Feasibility of a Cinematic-Virtual Reality Training Program for Health Professional Students: A Single-Arm Pre-Post Study.

BACKGROUND: Cinematic-virtual reality (cine-VR) has demonstrated improvements in cultural self-efficacy, diabetes attitudes, and empathy among healthcare providers, but its impact on health professional students is unknown. The purpose of the single-arm pre-post study was to examine the feasibility of this cine-VR diabetes training program as well as to assess changes in cultural self-efficacy, diabetes attitudes, and empathy among health professional students. METHOD: Participants viewed 12 cine-VR 12 simulations about a 72-year-old patient with type 2 diabetes. Pre-training and post-training, they completed the Transcultural Self-Efficacy Tool, Diabetes Attitude Scale-3, and Jefferson Scale of Empathy. RESULTS: All 92 participants completed the full training. No participants reported technological difficulties or adverse events. For the assessment, 66 participants completed the pre-post measures for a response rate of 71.7% (mean age = 21.1 ± 1.9 years, 82.6% [n = 57] women; 84.1% [n = 58] white). We observed positive improvements in all three cultural self-efficacy subscales: "Cognitive" (t value = -4.705, P < .001), "Practical" (mean change = -.99, t value = -4.240, P < .001), and "Affective" (t value = -2.763, P = .008). Similarly, we observed positive improvements in four of the five diabetes attitude subscales: "Need for special training" (Z = -4.281, P < .001), "Seriousness of type 2 diabetes" (Z = -3.951, P < .001), "Value of tight glucose control" (Z = -1.676, P = .094), "Psychosocial impact of diabetes" (Z = -5.892, P < .001), and "Attitude toward patient autonomy" (Z = -2.889, P = .005). Finally, we observed a positive improvement in empathy (t value = -5.151, P < .001). CONCLUSIONS: Findings suggest that the cine-VR diabetes training program has the potential to improve cultural self-efficacy, diabetes attitudes, and empathy among health professional students. A randomized controlled trial is needed to confirm its effectiveness.

Effects of the distribution of product samples to patients and physicians by pharmaceutical companies

Background@#Distribution of product samples is a typical and traditional marketing and promotion strategy used by pharmaceutical companies. However, issues have been raised about their influence on physicians' prescribing behavior and patients' health outcomes. @*Objectives@#This study aimed to determine the effects of the distribution of product samples on physicians' prescribing behavior and adherence to patients' treatment regimens. It also sought to provide policy recommendations on product sample distribution and the administrative order on pharmaceutical promotion. @*Methodology@#The study involved a descriptive design. The study sites were Manila City, Cebu City, and Davao City. Data were collected using focus group discussions, key informant interviews, and surveys among patients and physicians. Content analysis was performed to analyze qualitative data, while descriptive statistics and measures of association were conducted to analyze quantitative data. @*Results@#A total of four FGDs were conducted with one FGD for each stakeholder group, and 846 patients and 286 physicians answered the study questionnaire. About half (48.0%) of the patients received product samples; 75.8% had low medication adherence. Product sample distribution was not significantly associated with patients' adherence (p=0.150). The majority of the physicians (69.2%) received product samples. There was no significant association between product sample distribution and physicians' prescribing behavior (p=0.111). It was found, however, that the distribution of product samples was significantly associated with the other physicians' prescribing behavior (p=0.009). The issues identified included the influence of medical representatives on physicians' prescribing behavior, incapacity of the poor and marginalized population to complete their treatment regimen due to lack of supply of product samples, and mentality of patients that product samples have better quality.@*Conclusion@#This study emphasized that the regulation of product sample distribution was justifiable since this might negatively influence professional behavior affecting rational prescribing and the use of medicines. Furthermore, the distribution of product samples did not directly translate to increased patients' medication adherence. Should the distribution of samples be continuously practiced, the provision of product samples should be strictly followed, and the distribution should be regulated and monitored to prevent the occurrence of violative practices.

Dietary obesity in mice is associated with lipid deposition and metabolic shifts in the lungs sharing features with the liver.

Obesity is associated with both chronic and acute respiratory illnesses, such as asthma, chronic obstructive pulmonary disease (COPD) or increased susceptibility to infectious diseases. Anatomical but also systemic and local metabolic alterations are proposed contributors to the pathophysiology of lung diseases in the context of obesity. To bring perspective to this discussion, we used NMR to compare the obesity-associated metabolomic profiles of the lung with those of the liver, heart, skeletal muscles, kidneys, brain and serum from male C57Bl/6J mice fed with a high-fat and high-sucrose (HFHSD) diet vs. standard (SD) chow for 14 weeks. Our results showed that the lung was the second most affected organ after the liver, and that the two organs shared reduced one-carbon (1C) metabolism and increased lipid accumulation. Altered 1C metabolism was found in all organs and in the serum, but serine levels were increased only in the lung of HFHSD compared to SD. Lastly, tricarboxylic acid (TCA)-derived metabolites were specifically and oppositely regulated in the serum and kidneys but not in other organs. Collectively, our data highlighted that HFHSD induced specific metabolic changes in all organs, the lung being the second most affected organ, the main alterations affecting metabolite concentrations of the 1C pathway and, to a minor extend, TCA. The absolute metabolite quantification performed in this study reveals some metabolic specificities affecting both the liver and the lung, that may reveal common metabolic determinants to the ongoing pathological process.

Evaluation of the patient medication counseling services in the Philippine General Hospital using the CIPP model

@#<p style="text-align: justify;"><strong>Objectives.</strong> The patient medication counseling (PMC) services at Philippine General Hospital (PGH) started 21 years ago. While several changes have been incorporated into the program, no formal evaluation has been conducted to date. The objective of this evaluation was to assess the relevance, usefulness, responsiveness, acceptability, efficiency, impact, and sustainability of the service using the context, input, process (CIPP) model of Stufflebeam.</p><p style="text-align: justify;"><strong>Methods.</strong> The study utilized a mixed-methods study design. Interviews and surveys were conducted on pharmacist-counselors, a purposive sample of doctors, nurses, and other stakeholders. A review of records from the Department of Pharmacy of UP College of Pharmacy (UPCP) and PGH, such as patient and student satisfaction surveys and monthly reports of counseled patients served from 2015 to 2019, was conducted. The results were analyzed using descriptive statistics for quantitative data and content analysis for qualitative data.</p><p style="text-align: justify;"><strong>Results.</strong> Context evaluation revealed that the establishment of PMC resulted from informal interactions with hospitalized patients due to incorrect use of prescription medicines. Correct information was envisioned to address the irresponsible use of medicines. The input evaluation revealed that only 24% (N=75) of the pharmacists are involved in PMC, which comprise only 10% of their workload. There was also a lack of comprehensive training for counseling and insufficient physical facilities. The process evaluation identified lack of time (94%) as a significant limiting factor for the involvement of pharmacists in PMC. The interns became an additional workforce for the service, but scheduling and the consistent availability of both students and faculty-preceptors were experienced. The product evaluation revealed positive perceptions among the pharmacists, faculty, and student interns. From the patient satisfaction survey records of 5,071 patients counseled, 98 to 100% expressed high service satisfaction, and 100% were likely to recommend PMC to other patients. The pharmacists, interns, and faculty-preceptors suggested that PMC improved their confidence, communication skills, and decision-making.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The PMC service is relevant and valuable to ensure patients' rational and quality use of medicines. As a value-added service to existing hospital pharmacy services, it serves as a venue for enhancing soft skills among pharmacists and students alike. However, physical and human resources and current processes need to be upgraded to improve efficiency, ensure sustainability, and expand service coverage to more patients.</p>

The influence of a medication counseling program for hypertensive soldiers at the Army General Hospital: A pilot study

Background@#The incidence of hypertension and its complications continue to increase in the Philippine Army due to non-adherence resulting in poor health outcomes. @*Objective@#This study implemented a Medication Counseling Program (MCP) for hypertensive soldiers, and assessed the effects of the program on knowledge of disease and treatment (Knowledge), attitude towards medication (Attitude), adherence to treatment (Adherence), and blood pressure (BP). It identified and categorized pharmacist interventions applied during the counseling sessions. The perceptions of patients and physicians on pharmacist's clinical roles were also determined. @*Methodology@#The program was implemented from March to October 2015 in a government hospital for the Philippine Army. Knowledge, attitude, adherence, and BP (converted as mean arterial pressure or MAP) were measured at baseline, 30, 60, and 90th day after initial counseling. Data for pharmacist interventions were collected from patient's documentary form. The interview was conducted to patients after their 90-day counseling period and physicians after the 8-month duration of the program. @*Results@#A total of 20 patients were enrolled in the program, but only 13 patients completed the study. Of the 62 counseling sessions conducted by the pharmacist for the 8-month period, a total of 252 pharmacist interventions were administered. Knowledge, attitude, adherence, and MAP scores improved, and 100 % of the patients achieved normal/controlled BP after the 90-day counseling period. @*Conclusion@#A pharmacist MCP intervention may improve a patient's knowledge, attitude, adherence, and BP. The program enabled the pharmacist to apply pharmacist interventions to identified drug-therapy problems of the patients and resolved these through collaboration with the physicians and cooperation of the patients.

RETRACTED: Beyond the PGY-1 community pharmacy residency: Characterizing career pathways of residency graduates.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted by the authors because of data errors discovered after publication.

Establishing a blueprint for nature-based products development and conservation for the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Many of the leading causes of mortality and morbidity in the Philippines are controllable with nature-based products, either as agents of intervention, or prevention, as nutritional supplements or for the control of side-effects of medications. The different R&D programs on nature-based products in the Philippines are usually conducted in isolation, or through silos. These often lead to products that are shortsighted, duplicate products, or products with minimal innovation, not readily applicable to population and environmental sustainability.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to draft an internationally benchmarked and integrated blueprint for a population health and environmental health-led nature-based product development and conservation for the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> The methodology consisted of a review of literature; regional educational visits; and a series of consultative meetings with stakeholders.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The study resulted in a stakeholder-validated blueprint that assigns the Philippine Institute of Traditional and Alternative Health Care (PITAHC) to lead the way for Filipinos to produce more nature-based products that are of international quality and attuned with local health needs. The blueprint has identified "9 Optimizations" in the realization of this aspiration, including an expanded role for PITAHC, a national database, an ethical researchers list, and to produce at least five commercial products and 20 intellectual property rights within 5 years with an estimated total investment of approximately PhP 816 M.</p>

Isolation and characterization of pectin from the ripe fruit peels of jackfruit (Artocarpus heterophyllus Lam.)

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong> Pectin is a complex polysaccharide which is commonly used as a gelling agent for food preparations and pharmaceutical formulations. Currently, the Philippines imports 100% of its pectin requirement from other countries which adds to the cost of products that utilizes pectin. Hence, the aim of this study was to isolate and characterize pectin from ripe jackfruit peels.</p><p style="text-align: justify;"><strong>MATERIALS AND METHODS: </strong>Peels of ripe jackfruit (Artocarpus heterophyllus Lam.) were subjected to digestion with water and sulfuric acid at 90°C then purified using alcohol and acetone. The isolated material from the peels was subjected to pectin identification tests using the methods from the US Pharmacopeia (USP). To further characterize the isolate, the methoxy and anhydrouronic acid contents, degree of esterification, functional groups (through FT-IR), ash content, and swelling index were determined.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Ripe jackfruit peels yielded 5.74% of brown-colored pectin which was verified using the US Pharmacopeia identification tests for pectin. The methoxy and anhydrouronic acid contents were found to be 4.05% and 1.77%, respectively, with results comparable with the standard pectin (p<0.05). The peel's pectin has a degree of esterification of 26.34, 1.77% ash content, and swelling index of 9.09. FT-IR analysis of isolated pectin revealed functional groups identical to that of the standard pectin.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Pectin from the ripe jackfruit peels is reported to be a potential source of pharmaceutical grade pectin. However, the AUA content and methoxy content of the isolated pectin did not meet the USP specification. Thus, the authors recommend that future investigators must optimize the isolation procedure to obtain pectin which meets the specification of USP.</p>

Pharmacy students' perceptions of the formative objective structured clinical examinations (OSCE) and their learning outcomes

@#<p><strong>BACKGROUND</strong>: Objective structured clinical examinations (OSCEs) are used frequently in course subjects owing to their utility in determining the students' clinical competencies under a variety of simulated conditions. In the University of the Philippines (UP) College of Pharmacy, the use of a summative OSCE has already been used as a form of assessment in some of its courses. However, previous batches of students felt unprepared for their summative OSCE at the end of the semester. In particular, students reported unfamiliarity with the content and format of the said examination. To address this concern, formative OSCEs were conducted in a Pharmacy laboratory course.</p><p><strong>OBJECTIVE</strong>: This study aimed to evaluate the effect of the feedback component of formative OSCEs on the students' self-perceived learning and achievement of the course outcomes, facilitating knowledge, skills and attitudes development towards the course, and preparing them for the summative OSCE. It also sought to identify useful aspects of the formative OSCEs and how they can be improved further.</p><p><strong>METHODOLOGY</strong>: Four formative OSCEs were administered from January to May 2017 to all fourth-year pharmacy students taking Pharmacy 154 (Dispensing and Incompatibilities). The units covered were: (1) extemporaneous and sterile compounding; (2) over-the-counter (OTC) medicines and prescription drugs; (3) dangerous drugs and medical devices; and (4) therapeutic incompatibilities and medication safety. After each formative OSCE, feedbacks were provided to the students. Once all OSCEs were conducted, an online, self-administered questionnaire consisting of four parts was given to the students. Total population sampling was employed in the study. The responses (n = 44) were analyzed using frequency statistics. Thematic analysis was done for the aspects of the formative OSCEs that were most useful, and how they could be further improved.</p><p><strong>RESULTS AND CONCLUSION</strong>: The frequency analysis of responses from the questionnaire generally showed that the students had positive perceptions to the feedback component of the formative OSCEs. Still, there was no significant association found between passing the summative OSCE and the formative OSCEs owing to the differences in the content of each examination. Overall, formative OSCEs may be a good assessment tool to track the students' progress and give them constructive feedback in terms of the competencies expected in the course and to better prepare them for the summative OSCE. Increasing the time allotted for each station and orienting them better prior to formative OSCEs were the commonly suggested points for improvement.</p>

Beyond the PGY-1 community pharmacy residency: Characterizing career pathways of residency graduates.

OBJECTIVE: To characterize positions obtained upon graduation from Community Pharmacy Residency Programs (CPRPs). DESIGN: Descriptive nonexperimental study; online cross-sectional survey. SETTING: United States, February to April 2016. PARTICIPANTS: One hundred thirty-three community pharmacy residency program alumni. INTERVENTION: CPRP alumni identified by past program directors were surveyed using 3 contact attempts. MAIN OUTCOME MEASURES: Descriptive measures of demographics and information regarding post-CPRP employment including sex, region, degree status, number of positions offered, and further specialization were determined. Skills developed during CPRPs, such as research, teaching, management, advocacy, and clinical service provision during employment, were reported. RESULTS: E-mails were sent to 216 potential participants, and 133 useable survey responses were gathered from CPRP alumni. When asked how many positions were offered upon residency graduation, 57% were offered 2 positions and 26% were offered 3 positions. Of those employed, 50% of respondents indicated employment at the practice site at which they completed their CPRP. The amount of time spent on traditional dispensing decreased from the initial post-residency position to the current position. The time CPRP graduates spent in roles involving research, management, and advocacy activities in their current position was increased. CONCLUSION: Graduates of CPRPs spend approximately 34% of their time dispensing, which is less than the national average reported by the National Pharmacist Workforce Survey. A contributing factor to the expansion of CPRPs largely depends on the ability of employment opportunities that embrace the value this unique skill set brings. CPRPs foster clinical innovation and leadership in the community setting, thus creating additional opportunities for pharmacists to demonstrate their value to the health care system.

Effect of the expanded Senior Citizens Act of 2010 (Republic Act of 9994) on drug accessibility among the elderly

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aims to determine the effect of the Expanded Senior Citizens Act of 2010 on drug accessibility among elderly.<br /><strong>METHODS:</strong> Descriptive, cross-sectional design involving 775 senior citizens from Manila,Pampanga, Iloilo, Bacolod, Cagayan De Oro and Iligan.<br /><strong>RESULTS:</strong> Thirty-eight percent (38%) of senior citizens were not aware of the law, but 90% knew about the 20% discount and 54% knew about the 12% VAT exemption. Half (50%) of them ask for 20% discount all the time when they buy their medicines. Only half are given full discount every time they ask for it, and 32% are given to the VAT exemption. As a result, less than half (48%) are able to buy all their medicines.<br /><strong>CONCLUSION:</strong> Privileges are not fully enjoyed by senior citizens either due to lack of awareness or noncompliance of drug outlets to the provisions of the Law.</p>

Epidermal growth factor-induced neuroendocrine differentiation and apoptotic resistance of androgen-independent human prostate cancer cells.

Neuroendocrine differentiation (NED) has been implicated in prostate cancer progression and hormone-therapy failure. Neuroendocrine cells are non-proliferating and escape apoptotic cell death, although their origin and the causes of their apoptotic resistance have as yet been poorly elucidated. This study demonstrates a new mechanism involved in controlling NED. We report that epidermal growth factor (5-50 ng/ml) promotes neuroendocrine-like differentiation of androgen-independent DU145 prostate cancer cells. This differentiation is associated with an increase in the expression of Neuron Specific Enolase (NSE) and a reduction in cell proliferation and is blocked by inhibiting tyrosine kinase activity with genistein and with compound 56 (C56). An increase in the cAMP level, using dibutryl cAMP (db-cAMP) (1 mM) and isobutylmethylxanthine (100 microM), does not promote NED by itself, but does increase the effect of EGF on NED. In addition, EGF-induced NED protects cells from apoptosis induced with thapsigargin (1 microM) by reducing the thapsigargin-induced cytosolic calcium overload. In order to describe how EGF-induced NED protects cells against thapigargin-induced calcium overload we investigated the spatiotemporal calcium signalling linked to apoptosis. By using thapsigargin in various conditions on DU145 cells and using micro-fluorimetric calcium measurements, we show that depletion of intracellular calcium store induces apoptosis and that the amplitude and duration of the capacitive calcium entry are two apoptosis-modulating parameters. We show that protection against thapsigargin-induced apoptosis conferred by NED is achieved by reducing the amount and the speed of calcium that can be released from calcium pools, as well as modulating the amplitude of the subsequent calcium entry.