運用品管手法改善藥師在職教育課程的辦理成效

<p>目的：改善在職教育課程的辦理成效，期能強化部內藥事人員專業技能以提升病人的照護品質。</p> <p>方法：本專案結合Kern課程規劃循環(Kern curriculum cycle)與品管手法PDCA的概念，由課堂的課後資料與 問卷進行現況分析與學習者需求調查，找出「課程參與度與完成度低」之主要因，並擬定對策。課程參與度之目標設定為每堂課平均出席人數過半達64位，課程完成率達85%。（課程完成之定義為限期內完成課後評值且分數高於80分，以及滿意度填寫）</p> <p>結果：課程內容與品質改善後，平均出席人數由56位增加到65位，目標達成率112.5%；課程完成率由83.2%增加到87.3%，目標達成率227.8%。</p> <p>結論：藉由優化課程內容與品質，改善在職教育課程的辦理成效，進一步再將特定發展的課程主題以帶狀系列或社群模式進行，能提高同仁自主學習意願、促進自我成長，亦能強化同仁專業技能，進而提升病人照護品質，且有助於部門內人才師資培育兼顧員工職涯發展，並預做準備將全人照護概念向下扎根於藥學實習生。</p> <p>&nbsp;</p><p>Objective: To improve the effectiveness of on-the-job education programs for strengthening the professional skills of the pharmacists in our department and further enhance the quality of patient care.</p> <p>Methods: This project integrated the Kern curriculum cycle and the Plan-Do-Check-Act (PDCA) concept of quality control. We used post-class evaluations and questionnaires to do a situation analysis and survey learners’ needs to identify the main reasons for low course participation and completion and to develop countermeasures to these problems. The course participation targets were an average attendance of 64 pharmacists per class and a course completion rate of 85%. Course completion was defined as completing both the postcourse evaluation (80 points to pass) and the satisfaction questionnaires by the stipulated deadline.</p> <p>Results: After we improved the content and quality of the courses, the average attendance increased from 56 to 65, and the target achievement rate was 112.5%. In addition, the course completion rate increased from 83.2% to 87.3%, and the target achievement rate was 227.8%.</p> <p>Conclusion: By optimizing the content and quality of the courses, improving the effectiveness of the on-the-job education programs, and developing courses on specific topics within a series or community model, we cultivated independent learning and self-growth among our pharmacists, strengthened their professional skills, and improved the quality of patient care. Moreover, talents and teachers were fostered while taking into account the career development of our pharmacists, and preparations were made to root the concept of holistic care down in pharmacy interns.</p> <p>&nbsp;</p>

Higher one-year achievement rate of serum phosphate associated with lower cardiovascular mortality in hemodialysis patients

Background Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients. Methods This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality. Results The mean age of the study population was 61 ± 13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR = 4.117, P = 0.016) and 25% (HR = 3.343, P = 0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR = 2.129, P = 0.162) and 75% (HR = 1.080, P = 0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate. Conclusions Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.

Public Legal Awareness of the Importance of Covid-19 Vaccination in Southeast Maluku Regency

The spread of Covid-19 has an impact on all areas of human life universally throughout the world to all corners of the region in Indonesia, including the Southeast Maluku Regency, Maluku Province. Therefore, the government through the covid-19 vaccination program is one way to break the chain of the spread of Covid-19. This study uses a normative juridical research which is descriptive analytical through primary legal materials and secondary legal materials with literature studies. The analysis used is qualitative analysis. The implementation of the Covid-19 vaccination in Southeast Maluku Regency continues to be carried out in order to meet the national achievement target of 70%. As of early November, it was shown that in Southeast Maluku the achievement rate of Covid-19 vaccination for both the first and second doses was still below the national target of 70 percent. By not meeting the national Covid-19 vaccination achievement target in Southeast Maluku Regency, it shows that the legal awareness of the community to vaccinate Covid-19 in Southeast Maluku is still very minimal. The Southeast Maluku Regency Government needs to approach the community that is more humanistic and socio-cultural in order to provide education and good understanding for the community about the Covid-19 vaccination so as not to cause doubts in the community to vaccinate Covid-19.

The Effect of Hybrid Training Combined with On demand Classes

One aspect of life hit hard by the COVD-19 pandemic in 2020 was education in general and, in this case, actual ship training. The same is true for anchoring training, implemented annually as part of maritime training. Therefore, to conduct ship training effectively and briefly, this study advocates hybrid training, that is, shortened practical training combined with on demand video learning materials created and distributed to students in advance. Group work on ship handling planning that lasts for three to six hours is normally conducted annually in traditional classes. However, because of the pandemic, the allotted time for group work was reduced to approximately 1.5 hours. Therefore, in 2020, we conducted hybrid training, that is, anchoring training that included on demand video learning materials. Compared to students’ 66.3% average achievement rate in 2018 and 2019, the average in 2020 was 78.3%. ‘Anchoring procedure’ and ‘altering course’ items showed a particularly large gap in evaluation. The following were effects of hybrid training: (1) Videos that can be watched in advance can also be viewed repeatedly at one’s own pace. (2) The capacity to watch videos via smart phones provides students with better access. (3) As videos can be watched in advance, students become familiar with concepts before training, thus leading to better understanding of the training’s content and purpose. These results demonstrated hybrid training’s effect when practical training is combined with on demand materials.

Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07–0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.

Increase Student Learning Interest in Covid-19 with Digital Teaching Materials

The problem behind this research was the implementation of learning courses that tend to attract less students to study. This research was research and development. The subject of the research trial was a student of the Religious Education Study Program. The data collected in this research were data from expert test subject content, design expert test, learning media expert test, and from student trials. Data collection instrument used in the form of evaluation sheet (questionnaire). Data analysis used qualitative and descriptive quantitative descriptive analysis. The results of the assessment of media products were carried out based on six aspects, namely: aspects of the content of the field of study / with a percentage of achievement rate of 87.00% with a worthy predicate; reviewed from the aspect of learning design with a percentage of achievement rate of 85.55% worthy predicate; reviewed from the aspect of learning media with a percentage of achievement rate of 88.00% worthy predicate; reviewed from the aspect of individual trials, with a percentage rate of 90.65% pedikat very feasible; small group trials, with a percentage achievement rate of 95.55% predicate is very feasible;and reviewed from the aspect of field trials with a percentage achievement rate of 94.45% predicate is very feasible. Thus this product in the form of teaching materials has a good level of validity and deserves to be used in the learning process in religious education courses.

Treatment outcome of oral tofacitinib and ruxolitinib in patients with alopecia areata: A systematic review and meta-analysis

Background: Tofacitinib and ruxolitinib have been used off-label to treat alopecia areata. Although a number of case reports and small studies have been published, there are no comprehensive reviews examining the outcomes of using tofacitinib and ruxolitinib for the treatment of alopecia areata. Aims: The aim of the study was to examine the outcome of patients with alopecia areata treated with oral tofacitinib or ruxolitinib in previously published studies. Methods: A search of MEDLINE, Embase and Cochrane library was conducted. A systematic review and meta-analysis were performed focusing on the Severity of Alopecia Tool 50 achievement rate, the frequency of adverse events and recurrence after discontinuation of treatment. Results: A total of 1244 studies were identified of which only 12 studies met the inclusion criteria. Of the 346 patients in these 12 studies, 288 had received oral tofacitinib and 58 had received oral ruxolitinib. The overall Severity of Alopecia Tool50 achievement rate was 66% (95% confidence interval, 54%–76%). Subgroup analysis revealed that drug choice, mean age, sex ratio and alopecia areata subtype ratio did not significantly affect the treatment response. Infections and laboratory abnormalities were the most common adverse events (98 and 65 cases of 319 patients, respectively). Patients treated for more than six months had a greater frequency of laboratory abnormalities as compared to those treated for shorter durations (24% vs. 7%; P = 0.04). Recurrence of alopecia areata was observed within three months after discontinuation of treatment in the majority (74%) of patients. Limitations: This analysis was limited by the small number of observational studies available for review, the heterogeneity of patient characteristics and the lack of long-term data. Conclusion: Both oral tofacitinib and ruxolitinib are effective and well tolerated in the treatment of alopecia areata. Clinicians should be aware of the expected efficacy, adverse events and high recurrence rate of oral JAK inhibitors for alopecia areata to effectively counsel these patients before starting therapy.

Higher One-year Achievement Rate of Serum Phosphate Associated with Lower Cardiovascular Mortality in Hemodialysis Patients

Background: Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients.Methods: This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality. Results: The mean age of the study population was 61±13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR=4.117, P=0.016) and 25% (HR=3.343, P=0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR=2.129, P=0.162) and 75% (HR=1.080, P=0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate.Conclusions: Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.

Ship Handling Training for Collision Avoidance: Education via Group Work

In shipping, which is one of the drivers of the world’s economy, many marine accidents continue to occur, such as ship collisions and grounding. To prevent marine collision accidents, there is a strong demand to improve seafarers’ skills through training. Therefore, practical and simulation training sessions are carried out. However, these cannot be considered sufficient because of cost and time constraints. Therefore, the authors proposed a training method in which a group of students set the situation themselves by adding restrictions on actual cases of ship handling for collision avoidance and then discuss and present it. In this training method, ship training instructor assessment and an anchoring experiment were carried out, both of which obtained good evaluations. The anchoring experiment showed a difference of up to 27.5% in the achievement rate between the proposed training and previous training. Regarding ship handling for collision avoidance, as much as a 45.5% difference in achievement rate was observed. These are considered to have the effect of encouraging active thinking by the proposed training method. In addition, the effect of considering the ship handling for collision avoidance for many situations can be thought. Furthermore, it was considered to be the effect of discussions in group work.

What Health Information is Needed to Improve the Vaccination Outcomes of COVID-19? : Study Analysis in COVID-19 Vaccination in Sangihe Island Regency, Indonesia

The Indonesian government enforces a COVID-19 vaccination policy for all, but the achievement rate for the COVID-19 vaccination in Sangihe Islands Regency at the first dose is only 1.05%, while the achievement at the second dose to date is only 0.47%. With this in mind, the vaccination policy has not been in line with community participation. The purpose of this study was to find out what kind of health information is needed to increase the covid-19 vaccination rate. The method used in this research is a descriptive study with a purposive sampling technique which was held from 7 January to 8 February 2021 with a total sample of 85 respondents who are health workers in the Sangihe Islands Regency. The data analysis used is descriptive analysis with frequency distribution. The results in this study were 15.3% stated that they were not willing to vaccinate COVID-19 because 39% of COVID-19 survivors, 38% had comorbidities, 15% were unsure of safety and 8% feared side effects. The conclusion of this study is to increase health information regarding vaccines for COVID-19 survivors, information about comorbidities such as what is appropriate for COVID-19 vaccination, safety, and side effects resulting from the COVID-19 vaccine.