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PubMed2000

An initial evaluation of the Iowa Dental Surgical Simulator.

The University of Iowa colleges of dentistry and engineering are collaborating to build an effective but low-cost surgical simulator that uses force feedback to teach and assess the tactile skills of dentistry. A prototype simulator was built, and a formative evaluation examined the realism of the haptics and identified directions for future work. Using a cross-over design, twelve experienced practitioners probed two virtual teeth using two instruments attached to the force feedback device. The session was videotaped, the forces recorded, and a standardized questionnaire completed. Two analyses were conducted: an ANOVA examined practitioners' questionnaire responses, and a t-test analyzed the probing forces. Significant tooth order by instrument order interaction and instrument effects were found. Practitioners were generally satisfied. They preferred a standard joystick to an explorer, felt that two-dimensional graphics were sufficient, and emphasized that the existing vibration be eliminated. Random placement of caries should help teach generalized skills.

Analysis of Variance↗

PubMed2006

State diabetes prevention and control program participation in the Health Disparities Collaborative: evaluating the first 5 years.

BACKGROUND: Approximately 20.8 million people in the United States, or 7% of the population, have diabetes mellitus. Treatment for this disease costs Americans more than 130 billion dollars yearly, and it is the sixth leading cause of death. The prevalence of diabetes has grown substantially in recent decades and is expected to continue to rise. CONTEXT: The medically underserved and poor are at greater risk of developing diabetes and its complications than are other members of the U.S. population. The Health Resources and Services Administration makes health care resources and services available to economically disadvantaged populations through the Health Disparities Collaborative (HDC), a consortium formed to pool resources and services from state- and community-level donors. Since 1999, many of the Centers for Disease Control and Prevention's Division of Diabetes Translation State Diabetes Prevention and Control Programs (DPCPs) have joined the HDC to leverage resources and services. METHODS: The purpose of a 2004 evaluation was to examine the impact that DPCP involvement with the Collaborative had on aspects of diabetes care at Federally Qualified Health Centers (FQHCs). An electronic survey was administered to DPCP coordinators. They were asked about 1) their roles and experience as participants in the Collaborative; 2) the skills and expertise most useful in developing and maintaining an effective collaboration for improved health care for diabetes; 3) which DPCP contributions were viewed as being routine and which were perceived to be essential; 4) the effects of DPCP contributions on the use of the chronic care model under which FQHCs operate; and 5) which health systems improvements played the greatest role in enhancing components of the chronic care model. CONSEQUENCES: Most respondents identified themselves as DPCP coordinators with 3 years of experience in that position. Organizational skills, such as communication, leadership, conflict resolution, negotiation, and meeting management, were cited as necessary to develop and maintain collaborative partnerships. DPCP contributions to FQHCs were perceived to be training, technical assistance with clinical care and patient education, financial resources, linkages to other diabetes partners, educational materials, and improved linkages with community resources. INTERPRETATION: DPCPs contribute resources, skills, knowledge, and varied perspectives to the Collaborative that FQHCs may not have otherwise.

Centers for Disease Control and Prevention, U.S.↗

PubMed1984

Acquired immunodeficiency syndrome--an assessment of the present situation in the world: memorandum from a WHO meeting.

A consultative meeting was convened by the World Health Organization in Geneva on 22-25 November 1983 to assess the present situation of AIDS (the acquired immunodeficiency syndrome) in the world and to encourage collaboration between the different nations affected by this disease. AIDS was first reported in the USA in 1981, but probably existed there as early as 1978. Soon after its recognition in the USA, similar cases were identified in other areas of the world. In most western European countries and Canada, the epidemiological pattern is very similar to that in the United States, the majority of cases being in homosexual men. In other areas such as equatorial Africa and the Caribbean, the pattern seems to be different with no identifiable risk factors for the majority of cases.The disease is manifested by opportunistic infections and/or selected malignancies, with apparent differences in the clinical presentation between the cases in North America and Europe, on the one hand, and those in the tropics. To date there is no treatment that has significantly improved the underlying cellular immune deficiency, and the mortality is very high. The etiology of AIDS is unknown, but the epidemiological pattern is most consistent with its being caused by a transmissible agent; retroviruses come on top of the list of candidate agents. Despite the unknown etiology and the lack of laboratory diagnostic tests, sufficient information is available to permit health authorities to make recommendations that may reduce appreciably the incidence of the disease.AIDS is an important health problem in a number of countries and has international implications. Collaborative laboratory, epidemiological and clinical research between countries is needed to accelerate control efforts. In the meantime, WHO will coordinate exchange of information among countries.

Acquired Immunodeficiency Syndrome↗

PubMed1998

[A questionnaire study among 171 medical candidates enrolled in a PhD program. Three elements in the PhD education: supervision, research courses and international relations].

One hundred and seventy-one medical doctors (median age 34 years) registered as Ph.D.-students at the Medical Faculty, University of Aarhus, were given a questionnaire concerning the Ph.D-program (91% reply rate). The Ph.D.-students had typically graduated four years before enrollment and had gained basic clinical experience. Eighty-four percent had been involved in research projects prior to their formal research education. In general, the Ph.D.-students found the supervision offered by senior researchers adequate, although, more Ph.D.-students in clinical than in preclinical departments would have liked their main supervisor to be more enthusiastic and have more specific expertise. By tradition, the Medical Faculty in Aarhus offers a broad introductory course on research methodology, this was appreciated by the Ph.D.-students. However, they found that too much time was allocated for this purpose. The Ministry of Education recommends that Ph.D.-students gain experience from international collaboration, preferably from a stay abroad. However, only 24% of Ph.D.-students had stayed at an international collaborating institution. Although the overall evaluation of the medical Ph.d.-program was positive, the Ph.D.-students pointed out weaknesses and conflicts requiring adjustment.

Adult↗

PubMed2005

Formative evaluation of home visitors' role in addressing poor mental health, domestic violence, and substance abuse among low-income pregnant and parenting women.

OBJECTIVES: This research assessed home visitor effectiveness in communicating about and responding to poor mental health, domestic violence, and substance abuse among pregnant and parenting women home visited as part of a comprehensive family support strategy in seven urban communities. METHODS: Cross-sectional studies were conducted with mothers (n = 189) actively engaged in home visitation programs and home visitors (n = 45). Maternal interviews assessed need for and receipt of mental health, domestic violence, and substance abuse services, and home visitor discussion of these risk areas. Home visitor surveys assessed perceived adequacy of training and personal effectiveness in addressing these risk areas. RESULTS: Over half of mothers needed mental health, domestic violence, or substance abuse services; however, only 27% of mothers in need of service received services. Most mothers reported having communicated with their home visitor about the three risk areas, but there were no differences in communication frequency based on whether services were needed. Most home visitors perceived themselves as effective in communicating about and responding to these risk factors but rated the training they had received in these areas as less than adequate. CONCLUSIONS: Home visitors could benefit from more intensive training in the formal assessment of risks and the protocols for communication about those risks with their clients. Home visitors could also receive support from and work in collaboration with professionals in addressing client risks. Further research on home visit content is needed to determine which strategies facilitate home visitors' ability to effectively communicate about and address client risks.

Baltimore↗

PubMed1996

Information needs, sources of information, and decisional roles in women with breast cancer.

PURPOSE: To describe preferred and actual roles in treatment decision making among women with newly diagnosed breast cancer, to describe their sources of information, and to identify and prioritize their information needs. DESIGN: Cross-sectional survey. SAMPLE: Seventy-four women recently diagnosed with breast cancer. SETTING: Two tertiary, outpatient oncology clinics in Winnipeg, Manitoba, Canada. METHODS: Three measures were completed: control preferences card sort, Thurstone scaling of information needs, and ranking of information sources. MAIN RESEARCH VARIABLES: Decisional roles, sources of information, and information needs. FINDINGS: More women (43%) preferred and more (57%) actually assumed a passive role in treatment decision making. This is particularly true of older women. Although 37% of women preferred a collaborative role, only 19% were able to assume such a role. The women preferred personal sources of information (physician, nurse, friend, or relative) over written sources. A medical journal was more relevant to women with higher levels of education. Most information needs included stage of disease, likelihood of cure, and treatment options. The women ranked self-care issues and sexuality as least important; older women, however, ranked self-care issues as more important. CONCLUSIONS: Women who want collaborative roles in decision making may experience difficulty in achieving such roles. Personal sources of information were more important to women than written sources. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use a knowledge of women's priorities for information to guide information sharing. Nurses can assess women's desired roles in treatment decision making and facilitate women achieving their preferred roles.

Adolescent↗

PubMed1992

Multiple cardiovascular disease risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To estimate the prevalence and distribution of the coexistence of major cardiovascular disease (CVD) risk factors among Canadian adults. DESIGN: Population-based cross-sectional surveys. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women, aged 18 to 74 years, was selected from provincial health insurance registries. For 20,582 of these participants, at least two blood pressure (BP) measurements were taken using a standardized technique. At a subsequent visit to a clinic, two additional BP readings, anthropometric measurements and a blood specimen for plasma lipid analysis were obtained. OUTCOME MEASURES: The percentage distribution of subjects by number of major risk factors (smoking, high BP and elevated blood cholesterol level) and by concomitant factors (body mass index [BMI], ratio of waist to hip circumference [WHR], physical activity, diabetes, awareness of CVD risk factors and education). MAIN RESULTS: Sixty-four percent of men and 63% of women had one or more of the major risk factors. Prevalence increased with age to reach 80% in men and 89% in women aged 65 to 74 years. Prevalence of two or three risk factors was highest among men in the 45-54 age group (34%) and in women in the 65-74 age group (37%). The most common associations were between smoking and high blood cholesterol level (10%) and between high BP and high blood cholesterol level (8%). Prevalence of high BP and elevated blood cholesterol, alone or in combination, increased with BMI and WHR. Smoking, elevated blood cholesterol, BMI and prevalence of one or more risk factors increased with lower level of education. Less than 48% of participants mentioned any single major risk factor as a cause of heart disease. Awareness was lowest in the group with fewest years of education. CONCLUSION: The findings of this study call for an approach to reduce CVD that stresses collaboration of the different health sectors to reach both the population as a whole and the individuals at high risk.

Adult↗

PubMed2000

Continuous distending airway pressure for respiratory distress syndrome in preterm infants.

BACKGROUND: Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants (Greenough 1998, Bancalari 1992). Intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition. The major difficulty with IPPV is that it is invasive, resulting in airway and lung injury and contributing to the development of chronic lung disease. OBJECTIVES: In spontaneously breathing preterm infants with RDS, to determine if continuous distending airway pressure (CDAP) reduces the need for IPPV and associated morbidity without adverse effects. SEARCH STRATEGY: The standard search strategy of the Neonatal Review group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language. SELECTION CRITERIA: All trials using random or quasi-random patient allocation of newborn infants with RDS were eligible. Interventions were continuous distending airway pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharnygeal tube, or endotracheal tube, or continuous negative pressure (CNDP) via a chamber enclosing the thorax and lower body, compared with standard care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each author, were used. MAIN RESULTS: CDAP is associated with a lower rate of failed treatment (death or use of assisted ventilation), overall mortality, and mortality in infants with birthweights above 1500 g. The use of CDAP is associated with an increased rate of pneumothorax. REVIEWER'S CONCLUSIONS: In preterm infants with RDS the application of CDAP either as CPAP or CNDP is associated with some benefits, particularly in infants with birthweights over 1500 gms. The extent of this benefit is difficult to assess given the outdated methods to administer CDAP, low use of antenatal corticosteroids, non-availability of surfactant and the intensive care setting of the 1970's in which these trials were done. Where resources are limited, such as in developing countries, CPAP for RDS may have a clinical role. Further research is required to determine the best mode of administration and its role in modern intensive care settings

Humans↗

PubMedDate not supplied

[Community collection of syringes by parenteral drug users complementary to syringe exchange programs].

OBJECTIVES: To contribute to harm reduction in injecting drug users (IDUs) by the implementation of a programme to withdraw abandoned syringes from public places, as well as to collaborate on the social reinsertion of IDUs. METHODS: Descriptive study of the Syringe Withdrawal Community (RECOJE in Spanish), carried out from 1997 to 1999 by IDUs, the We Are Helpful Association (ASUT in Spanish) and the Social and Health Prevention and Attention Service (SAPS in Spanish) of the Red Cross, in Ciutat Vella (Barcelona, Spain). RESULTS: 4,332 syringes were withdrawn, 849 in 1997, 1,324 in 1998 and 2,159 in 1999. The mean number of syringes withdrawn each time was 57 33. 45 different IDUs worked in RECOJE. 74.2% of the abandoned syringes were found in parks, gardens, car parks and open spaces. CONCLUSIONS: RECOJE can be a valid programme for harm reduction complementary to the exchange syringe programmes. It could improve the self-esteem, external image and organization of IDUs, contributing to their social reinsertion.

Adult↗

PubMed2002

Estimating time to pregnancy from current durations in a cross-sectional sample.

A new design for estimating the distribution of time to pregnancy is proposed and investigated. The design is based on recording current durations in a cross-sectional sample of women, leading to statistical problems similar to estimating renewal time distributions from backward recurrence times. Non-parametric estimation is studied in some detail and a parametric approach is indicated. The results are illustrated on Monte Carlo simulations and on data from a recent European collaborative study. The role and applicability of this approach is discussed.

Journal Article↗

PubMed2002

Coherent rho(0) production in ultraperipheral heavy-ion collisions.

The STAR Collaboration reports the first observation of exclusive rho(0) photoproduction, AuAu-->AuAurho(0), and rho(0) production accompanied by mutual nuclear Coulomb excitation, AuAu-->Au*Au*rho(0), in ultraperipheral heavy-ion collisions. The rho(0) have low transverse momenta, consistent with coherent coupling to both nuclei. The cross sections at sqrt[s(NN)]=130 GeV agree with theoretical predictions treating rho(0) production and Coulomb excitation as independent processes.

Journal Article↗

PubMed1997

ICS-II USA research design and methodology.

The purpose of the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II) was to provide policy-markers and researchers with detailed, reliable, and valid data on the oral health situation in their countries or regions, together with comparative data from other dental care delivery systems. ICS-II used a cross-sectional design with no explicit control groups or experimental interventions. A standardized methodology was developed and tested for collecting and analyzing epidemiological, sociocultural, economic, and delivery system data. Respondent information was obtained by household interviews, and clinical examinations were conducted by calibrated oral epidemiologists. Discussed are the sampling design characteristics for the USA research locations, response rates, samples size for interview and oral examination data, weighting procedures, and statistical methods. SUDAAN was used to adjust variance calculations, since complex sampling designs were used.

Adult↗

PubMed2000

Quality of care of children with chronic diseases in Alexandria, Egypt: the models of asthma, type I diabetes, epilepsy, and rheumatic heart disease. Egyptian-Italian Collaborative Group on Pediatric Chronic Diseases.

OBJECTIVES: To evaluate the quality of care delivered to children suffering from index chronic diseases using specific indicators of health care delivery and to study the predictors of suboptimal quality of care (SQC) and its outcome on children. DESIGN: Over a 9-month period, guidelines for optimal care were formulated. A specific questionnaire for every studied chronic disease was prepared in collaboration with the clinicians in charge of the diseased children (66% pediatricians and pediatric specialists and 34% adult specialists). The clinicians were asked to write the details of daily practice, ie, how these children were managed on a routine basis as well as in an emergency situation. A cross-sectional study was conducted over a 4-month period and included 953 children suffering from bronchial asthma (BA), childhood epilepsy (CE), type I diabetes mellitus (IDDM), and rheumatic heart disease (RHD). A systematic random sample of children was selected from children visiting the ambulatory settings of all children's hospitals. Every fourth child was selected on 2 randomly chosen days each week, while all diseased children admitted in the hospital settings of the children's hospitals during the study were included. A general form describing the impact of the diseases on the child was prepared. A network of clinicians was created in all children's hospitals; seminars were held during which the content validity of the questionnaire was tested. Items were evaluated for their internal consistency using the Cronbach alpha. According to the degree of adherence to the recent therapeutic guidelines concerning selected indicators of the quality of care specific to every disease, children were categorized as receiving optimal quality of care or SQC. These indicators were: the use of inhaled bronchodilators in acute asthmatic attacks in mild asthma and the use of the prophylactic drugs (inhaled sodium cromoglycate or inhaled beclomethasone) in moderate to severe chronic BA in between acute asthmatic attacks; compliance with antiepileptic drugs in epileptic children; regular performance of self-monitoring of blood glucose and/or urine testing in diabetic children; and compliance with prophylactic antibiotics in children suffering from RHD. The records of the outpatient clinics for ambulatory and hospitalized cases were reviewed to assess the degree of compliance with the prescribed management before the index visit. Sociodemographic characteristics and health care system-related predictors of SQC were analyzed via stepwise logistic regression analysis. The impact of illness on the child was assessed by 7 items which were: dependence on parents in domestic activities, level of activity compared with peers, mood compared with peers, level of socializing, degree of discomfort attributable to illness, level of physical disadvantage, and urinary incontinence. Factor analysis with Varimax rotation was performed on items related to the impact of illness. Parental satisfaction with care was rated as excellent, very good, fair, or poor. Information on school outcome was obtained by asking the caretakers whether the child was able to attend school regularly despite his sickness. Scholastic achievement was also rated as excellent, very good, good, and acceptable. Parents were asked whether the child had ever repeated a grade because of his sickness. SETTING: Ambulatory and hospital settings of all children's hospitals in Alexandria, Egypt. RESULTS: Only 52% of mild asthmatics were given inhaled bronchodilators during acute attacks and 6.84% of moderate to severe asthmatics were taking prophylactic drugs (inhaled sodium cromoglycate and/or inhaled beclomethasone) between acute attacks. Similarly, only 53 of 134 (39.6%) of diabetic children were regularly performing self-monitoring of blood glucose and/or urine testing. In contrast, in epileptic children, 121 of 173 (69.9%) were judged as being compliant by their managing clinicians and more than two

Adolescent↗

PubMed2000

National and state policies influencing the care of children affected by AIDS.

The portrait of HIV-affected children and youth that emerges from this policy overview is still one of children obscured from view by the shadow of their parents' and siblings' illness and policies that only address the needs of HIV-infected individuals. In addition, the secrecy and stigma that still surround HIV and AIDS make it difficult for HIV-affected children and youth to benefit as fully as they might from policies and programs that provide more generic types of care and assistance. Our failure as a nation to better illuminate the plight of HIV-affected children and youth can only leave us with a generation of children who are at greater risk of psychiatric illness, involvement with the criminal justice system, substance abuse, and contracting HIV. To avoid these consequences, both public and private sectors must place the spotlight on the development of new policies and programs designed to specifically meet their needs. Because the solutions defy traditional disciplinary and administrative boundaries, we also need to become more skilled at interagency planning and collaboration. No one system alone can be responsive to the many social, mental health, legal, and support needs of these children and their caretakers. More specifically, recommendations for improved systems of care to HIV-affected children, youth, and their families are as follows: To promote and fund cross-disciplinary initiatives among agencies that administer child welfare services, income supports, AIDS care, and children's mental health services at the national, state, and local levels to specifically meet the mental health, psychosocial, and permanency planning needs of HIV-affected children and youth. To provide training opportunities for Ryan White Title I, II, and III case managers on assessing the needs of HIV-affected children and youth, developmental theories and concepts, principles of family-centered care, and child welfare issues. To increase funding of the Ryan White CARE Act to permit a more family-centered approach to care across Titles. To establish clearer guidelines for establishing a proportional basis for funding services to infants, children, and women under the Ryan White CARE Act. To support legislative, educational, and advocacy efforts to make managed care and welfare reform more responsive to the needs of HIV-affected children, youth, and their families. To encourage states to provide additional funding for mental health services specifically targeted to HIV-affected children and youth that are sufficiently flexible and of a long enough duration to adequately meet their needs. Surely, as we move into a new millennium with the capacity to map the human genome and clearly view distant galaxies, we should be able to marshal the will and resources necessary to formulate a sufficiently focused effort to respond compassionately and effectively to the needs of a generation of AIDS-affected children and youth.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Data organizations and data networks in Minnesota.

The state of Minnesota offers examples of data-driven organizations as well as a statewide effort to electronically link these into an integrated network. The examples provided by Blue Cross Blue/Shield of Minnesota demonstrate an array of analytical tools to improve quality and enhance financial performance. Blue Cross/ Blue Shield of Minnesota uses a clinical severity measurement system to aid in the development of an inpatient hospital reimbursement methodology which enables hospitals to better manage the quality of care delivered to the patient population. They also make use of population-based utilization analysis in a collaborative environment with providers to improve quality and efficiency of care. The Minnesota Health Data Institute was created by the state legislature to support the information needs of the health care stakeholders in Minnesota. One of its first initiatives is to develop a uniform method of comparing health care plans.

Computer Communication Networks↗

PubMed1998

Socioeconomic status and health in women with systemic lupus erythematosus.

OBJECTIVE: Health outcomes of patients with chronic illnesses are commonly worse in people of lower socioeconomic status (SES). We investigated psychosocial factors that may mediate the relationship between SES and measures of morbidity in women with systemic lupus erythematosus (SLE). METHODS: We collected information on SES, psychosocial factors, and health status in a cross sectional survey of 100 women with SLE. SES was rated using the Hollingshead Two-Factor Index, a weighted average of years of formal education and occupational prestige (higher Hollingshead Index=lower SES). Health status measures included the Health Assessment Questionnaire Disability Index (HAQ), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR), the Systemic Lupus Activity Measure (SLAM), and the SLE Disease Activity Index (SLEDAI). Potential mediators consisted of 18 environmental, medical care, social, psychological, and behavioral factors. RESULTS: Patients with higher Hollingshead Indexes (lower SES) had more functional disability as measured by the HAQ (r=0.22: p=0.03) and more cumulative organ damage as measured by the SLICC/ACR Damage Index (r = 0.19; p=0.06). SES was not related to either the SLAM or SLEDAI. Significant univariate associations were present between the Hollingshead Index and 10 potential mediating variables: household crowding, insurance status, organizational barriers to medical care, depression, health locus of control by powerful others, SLE knowledge, social support, marital status, body mass index, and regular alcohol use. However, in multiple linear regression analyses, only 3 of these variables modified the relationship between Hollingshead Index and the HAQ: more severe depression scores, higher body mass index, and more restricted access to medical care. More severe depression and greater locus of control by powerful others tended to mediate the relationship between low SES and greater organ damage. CONCLUSION: SES is related to morbidity in women with SLE. There are identifiable and potentially modifiable mediators of this relationship.

Adult↗

PubMed2005

Obesity management: attitudes and practices of French general practitioners in a region of France.

OBJECTIVES: To document the attitudes and practices of French general practitioners (GPs) regarding obesity management. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey of a randomly selected sample of 744 French GPs was conducted, of which 607 questionnaires were returned. The measures included views on weight management, definitions of success, approaches to and strategies recommended for weight management and prevention, problems, frustrations, and expectations in managing obesity. RESULTS: GPs have a high awareness of obesity as a medically relevant issue, with 90% of them considering it to be a disease. However, they are only 42% to consider themselves well prepared to manage obesity and 51% to find obesity management professionally rewarding. They are 66% to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals, with only 20% of them considering weight maintenance as a success. They do not consider collaboration with other health professionals like dietitians as a priority. Only 34% of the GPs believe that the currently available drugs are effective. Their views regarding bariatric surgery are in agreement with the recommendations of international experts. Their main expectations regarding obesity management are to improve their professional intervention through formation, education and easy-to-use tools, rather than improving their collaboration with other health professionals. DISCUSSION: There remains considerable opportunity to improve GPs' practice in obesity management. Medical education, increased cooperation with dietitians, improved long-term follow-up, and implementing better use of the available documents are key issues.

Adult↗

PubMedDate not supplied

Need for community pharmacist-provided food-allergy education and auto-injectable epinephrine training.

OBJECTIVE: To determine whether community pharmacist-provided food-allergy education and auto-injectable epinephrine training is needed. DESIGN: Cross-sectional assessment. SETTING: United States. PARTICIPANTS: 1,887 recently joined members of the Food Allergy & Anaphylaxis Network. INTERVENTION: Electronic survey. MAIN OUTCOME MEASURES: 35 items covering past education and training associated with food allergy and use of auto-injectable epinephrine, demographics, attitudes toward pharmacist-provided education about food allergy, training in the use of auto-injectable epinephrine, confidence in managing food allergies on a daily basis and in emergency situations, and the necessity for pharmacists to provide education and training about food allergy and auto-injectable epinephrine use. RESULTS: Prescriber-provided food-allergy education and auto-injectable epinephrine training is incomplete (60.7%) or absent (16.3%) at the time auto-injectable epinephrine is first prescribed. These initial prescriptions are being dispensed from community pharmacies (94%), and written information is commonly provided with the medication (73.6%); however, oral counseling is largely absent (86.6%), and training in administration of auto-injectable epinephrine occurs infrequently (13.3%). Food-allergic patients and their care-givers are receptive to the idea of pharmacist-provided education and training. The majority (63.6% or more) feel confident about managing their food allergies. They are not requesting counseling when refill prescriptions are dispensed (81.4%); however, they would like to see routine review at refill time of the signs of allergic reaction (54.5%) and use of the epinephrine auto-injector (79.3%). CONCLUSION: Community pharmacists have an opportunity to assist newly diagnosed food-allergic patients by working collaboratively with their pediatricians and allergists. Community pharmacists can provide ongoing assistance at refill time by retraining patients in the use of the epinephrine auto-injector and reviewing the signs of allergic reaction.

Community Pharmacy Services↗