindfulness mobile application in improving student pharmacists' perceived stress, burnout, and mindfulness. METHODS: This study was a randomized, longitudinal, waitlist-controlled trial. The intervention group was asked to meditate using the mindfulness application Headspace daily for at least 6 weeks. The waitlist control group was asked to abstain from using the application for the entire study. Stress, burnout, and mindfulness were assessed using validated survey instruments at baseline, 6 weeks, and 10 weeks. A secondary outcome was to assess the persistence of application use after the intervention period. RESULTS: Fifty-six participants completed the study. The intervention group reported significantly lower scores on stress and burnout at 6 weeks compared to the control group. The intervention group also reported significantly higher scores on mindfulness. The differences in stress, burnout, and mindfulness persisted at follow-up. The mean percentage of students in the intervention group who used the application each day was 90% over the intervention period and 62% over the follow-up period. CONCLUSION: A mindfulness mobile application significantly improved student pharmacists' stress, burnout, and mindfulness with daily use. Most participants continued to use the application for 4 weeks after the end of the intervention. Positive effects on stress and mindfulness persisted even with decreased use.

Survey data on orientations, boot camps, and pre-matriculation programs in schools/colleges of pharmacy.

A survey about orientations, boot camps, and pre-matriculation programs in schools/colleges of pharmacy was approved by the South College Institutional Review Board (IRB). The survey was sent electronically to Assistant/Associate Deans of Academic Affairs or administrators in similar positions at schools/colleges of pharmacy in October 2016. The survey was closed two months later, in December, with 50 responses. The data that was collected from the survey included characteristics and components of orientations, boot camps, and pre-matriculation programs, such as session content and the frequency sessions appeared. The survey also collected descriptive information from respondents regarding certain demographics related to their schools/colleges of pharmacy (e.g., public or private institutions, a 4-year program or a 3-year program). The data can be used by schools/colleges of pharmacy and other healthcare professions that wish to revise or establish orientations, boot camps, and pre-matriculation programs.

Normal values for cervical and ocular vestibular-evoked myogenic potentials using EMG scaling: effect of body position and electrode montage.

BACKGROUND: The clinical utility of cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) is limited by variability of testing protocols and a dearth of normative data using contemporary methods for amplitude scaling. AIMS/OBJECTIVES: To investigate the effect of body position and electrode montage on VEMP responses and to establish normative values. MATERIAL AND METHODS: This is a repeated measures study of 44 healthy young adult subjects (22 men and 22 women). RESULTS: The highest response rate (99%) for cVEMP was achieved in the supine position with the head elevated and turned. For oVEMP, the highest response rate (90%) was achieved using nasal alar electrode montage with the subject in a sitting position. Scaled peak-to-peak amplitude was higher in males than in females for both cVEMP and oVEMP. CONCLUSION: Normative data for 44 young healthy adults was successfully collected for two body positions for cVEMP and two head positions and two electrode montages for oVEMP. SIGNIFICANCE: Our findings describe VEMP protocols that efficiently detect VEMP responses, and we provide normative VEMP response data for young healthy subjects. We describe a potential difference in response between males and females, which may be clinically important.

Implementation, Revisions, and Student Perceptions of a Pre-Matriculation Program in a School of Pharmacy.

Objective. To characterize the development, revision, and student perceptions of a pre-matriculation program entitled Pharmacy Readiness and Enrichment Program (PREP) in a school of pharmacy. Methods. The program was first implemented in June 2013 for the incoming class of 2016. The main components of PREP were curriculum and scientific content review, professionalism, time management, critical thinking, and personal interactions. Entering student pharmacists were surveyed immediately and six or more months after PREP concluded. Statistical analysis was performed to determine if participation in PREP affected students' academic performance. Results. Student perceptions regarding the program and its components were favorable immediately after PREP but less favorable six or more months later. Statistical analysis showed that students who completed PREP had significantly higher cumulative grade point average (GPA) in pharmacy year one and year two. Conclusion. It is possible to implement a two-day pre-matriculation program with a wide range of components and deliver it prior to the start of the first professional year. It is also possible to deliver some PREP components during the first professional year rather than prior to matriculation into the program. The PREP may serve as a model for other schools of pharmacy that are considering the implementation of a pre-matriculation program, or that have a pre-matriculation program in place and are seeking to modify or update their program.

[Treatement of sex offenders: limits and possibilities]. / Traitement des agresseurs sexuets: possibilités et limites.

Sexual offending is a matter of public concern and of interest to caregivers because of the consequences to the victims. Though there is a high prevalence of paraphilias among sexual aggressors, there is no strict link between aggressive sexual behavior and psychiatric disorders. Several typologies of sex offenders, based on personality and motivation, have been described. According to several studies, recidivism risk, for all known typologies of sex offenders, is estimated to be around 15% at 5 years. The use of standardized scales improves the reliability of the risk assessment. Psychotherapy, with or without a pharmacological treatment, forms the basis of the psychiatric treatment of these patients. Serotoninergic selective reuptake inhibitors, antiandrogens and GnRH analogues are the main drugs that are used.

[Psychiatric care for asylum seekers in Geneva: a multidisciplinary approach for individualized care]. / Soins psychiatriques pour les requérants d'asile à geneve. Une approche multidisciplinaire pour préserver la singularité des soins.

Asylum seekers constitute a vulnerable population insofar as they are submitted to numerous stress factors which facilitate the emergence of mental disorders, such as low socio-economic status, forced separation from loved ones and exposure to violence. Asylum seekers who consult at our community psychiatry facility usually have short-term residence permits, live in collective housing and do not speak the local language. The most frequent diagnoses are depressive disorder (64.7%) and post-traumatic stress disorder (34.5%). Due to their specific clinical and social situation and to the involvement of several professionals in these situations, a specialized psychiatric intervention coordinated with the rest of the network seems necessary.

Corneal gene delivery: chitosan oligomer as a carrier of CpG rich, CpG free or S/MAR plasmid DNA.

BACKGROUND: Corneal gene therapy can potentially treat acquired and inherited corneal disorders that otherwise lead to blindness. In a previous study on the development of effective vectors for corneal gene delivery, we showed that a particular formulation of chitosan-DNA nanoparticles, based on ultrapure chitosan oligomers injected into rat corneas, led to transgene expression that was 5.4-fold higher than that obtained using polyethylenimine-DNA nanoparticles. METHODS: In the present study, we investigate the same formulation of chitosan-DNA nanoparticles as carriers of six different plasmids for corneal gene delivery. Size, zeta potential, the ability to condense plasmid DNA, and transfection efficiency in cell cultures and in rat corneas, were all investigated. RESULTS: Size, zeta potential, the ability to condense plasmid DNA, and transfection efficiency in cell cultures did not substantially vary for nanoparticles based on different plasmids. One day post-injection of nanoparticles into rat corneas, we found that a CpG-free plasmid DNA, pCpG-Luc, which has an EF1α promoter, led to transgene expression that was 7.1-fold higher than that for gWiz-Luc, a commercially available plasmid DNA with a cytomegalovirus (CMV) promoter used in our previous study; 116.8-fold higher than that for pEPI-CMV, a commercially available plasmid that has a scaffold/matrix attachment region (S/MAR) sequence and a CMV promoter; and 76.8-fold higher than that for pEPI-UbC, an experimental plasmid that has an S/MAR sequence and a ubiquitin C promoter. CONCLUSIONS: The present study reveals the potential of comparing various plasmids as an approach for enhancing transgene expression. The delivery system designed in the present study represents the next step in the development of effective vectors for corneal gene therapy.

Primary care services provided to adolescents in detention: a cross-sectional study using ICPC-2.

AIM: The aim of this study was to provide a detailed description of the health problems for which primary care services are provided to adolescents in a juvenile detention facility in Europe. METHODS: We reviewed the medical files of all detainees in a juvenile detention centre in Switzerland in 2007. The health problems for which primary care services were provided were coded using the International Classification for Primary Care, version 2. Analysis was descriptive, stratified by gender. RESULTS: A total of 314 adolescents (18% female) aged 11-19 years were included. Most (89%) had a health assessment and 195 (62%) had consultations with a primary care physician; 80% of the latter had a physical health problem, and 60% had a mental health problem. The most commonly managed problems were skin (49.7%), respiratory (23.6%), behavioural (22.6%) and gynaecological problems (females: 23.9%); 13% females (no males) had sexually transmitted infections (STI), and 8.7% were pregnant. Substance abuse was common (tobacco: 64.6%, alcohol: 26.2%, cannabis: 31.3%). CONCLUSION: In addition to health problems known to be more prevalent among young offenders, such as mental health problems and STI, these adolescent detainees required care for a range of common primary care problems. These data should inform the development of comprehensive primary care services in all juvenile detention facilities in Europe.

Ultrapure chitosan oligomers as carriers for corneal gene transfer.

NOVAFECT chitosans are ultrapure chitosan oligomers that were recently marketed as carriers for non-viral gene therapy. There are no reports on systematic design and improvement of formulations based on NOVAFECT chitosans for gene delivery. Therefore, we have designed and characterized chitosan-DNA nanoparticles based on NOVAFECT. We found that the size of oligomeric chitosan-DNA nanoparticles is small, or=44.1+/-3.5 millivolt. In vitro transfection studies demonstrated the ability of oligomeric chitosan-DNA nanoparticles to effectively transfect COS-7 cells. In rat corneas, injection of a select formulation of oligomeric chitosan-DNA nanoparticles into the stroma showed that (a) luciferase gene expression was 5.4 times greater than following administration of polyethylenimine-DNA nanoparticles; and (b) the cells that express the transgene, green fluorescent protein, were keratocytes (corneal fibroblasts). This study lays the foundation for evaluating oligomeric chitosan-DNA nanoparticles as pharmaceuticals for corneal gene therapy, a promising approach for the treatment of acquired and inherited corneal diseases that otherwise lead to blindness. Oligomeric chitosan-DNA nanoparticles can also be evaluated for the treatment of ocular diseases outside of the cornea, and for various additional gene therapy applications.

[Self aggressive-behaviours in prison]. / Comportements auto-dommageables en prison.

Suicide among prisoners is a relatively well documented public health issue. On the other hand, data about self-aggressive behaviours in prisons are scarce, despite the fact that this problem seems to be highly prevalent. We conducted a retrospective study over a fifteen months period in a remand prison situated in the French speaking area of Switzerland. During this time period, 161 self-aggressive behaviours were recorded, corresponding to 80 inmates. The most frequent acts were self-cuttings and self-mutilations, followed by strangulations. All these patients were male and their mean age was 25. Some of these behaviours (ingesting cutting objects and sewing of the lips) were specific to some ethno-cultural groups. Copycat behaviours play a significant role in closed communities such as prisons. These results underline the necessity of taking into account self-aggressive behaviours in penitentiary institutions.