Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa.

BACKGROUND: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. METHOD: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. RESULTS: Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. CONCLUSION: To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to "leave no one behind".

Assessment of English language performance scores and academic performance in an English-based curriculum for pharmacy students with English as a second language.

BACKGROUND: The primary objective was to determine if there is a relationship between English language performance and graduating grade point average (GPA) in pharmacy students with English as a second language (ESL). METHODS: Students graduating from a four-year pharmacy program in 2016-2018 were invited to participate in the study. We compared pharmacy students' pre-admission ESL scores to their cumulative GPA at graduation in each of the three graduating cohorts and also determined if these results held true for both genders. Correlation of GPA to individual mathematics, chemistry, and Chinese language scores were used as points of reference to compare the degree of correlation. RESULTS: There were 148 students screened for the study with 31 students not meeting the inclusion criteria and four students declining to participate. Statistical analyses show an overall weak correlation. There was a statistically significant stronger correlation between pre-admission ESL scores and cumulative graduating GPA (r = 0.273) as compared to the correlation of GPA with mathematics (r = 0.187), chemistry (r = 0.181), or Chinese language scores (r = 0.059). The results did not change when the study population was separated by gender as English score still had the strongest correlation as compared to the other subjects. CONCLUSION: This study provides evidence that English language scores correlate more strongly with academic performance than mathematics, chemistry, or Chinese language scores in ESL pharmacy students. Also, this English language correlation is stronger for females than males.

Evaluation of Drug-Disease Interactions and Their Association with Unplanned Hospital Readmission Utilizing STOPP Version 2 Criteria.

Early hospital readmission is a common problem among geriatric patients, as they are more susceptible to adverse drug events, which are associated with increased hospital admission. The objective is to examine the association between exposure to potentially inappropriate medications under selected STOPP version 2 criteria related to drug-disease interactions and unplanned early hospitalization within 28 days of index admission in elderly patients prescribed a potentially inappropriate medication. This retrospective single-center study reviewed patients 75 years of age or older that were discharged with 5 or more medications, including at least one selected medication listed in the STOPP version 2 criteria relating to drug-disease interactions. 182 patients, with a mean age of 83.5 years, were included in the study, with anticholinergics being the most common potentially inappropriate medications (22.4%). Potentially inappropriate medications (57.1% vs. 17.1%, p < 0.001), gout (31% vs. 11.5%, p = 0.003), and gastrointestinal disease (11.9% vs. 2.5%, p = 0.026) were shown to increase risk of 28-day readmission, whereas no other factors assessed correlated with readmission. A rapid evaluation of elderly patient discharge medications and concomitant disease states with the aid of the STOPP version 2 criteria could potentially reduce hospital readmissions or emergency department visits.

Antithymocyte globulin dosing effects on biopsy-proven acute rejection and infection risk.

BACKGROUND: Antithymocyte globulin (rATG) is a polyclonal antibody commonly used as induction therapy in kidney transplantation to reduce risk of allograft rejection. Currently there is no consensus on the optimal dosing. rATG is not FDA approved for induction therapy, so no dosing recommendations are provided by the manufacturer. Current kidney transplant guidelines do not provide dosing recommendations. The objective of this study was to evaluate effects of different cumulative doses of rATG on rejections and infection rates. MATERIAL AND METHODS: This was a retrospective, single-center chart review that included 142 renal transplant patients from January 2007 to October 2012 who received either 3 or 5 doses of rATG. RESULTS: The primary outcome of biopsy-proven acute rejection (BPAR) was not significantly different between the 3-dose and 5-dose groups, (6.1% versus 7.4%, p=NS). No significant difference was seen between the 3-dose and 5-dose groups in regards to bacterial infections (33.9% versus 40.7%, p>0.05) or BK viremia (24.3% versus 18.5%, p>0.05). However, in regards to CMV viremia there was a significantly higher incidence in the 5-dose group (37% versus 15.7%, p=0.47). CONCLUSIONS: Five doses of rATG versus 3 doses did not provide any additional benefit in preventing BPAR.