Validating a theory of planned behavior questionnaire for assessing changes in professional behaviors of medical students.

Introduction: Teaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students. Methods: To validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes. Results: Quantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9-1 for relevance and 0.7-1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as "worthless/worthwhile" were replaced with "not important/important"); and (ii) suggestion of the addition of social media in the construct of subjective norms. Discussion: The proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

Interprofessional Interventions Involving Pharmacists and Targeting the Medicines Management Process Provided to Older People Residing in Nursing Homes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: Nursing home residents are often prescribed multiple medications, which increases their susceptibility to drug-related problems. The medicines management process involves multiple stages, for example, assessing, prescribing, dispensing, delivering and storing, administering, reviewing and monitoring. The medicine management process aims to optimise medicine use and associated patient outcomes. Interprofessional interventions of healthcare professionals from different disciplines in many clinical settings, including the nursing home setting, have shown success in improving patients' clinical outcomes. However, reporting of the pharmacist's role and the impact of these interventions has been unclear. OBJECTIVES: We aimed to systematically identify and describe interprofessional interventions involving pharmacists that target the medicine management process in nursing homes by (a) describing interprofessional interventions and the role of pharmacists within, (b) describing the impact of these interventions, (c) exploring which of the medicine management process stages were targeted and (d) identifying any reported theoretical underpinning. METHODS: EMBASE, MEDLINE, CINAHL, SCOPUS, PsycInfo, Cochrane library, Web of Science and clinical trial registers were searched from the inception date until August 2021. Randomised controlled trials reporting interprofessional interventions involving pharmacists, targeting at least one stage of the medicine management process and provided to nursing home residents with a mean age ≥ 65 years, were included. The search had no restriction on outcomes measured. Included randomised controlled trials were assessed for quality and risk of bias using the Jadad scale and Cochrane Collaboration tool, respectively. The overall certainty of outcomes was assessed using GRADEpro. If present, details about theoretical underpinning were extracted using the theory coding scheme. Fixed and random-effects models were used to calculate the pooled effect estimates to compare outcomes between intervention and control groups, where feasible, or a narrative description was reported. RESULTS: Eighteen manuscripts describing interprofessional interventions involving pharmacists were identified: medication review (n = 14), education (n = 3) and medication simplification (n = 1) based interventions. The pharmacists' most frequent role was the provision of medicine-related recommendations, and they worked mostly with general practitioners and nurses. Residents/family members contributed in 44% of included interventions. A meta-analysis identified that interventions were significantly associated with significant improvements in prescribing appropriateness (standard mean difference - 0.20; 95% confidence interval - 0.33 to - 0.77; I2 = 27%) but not with hospitalisation and mortality. None of the included studies reported a theoretical underpinning to intervention development. CONCLUSIONS: This systematic review provides a detailed description of the impact of interprofessional practice, involving pharmacists, which targets at least one stage of the medicine management process in the nursing home setting. The findings suggest that future research should prioritise improving prescribing inappropriateness rather than the number of long-term medications prescribed. It remains unknown if interventions are designed using theory and, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. CLINICAL TRIAL REGISTRATION: The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42020181744].

Risk factors for hospital readmission of patients with heart failure: A cohort study.

AIM: The aim of this study was to develop a risk factor model for hospital readmission in patients with heart failure. BACKGROUND: Identification of risk factors and predictors of readmission to hospital in patients with heart failure is very crucial for improved clinical outcomes. OBJECTIVE: The objective of the current study was to investigate and delineate the risk factors that may be implicated in putting a patient at greater risk of readmission due to uncontrolled heart failure. MATERIALS AND METHODS: This is a prospective follow-up cohort study of 170 patients with heart failure at a tertiary hospital in Al Ain city in the United Arab Emirates. We have developed a risk factor model based on the recommendations of validated published data. We have used univariate and multivariate logistic regression analyses on structured steps based on the published data. The main outcome was the risk factors for readmission to hospital due to heart failure. RESULTS: A final predictive model (10 variables) was produced for unplanned readmission of patients with heart failure. The risk factors identified in the final model with their odds ratios (ORs) and confidence intervals (CIs) were as follows: four or more prescribed medicines (OR = 4.13; CI = 3.5-4.1; P = 0.003), more than twice daily dosing regimen (OR = 2.34; CI = 1.0-5.0; P = 0.023), poor knowledge of prescribed medications (OR = 4.24; CI = 1.213-14.781; P = 0.006), diabetes mellitus (OR = 3.78; CI = 1.6-8.7; P = 0.006), edema (OR = 2.64; CI = 1.2-5.6; P = 0.011), being house bound (OR = 2.77; CI = 1.2-6.2; P = 0.014), and being prescribed diuretics (OR = 3.69; CI = 1.4-9.2; P = 0.042). CONCLUSION: The specificity of the developed risk prediction model was 82.2%, the sensitivity was 74.3%, and the overall accuracy was 72.9%. The model can be emulated in population with similar characteristics to prevent early readmission of patient with heart failure.

Druggability analysis and classification of protein tyrosine phosphatase active sites.

Protein tyrosine phosphatases (PTP) play important roles in the pathogenesis of many diseases. The fact that no PTP inhibitors have reached the market so far has raised many questions about their druggability. In this study, the active sites of 17 PTPs were characterized and assessed for its ability to bind drug-like molecules. Consequently, PTPs were classified according to their druggability scores into four main categories. Only four members showed intermediate to very druggable pocket; interestingly, the rest of them exhibited poor druggability. Particularly focusing on PTP1B, we also demonstrated the influence of several factors on the druggability of PTP active site. For instance, the open conformation showed better druggability than the closed conformation, while the tight-bound water molecules appeared to have minimal effect on the PTP1B druggability. Finally, the allosteric site of PTP1B was found to exhibit superior druggability compared to the catalytic pocket. This analysis can prove useful in the discovery of new PTP inhibitors by assisting researchers in predicting hit rates from high throughput or virtual screening and saving unnecessary cost, time, and efforts via prioritizing PTP targets according to their predicted druggability.