Infringement of clinical pharmacist's authority.

Clinical pharmacists are healthcare practitioners who have advanced education and training in comprehensive medication management. Clinical pharmacists work with other members of the healthcare team to manage particular medications or disease states. Even though clinical pharmacists are members of healthcare teams, there are still many cases of challenge in the interprofessional relationship with other healthcare team members, especially related to drug management. Increasing interprofessional communication between physicians and clinical pharmacists within the healthcare system could enhance the role of clinical pharmacists. Earlier studies reported that physicians were comfortable with pharmacists detecting and preventing prescription errors, but were uncomfortable with them recommending drug therapy to patients. Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services. The role of clinical pharmacists could be improved by increasing interprofessional communication between doctors and clinical pharmacists in the healthcare system.

FITRI's four steps in developing primary health cares' interprofessional collaborative: an intervention for fostering IPCP competencies.

It is important to fill the gaps in collaborative practice due to the lack of the healthcare professionals' ability to work in collaboration with other disciplines. However, the current team training does not routinely address this important issue. This study aimed to identify how interactive interprofessional collaborative practice (IPCP) learning materials in a virtual course and community implementation called FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be used in primary healthcare settings to address IPCP competencies of healthcare providers. This research was a quasi-experimental study with an untreated control group design using a dependent pretest and posttest sample. A purposive sample of 50 primary healthcare providers consisting of general physicians, dentists, nurses, dietitians, and pharmacists were nonrandomly divided into the control and intervention groups. This study showed that IPCP competencies measured by the Interprofessional Collaborator Assessment Rubric (ICAR) in the intervention group were significantly higher after the training and implementation than before. The Mann-Whitney tests indicated that IPCP competencies were better in the intervention group than the control group. Based on effect size analysis, the intervention had a very strong impact and could significantly improve the participants' competencies, especially in the collaborative patient/client-family centered approach domain. The FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be implemented and provide positive impacts in primary healthcare settings to improve and foster competencies of IPCP in primary healthcare.

Disease-Associated Systemic Complications in Childhood Nephrotic Syndrome: A Systematic Review.

INTRODUCTION: Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. During the active phase, the disease pathogenesis affects various biological functions linked to loss of proteins negatively, which can result in systemic complications. Complications of childhood NS are divided into two categories: disease-associated complications and drug-associated complications. However, complications in pediatric patients with NS, especially disease-associated complications are still limited. Although reported in the literature, information is not comprehensive and needs to be updated. This study aimed to systematically assess systemic complications in children with NS, especially disease-associated complications, to better understand how they impact outcomes. METHODS: We conducted a systematic search of several databases: BioMed Central Pediatrics, PubMed, Google Scholar, the National Library of Medicine, Cochrane Library, CINAHL/EBSCO, British Medical Journal, Science Direct, Scopus, and Elsevier's ClinicalKey. We followed the PRISMA guidelines to plan, conduct, and report this review. We used the Joanna Briggs Institute's critical appraisal tools for assuring the quality of the journal articles that were chosen. RESULTS: Eleven articles concerning complications in childhood NS were analyzed. Systemic disease-associated complications in covered were cardiovascular complications, infections, thyroid-hormone complication, kidney complications, and oral health complications. CONCLUSION: NS is marked by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which can result in systemic disease-associated complications. Cardiovascular complications, infections, thyroid-hormone complications, kidney complications, and oral health complications are the main systemic complications in childhood NS. It is essential that health-care providers prevent these complications for proper maintenance of patients' health.

Effectiveness of collaboration in older adults: do interprofessional teams improve nutritional status more compared to usual care?

BACKGROUND: Ageing is accompanied by many changes that make it more difficult for nutritional needs to be met. Management of malnutrition in older adults requires collaboration among multiple clinical disciplines. OBJECTIVE: This study aimed to determine the effectiveness of interprofessional collaboration and practice (IPCP) implementation for older adults with malnutrition compared to usual care. METHODS: This was a quasi-experimental study using an untreated control group design with dependent pretest and posttest sample of older adults with malnutrition. The intervention group worked as a team to give the intervention based on their own roles and responsibilities. The older adults of the control group received usual care from primary health care. Outcome measurement of nutritional status used the Mini Nutritional Assessment (MNA). RESULTS: The study results show significant differences between before and after IPCP implementation in the intervention group which had better scores of MNA after implementation. In the control group, there was no significant difference between before and after implementation of usual care. The statistical analysis showed there was a significant difference between the control and intervention groups who had improved nutritional status after IPCP implementation. IPCP had strong correlation with nutritional status based on correlation analysis. These results demonstrate that the collaboration by more than one health profession can improve nutritional status better than usual daily care. CONCLUSION: IPCP has a strong and significant correlation with the nutritional status in older adults. The IPCP implementation could significantly improve their nutritional status after the IPCP implementation compared to usual care.

Malnutrition in older adults: how interprofessional teams see it? A systematic review of the qualitative research.

BACKGROUND: The understanding of health care providers' experiences involved in malnutrition treatment is a key component that should be explored. OBJECTIVE: This systematic review aimed to explore the views and perceptions of community health care providers related to malnutrition and its management for older adults, through synthesizing the qualitative studies. METHODS: Six electronic databases were used to search relevant articles. Qualitative research synthesis using Sandelowski and Barroso's method and thematic synthesis were used to broaden the range of methodology in this study. Joanna Briggs Institute (JBI) Critical Appraisal Tools for Qualitative Research was used to enable judgement about the strength of qualitative research. RESULTS: A total of four qualitative studies of health care providers' views and perceptions related to malnutrition in older adults were analysed. The results showed that there are three main themes that reflect their malnutrition experiences: (i) knowledge and skills about malnutrition, (ii) management of malnutrition and (iii) the need for collaborative teams. CONCLUSION: While health care professionals understand about the aetiology of malnutrition, however screening for malnutrition is not routine in their practice. Proper education and training about nutritional care is needed. Dietary changes and public education are preferable over oral nutritional supplements. Some solution and recommendations for management of malnutrition in older adult such as supportive interventions include environmental changes, nutritional counselling, food modification, oral nutrition supplement and pharmacotherapy if needed, routine screening and multidisciplinary approach.