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Objectives. We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context. Methods. We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization. Results. Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a ''White'' system. The image of the ''strong Black woman'' was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use. Conclusions. Although violence and drug use were central to our participants' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine what impact, if any, oral health was having on the quality of life for selected seniors in Prince Edward Island, Canada. The attitudes of seniors towards oral health and its relationship to quality of life is important to define. This self-reported assessment provides information on this particular relationship. The research design was a random cluster sampling that covered all geographical areas of Prince Edward Island. It represented the cultural diversity within these geographical areas. The survey instrument selected was the Subjective Oral Health Indicators' Status, a validated survey instrument. This particular instrument addressed all the issues raised in the objectives. Data were analysed using Pearson's correlation with age and number of teeth present. The independent t-test was used to identify differences in responses by gender. Results of the survey showed identification of individual indicators that were having an impact on quality of life. Gender differences in responses were identified in four of the eight subject areas. The level of worry/concern was inconclusive because of the high non-response rate to the last question. Non-response rates increased with each topic in the questionnaire. More research is needed to identify clinical needs of seniors on Prince Edward Island. Qualitative study to determine attitudes and beliefs could provide groundwork for future programme design. [ABSTRACT FROM AUTHOR]

Background: Pharmacy-led medication reconciliation identifies and corrects medication errors that can potentially cause moderate to severe harm. This research sought to identify the impact of pharmacy-led medication reconciliation on patient outcomes and describe the changes in healthcare workers' perceptions of the program., Methods: A pharmacy-led admission medication reconciliation program pilot started in July 2019, and a discharge medication reconciliation proof of concept was tested in September 2020 at a 432-bed hospital. The following periods were compared: August 2018 to February 2019 (pre-program implementation) and August 2019 to February 2020 (post-program implementation). Endpoints included patient outcomes, workforce productivity and interdisciplinary healthcare team satisfaction through program surveys. Patient outcomes were assessed with chisquared tests. Survey responses were assessed using the Likert scale. Descriptive statistics were used for productivity outcomes and the number of discharge medication reconciliations completed., Results: Approximately 18,000 admissions were recorded for each period. The adverse drug event (ADE) rate decreased 49% (p < 0.001), and the complication rate decreased 29.7% (p = 0.001). During post-pilot implementation, 6,530 medication histories were completed, and 70,050 medications were reviewed. Of medication histories completed, 22.6% of patient allergies/adverse drug reactions were updated, 52.3% of medications were clarified, and 54.7% of preferred outpatient pharmacies were updated. Pharmacy services completed medication histories in 38.8% of inpatients. In the proof of concept, 168 discharge medication lists were drafted. Survey results showed statistically significant improvement in healthcare team satisfaction., Conclusion: A pharmacy-led medication reconciliation program involving designated pharmacists and pharmacy technicians has shown to decrease ADEs and complications while improving interdisciplinary healthcare team satisfaction., Competing Interests: Conflicts of Interest The authors declare they have no conflicts of interest., (© 2021 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

Rationale, Aims, and Objectives: Poor adherence to evidence-based medications is a major problem in conventional clinical practise. Better prognostic tools are needed to identify those with the highest likelihood of being non-adherent. The objective of this study is to determine if a 2-item patient activation status (PAS) measure identifies Medicare beneficiaries at risk of poor adherence to drugs typically recommended in treating type 2 diabetes., Methods: PAS and medication adherence were assessed for respondents to the 2009 Medicare Current Beneficiary Survey and then compared using bivariate and multivariate tests. Participants' PAS was classified as "active," "high effort," "complacent," or "passive" based on how confident they were in identifying needed medical care and whether they brought medication lists to their doctors' visits. Adherence with oral antidiabetic drugs, angiotensin-converting enzyme-inhibitors/angiotensin receptor blockers, and statins was assessed using proportion of days covered (PDC)., Results: A total of 940 Medicare beneficiaries with diabetes enrolled in Part D plans in 2009. The overall effect of PAS on medication adherence was small (3% lower PDC for complacent/passive vs active/high effort beneficiaries, P < 0.10). However, interactions of complacent/passive PAS with other characteristics associated with poor adherence identified certain subgroups as especially prone to problematic adherence: age < 65 (PDC -11%, P < 0.05), non-Hispanic black (PDC -13%, P < 0.05), and morbidly obese (-9%, P < 0.10)., Conclusion: A single question relating to taking medication lists to doctor visits may help identify patient subgroups prone to poor adherence in conventional practise, but larger samples are necessary to validate and extend these findings., (© 2020 John Wiley & Sons, Ltd.)

Purpose: To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates., Summary: Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division's completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006)., Conclusion: The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Provider-entered indications for antibiotics have been recommended as a tracking tool for antibiotic stewardship programs. The accuracy and utility of these indications are unknown., Methods: Drug-specific lists of evidence-based indications were integrated into an electronic health system as an ordering hard-stop. We reviewed antibiotic orders with provider-entered indications to determine whether the chosen indication matched the documentation and whether antibiotic use was appropriate., Results: One hundred fifty-five antibiotic orders were reviewed. Clinical documentation supported the entered indication in 80% of vancomycin orders, 78% of cefepime orders, and 74% of fluoroquinolone orders. The clinical appropriateness for vancomycin, cefepime, and fluoroquinolones were 94%, 100%, and 68%, respectively. When providers chose indications from the list as opposed to choosing "other" and entering free text, antibiotic orders were significantly more likely to be appropriate (odds ratio, 5.8; P = .001) but also less likely to match clinical documentation (odds ratio, 0.25; P = .0043)., Discussion: Provider-chosen indications are, overall, an accurate reflection of the true reason for antibiotic use at our institution. Providers frequently documented reasons for fluoroquinolone use that were not among the provided indications., Conclusion: Selecting an indication from an evidence-based list as opposed to free-text indications increases the odds that antibiotic agents will be used appropriately., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

This article focuses on design, training, and delivery of a culturally tailored, multi-faceted intervention that used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a community-based participatory research approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program.

Background: Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings., Objectives: To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV., Methods: We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data., Results: Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants' unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value., Conclusion: Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.

This paper presents an overview of curriculum and program development activities at the four Canadian Regional Training Centres directed towards the goal of achieving increased knowledge to action. The RTCs have initiated learning opportunities to increase the skills of graduate students in conducting knowledge translation and exchange (KTE). The authors describe similar as well as unique approaches used at each centre to hone understanding and skills. RTC activities include the development of a new four-year residency program for doctoral students, new Web-based and real-time interactive theory courses and new linkages with departments of journalism. While formal evaluation is yet to be completed, interim feedback from participating graduate students has been encouraging., (Copyright © 2008 Longwoods Publishing.)

Introduction: Knowledge translation implies the exchange and synthesis of knowledge between researchers and research users, employing a high level of communication and participation, not only to share the knowledge found through research, but also to implement subsequent strategies. Prince Edward Island, a rural province in Canada, provided the setting to exchange knowledge between researchers and a rural community on the health issues affecting children., Methods: A case study reports census data, demographic trends, and information about health issues immediate to the community. These focus groups were held to plan solutions to the community's health priorities. The process was participatory, characterized by community involvement., Results: Those participating in the focus groups were interested in research findings and literature to solve local problems. Parenting and mental health were determined to be priority issues requiring broader community engagement. The process of translating knowledge into action after the focus groups met lacked widespread involvement of the community., Discussion: Although encouraged to do so, the larger rural community did not participate in examining research findings or in planning interventions. The parents in this community may not have perceived themselves as having influence in the process or goals of the project.

Objective: To assess food consumption among aboriginal children living on Mi'kmaq reserves in Prince Edward Island, Canada., Design: Data were collected as part of a larger study of health perceptions and behaviors in Mi'kmaq children and youth ages 1 to 18 years. Food consumption was assessed using a self-administered food frequency questionnaire during an in-home interview., Subjects/setting: Fifty-five children living on a reserve (53% of total population) ages 9 to 18 years., Statistical Analyses Performed: The number of servings of milk products, vegetables and fruit, and snack foods/beverages was calculated by adding the responses to the frequency of consumption of foods assessed in each group. chi(2) analysis was used to assess differences in food consumption according to sex and age., Results: Only one child reported consuming the recommended minimum of five vegetables and fruit daily (Canada's Food Guide to Healthy Eating, 1992) (mean [+/-standard deviation]=2.8+/-1.1 servings). Twenty-five (49%) of the children consumed three or more servings of milk products daily (mean=2.6+/-1.3 servings). Approximately half of the children had three or more snack foods/beverages daily (mean=3.1+/-2.2 servings). Younger children (grades 4 to 6) consumed more cereal, peanut butter, and yogurt than older children. There were no significant differences in food consumption between boys and girls., Conclusions: Our findings are consistent with past reports in aboriginal children. However, except for higher consumption of french fries, results are similar to recent surveys of other Prince Edward Island school children, suggesting a province-wide rather than cultural health issue.

Objective: To evaluate the ability of a questionnaire regarding the nonphysical aspects of quality of life (QOL) to differentiate sick and healthy dogs., Animals: 120 dogs., Procedure: The questionnaire was administered by telephone to owners of 120 dogs with appointments at a veterinary teaching hospital. A QOL score was calculated for each dog on the basis of questions relevant to the dog during the 7 days before the interview. Scores were recorded as bar graphs, and linear regression was used to examine the effect of health status and other variables on QOL score. Certain questions were eliminated post hoc, on the basis of defined criteria, and the analyses were repeated., Results: Scores were similar for sick (range, 670% to 93.8%) and healthy (range, 68.0% to 89.8%) dogs. Environment (suburban vs rural) and duration of ownership were significant explanatory variables and accounted for 10.5% of the variation in the QOL score. Eleven questions were eliminated post hoc. The scores derived from the 2 versions of the questionnaire were highly correlated (r = 0.92)., Conclusions and Clinical Relevance: There was no evidence that the QOL questionnaire could differentiate healthy dogs from sick dogs; environmental and owner factors appeared to be more important.

Objective: To develop a preliminary discriminative questionnaire for assessment of nonphysical aspects of the quality of life (QOL) of pet dogs and evaluate the questionnaire's content validity, test-retest reliability, and internal consistency., Study Population: Owners of 120 dogs., Procedure: Each QOL question had 4 response options, representing descending levels of QOL that were equally weighted. A maximum of 38 items contributed to the QOL score. The questionnaire was administered by telephone to owners of dogs with appointments at a veterinary teaching hospital before the appointment. After the appointment, each dog was classified as sick or healthy by use of defined criteria; owners of healthy dogs had a second interview 3 to 4 weeks later. Test-retest reliability (kappa), internal consistency (Cronbach alpha), and respondents' comprehension were used as criteria for excluding an item., Results: There were 77 sick and 43 healthy dogs. Twenty-two QOL questions had significant kappa values (0.11 to 0.91). The Cronbach alpha values for 5 domains of QOL ranged from 0.45 to 0.61, indicating that the domains had moderate internal consistency (homogeneity). The initial pool of 38 items was reduced to 27., Conclusions and Clinical Relevance: The questionnaire was designed to complement veterinary assessment of dogs' physical health. The questionnaire may be a useful tool in making decisions regarding dogs' QOL.