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A 2-week community health clinical experience in Ghana, Africa, provided undergraduate nursing students a study abroad opportunity to expand their cross-cultural skills. Journal entries (N = 512) of four cohorts were analyzed for common themes using Atlas.ti 7 in this descriptive qualitative study. No emphasis was placed on how to cope with cultural shock in Ghana, nor any attempt made to teach effective coping skills during the trips. Bochner's ABC cultural learning response model provided the framework for grouping themes. Positive coping skills included the need for control, humor, normalizing, and reframing as well as a need for a break and relaxation. Venting, frustration, and physical ailments were coded as negative responses to culture shock. Due to these findings, student preparation for short-term study abroad should include discussions on effective coping with culture shock during orientation sessions and on-going debriefing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact that Charitable Pharmacy of Central Ohio (CPCO), a pharmacy providing free pharmacy services and medications, had on an indigent patient population by determining the change in patient-reported hospital use, ability to access medications, and perception of health status after receiving CPCO services. Design: Cross-sectional study with face-to-face interviews using a convenience sample. Setting: Columbus, OH, in January to March 2013. Patients: 206 English-speaking patients 18 years or older at CPCO. Intervention: Free pharmacy services and medications provided by CPCO. Main Outcomes Measures: Number of patient-reported hospital visits before and after CPCO use. Results: In the year before using CPCO, patients reported using the hospital a mean of 2.36 (median, 2.00) times per year versus 1.33 (median, 0.67) times per year after, a decrease of 1.03 hospital visits per year per patient. Before coming to CPCO, 41% of patients were able to have all of their prescribed medications filled; this rose to 85% after using CPCO. A total of 89% of patients reported that not only was their overall health better, but they also had a better understanding of their medications and believed they were in more control of their own health since receiving CPCO services. Conclusion: A charitable pharmacy model has the potential to decrease health care costs and empower patients to be more in control of their health. [ABSTRACT FROM AUTHOR]

Objective: To assess the continuity and consistency of drug therapy among indigent patients following drug sample provision. Design: Retrospective study. Setting: Indigent ambulatory care. Patients: 129 adult patients, identified as having been given a drug sample between January 1, 2004, and February 27, 2004. Interventions: Analysis of data regarding the sample regimen, duration, rationale for sample provision, therapeutic indication, and subsequent therapy prescribed in the 6 months following sample provision. Main outcome measures: Lengths of gaps between sample provision and subsequent prescribed therapy were analyzed to evaluate the effect of sample provision on the continuity and consistency of drug therapy. Results: Of the 52 patients for whom continuous therapy was indicated, interruptions in therapy occurred in 50% (mean duration, 51.1 ± 37.8 days; range, 2-123). Of the 65 patients who were prescribed subsequent therapy, 89.2% were prescribed the exact same drug, 9.2% a different drug in the same class, and 1.5% a different drug in a different class. Following sample provision, only 2 (3.1%) patients were prescribed generic medications. Conclusion: Significant interruptions in drug therapy frequently followed sample provision in those requiring continuous treatment. On average, patients experienced interruptions in therapy for nearly 2 months. The majority of patients who were prescribed subsequent therapy were prescribed the same drug as the drug sample initially provided. [ABSTRACT FROM AUTHOR]

We have an ethical and scientific obligation to Refine all aspects of the life of the laboratory-housed dog. Across industry there are many differences amongst facilities, home pen design and husbandry, as well as differences in features of the dogs such as strain, sex and scientific protocols. Understanding how these influence welfare, and hence scientific output is therefore critical. A significant proportion of dogs' lives are spent in the home pen and as such, the design can have a considerable impact on welfare. Although best practice guidelines exist, there is a paucity of empirical evidence to support the recommended Refinements and uptake varies across industry. In this study, we examine the effect of modern and traditional home pen design, overall facility design, husbandry, history of regulated procedures, strain and sex on welfare-indicating behaviours and mechanical pressure threshold. Six groups of dogs from two facilities (total n=46) were observed in the home pen and tested for mechanical pressure threshold. Dogs which were housed in a purpose-built modern facility or in a modern design home pen showed the fewest behavioural indicators of negative welfare (such as alert or pacing behaviours) and more indicators of positive welfare (such as resting) compared to those in a traditional home pen design or traditional facility. Welfare indicating behaviours did not vary consistently with strain, but male dogs showed more negative welfare indicating behaviours and had greater variation in these behaviours than females. Our findings showed more positive welfare indicating behaviours in dogs with higher mechanical pressure thresholds. We conclude that factors relating to the design of home pens and implementation of Refinements at the facility level have a significant positive impact on the welfare of laboratory-housed dogs, with a potential concomitant impact on scientific endpoints., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Chronic kidney disease (CKD) poses significant public health concerns. Early identification and interventions can help prevent or slow progression to end-stage renal disease., Objective: To characterize CKD in high-risk indigent patients in a primary care setting and evaluate opportunities for pharmacists to work collaboratively with physicians to improve medication use and CKD patient outcomes., Methods: Medical records of 200 patients with diabetes mellitus and/or hypertension were reviewed by the clinical pharmacist. Estimated glomerular filtration rate (creatinine clearance [Cl(cr)]) and urinalysis were used to identify and stage CKD according to published guidelines. Glycosylated hemoglobin concentrations and blood pressures were recorded. The pharmacist evaluated medications for possible drug-related problems (DRPs), made therapeutic recommendations, and evaluated the acceptance rate by physicians., Results: One hundred nineteen patients met inclusion criteria, and a total of 68.9% met CKD criteria: stage 1, 16.0%; stage 2, 20.2%; stage 3, 25.2%; stage 4, 1.7%; stage 5, 0.8%; and not stageable, 5.0%. A total of 381 DRPs were identified, averaging 3.2 (1.7) per patient (range 0-11). The number of DRPs correlated with Cl(cr) (r = -0.25; p = 0.007). Therapeutic recommendations included change of drug, dose and/or interval adjustment of the current drug, discontinuation of nonsteroidal antiinflammatory drugs, additional laboratory monitoring, meeting goal blood pressure and glycosylated hemoglobin, adding renoprotective drug and/or low-dose aspirin, and nephrologist referral. Fewer than half (40.9%) of the recommendations were accepted or accepted with modifications, and an approximately equal percentage were not accepted by the physicians., Conclusions: CKD prevalence was high among the patients evaluated here. New guidelines are available to assist in managing CKD ambulatory patients. Pharmacist collaboration with physicians may optimize CKD screening in high-risk patients and improve medication usage.