Settling In

My name is Andre and I am a fourth year PharmD student at the University of Toronto. I started my Advanced Pharmacy Practice Experience placement here at mdBriefCase a few days ago so I have already had some time to adjust. 

So far I have worked exclusively in a community setting at various Shoppers, Rexalls and Loblaws so this is a new and exciting experience for me. I didn’t know exactly what to expect, but everything I have heard from fellow classmates has been positive and I am already starting to see what everyone is talking about. 

So far I have been oriented, met many of the staff members and began working on the projects I will be completing over the next five weeks. I am responsible for conducting a critical appraisal of a continuing education program, writing a pharmacy newsletter and completing a patient-focused module on medSchool For You. I very much appreciate the fact we are able to choose our own topics for our projects as it allows us to pick ones that we are passionate about.  My areas of interest are diabetes, mental health and minor ailments so I will be choosing topics that allow me to demonstrate and expand upon my knowledge.   

If you are an APPE student who has just started your rotation at mdBriefCase and you are reading through old posts, especially if you are new to non-direct patient care like myself, it seems like you’ve picked a good rotation. Everyone is very friendly and helpful. 

Blogging as a reflective exercise

Here we are, heading into the last few days of my rotation at mdBriefCase and looking back at my single, lonely blog post. I apologize for not updating the blog but maybe my other projects will make up for it. If you have the time, take a look at my eNewsletter on COPD management and dual bronchodilation or drop by MSFY and check out my diabetes article!

I would however like to take the time to reflect on my time here at mdBriefCase.

Medical writing. If you’ve never been exposed to it, I urge you to try and find an opportunity. It isn’t just the writing. It’s conducting research to identify all the information available, filtering and sorting through it to find the valuable pieces, and then finding a way to share with those interested. Communication is a skill that is vital to many professions, pharmacists especially. We are constantly interacting with patients, physicians, or other healthcare professionals. That being said, our language and tone differ with each of these groups. Being exposed to medical writing, however briefly, helped me realize how drastic these differences can be.

Continuing education. For someone still technically in school, I never thought twice about it. I can say now that I have a better understanding of the value continuing education has for a practicing pharmacist. Our practices are changing. From expanded scopes to new medication classes, it’s quite easy to become overwhelmed with all the new information available to us and our patients. Continuing education programs distills a lot of this new information for us, making it much more manageable. I expect to be browsing through the rxBriefCase programs throughout my career to stay up to date with my practice!

I’d just like to thank the team here at mdBriefCase for being nothing but welcoming. Although not your traditional pharmacist role, being exposed to this facet of pharmacy has been really interesting and rewarding.

The ball is in my court

Greetings readers,

My name is Bob, and no, that isn’t short for anything (unfortunately). I, like those before me, am a fourth-year pharmacy student undergoing an APPE rotation here at mdBriefCase. I've spent a majority of my time in the community practice setting, and just the tiniest bit of time in a hospital practice. Usually the first question I get asked when I introduce myself as a pharmacy student is where I plan to practice in the future. I wish I could answer you, but every time I step into a new practice setting I find myself really enjoying it. As a result, I’m left with too many interests! As for my rotation here at mdBriefCase, I look forward to diving into the world of continuing education. Hopefully, I’ll be able to leave my own mark. I don’t really know what to expect, but I guess that’s part of the ride!

I’ll close off with a little bit about me, outside of pharmacy. Like my name, my life is rather… uninteresting. I do find enjoyment (lots actually) in eating. That said, I'm also known to be quite picky! Aside from my love of (certain) foods, I’d say I spend most of my time at the theaters, binge watching shows on Netflix, or in front of the computer trying to identify next restaurants to try, movies to see, or shows to binge watch.

That’s it for now, but stay tuned for updates, posts, and work on an eNewsletter as well as MSFY! Oh and please, do feel free to approach me with any questions, suggestions, or just to introduce yourself!

Learning Communication Skills

It’s Azadeh Vasefi writing one last blog as the rotation comes to an end. This was a new and unique experience.

Working on the e-newsletter helped improve my medical writing skills, particularly expressing technical concepts in plain, everyday language. I learned (specifically by writing the Q&A for MSFY) that it is important to be aware of your ‘audience’, and adapt your language so they can understand your meaning. Medical terms may not be helpful to a general audience. Putting your message simply and to the point is important in order to be understood.

I learned many useful concepts that I will use in my future career as pharmacist, especially since I intend to work in retail pharmacy. I want to be one of the best pharmacists by helping my patients to understand their therapy, so patients will be more adherent, and better results achieved.

Women’s health: why is it important?

I would like to take a moment to discuss women's health.

Why am I interested in this topic? Because I am a female who likes to be informed and take care of my own health, and as a female healthcare professional, I would like to help other women. Women's health is determined by several factors, including biological influences, and like all humans, their health is affected by stress, nutrition, and work load.

The main medical science dealing with women’s health problems is called Gynecology, which means ‘woman knowledge’ from ‘gyno’ or ‘woman’ and ‘logos’ or ‘knowledge’.² A vast amount of information is now available to women for a wide range of problems from general issues such as proper nutrition, exercise and hygiene to management of serious conditions like stress, eating disorders, depression and heart health.² In cases where a condition is being treated with medication, women should be informed that they metabolize a number of drugs differently and at a different rate than men.²

Following are some common issues seen in women:³ 

• Breast Cancer
• HPV and abnormal Pap Smears
• Vaginal yeast infection
• Fibroids
• Herpes
• Urinary Tract Infection
• Endometriosis
• Primary and secondary dysmenorrheal

How pharmacists can help

Pharmacists play a large role in informing patients about their medication use.⁴ Pharmacists are closely involved with women’s health, including support with menstruation and menopause issues.⁵ They play a big role in counseling on emergency contraceptives and the proper use of them⁴; they can also provide useful and practical information about sexually transmitted diseases and prevention methods. 

Consultation with pharmacists about women’s health can help women identify options to improve their health through optimizing therapy and lifestyle modifications.⁶ Pharmacists can be a great help in menopause management by providing symptom assessments and education about current therapies, nutritional information, and recommendations for lifestyle changes. ⁶

I really love to help all patients, but especially as a female pharmacist assisting women with their health issues.

My interest in women’s health led me to choose ‘primary dysmenorrheal’ as the e-newsletter topic to explore and further my knowledge. Stay tuned!

References

1. Kerala Women. (2012) The Importance of Women's Health. Retrieved from http://www.keralawomen.gov.in/index.php/health/190-the-importance-of-women-s-health

2. MedicineNet, Inc. (2014) Women's Health. Retrieved from http://www.medicinenet.com/womens_health/article.htm

3. Women’s Health Specialists. (2015) The Feminist Women’s Health Centers of California. Retrieved from http://www.womenshealthspecialists.org/health-information/common-problems

4. Drug Topics. (2010) Pharmacists expand focus on women's health. Retrieved from http://drugtopics.modernmedicine.com/drug-topics/news/modernmedicine/modern-medicine-feature-articles/pharmacists-expand-focus-womens-hea?page=full

5. Sam’s Club, Healthy Living Made Simple. (?) Women’s Health: How your pharmacist can help.  http://healthylivingmadesimple.com/womens-health-how-your-pharmacist-can-help/

6. The Medicine Shoppe pharmacy. (2012) Women’s Health Consultations. Retrieved from http://www.medicineshoppecrowfoot.ca/womens-health-consultations/

Another New Pharmacy Student

I am Azadeh Vasefi, a 4th year pharmacy student at the University of Toronto. This type of rotation is new and exciting to me. 

I will be developing an eNewsletter on the topic of primary dysmenorrheal management, preparing some FAQs on the topic of Acute Otitis Media (middle ear infection), and critically appraising rxBriefCase program,Managing Iron Deficiency Anemia in Pharmacy Practice. 

I am interested in pediatrics and women’s health, and hope to gain more knowledge on these topics during this rotation.

This is my second rotation of my fourth year. I soon got over my initial lost and anxious feelings since the environment at the mdBriefCase is very welcoming. 

Stay tuned for more blog posts and updates from my experience at mdBriefCase!

Parting Thoughts

It’s Ashu Randhawa, checking in as my rotation draws to a close. It’s been quite the journey! I’m glad that I had the chance to work with such a talented and diverse group of people.

I’ve improved my medical writing at mdBriefCase, but more importantly I’ve refined my communication skills. If there’s anything I want you guys to take away from my blog posts, it’s this:

• Know your audience
• Keep it simple and to the point

That’s how you get your messages across effectively. I’ll incorporate what I’ve learned here to become an even better pharmacist. 

Thanks for everything, mdBriefCase!

Cultural Shifts, Biases, and Do-It-Yourself Healthcare

Our approach to healthcare has changed over the years. Healthcare providers used to have a paternal, authoritarian stance when dealing with patients. A few decades ago, it wouldn’t have been unusual to hear a doctor say, “Take this pill everyday and come see me in 2 months.”

Would you listen to your doctor if they told you that today? Maybe, but I bet you’d ask why, first.

We’ve had a recent cultural shift. The power imbalance between patients and healthcare providers is shrinking, and healthcare institutions now promote working with patients instead of just telling them what to do. We’re improving our communication skills. I believe that overall, we’re heading in the right direction.

However, I also believe that our cultural shift is a double-edged sword. People are trying to solve their own health problems. I’ve seen a fair number of cases where patients self-medicate with products (ex. herbals) recommended by friends, commercials, or the internet. Patients rarely share this to healthcare providers unless they’re explicitly asked. It’s usually not a big issue, but in some situations self-medicating can be dangerous.

The problem with having patients make completely independent healthcare decisions is that humans are naturally weak in sorting out good information from bad information. We’ve got too many biases in our way. These include:

• Confirmation bias: We tend to look for information that lines up with our beliefs, and ignore everything else.
• For example, a man distrusts medications. He sees a new headline that says, "New heart medication works great; but it may cause muscle pain." He says to his friends, "Muscle pain? I knew these drugs were bad for you," ignoring the protective effects of the drug on the heart.
  
• Availability Bias: We give more attention to personal stories and examples. We give less attention to impersonal numbers and data.
  
• Anchoring Bias: We rely too heavily on the first pieces of information we get.

Overcoming these biases is hard.

Things become especially complicated when the internet is involved. People have mastered the art of Google-Fu, but the internet isn’t well-regulated. It’s incredibly easy to find false or misleading information. When looking online, it’s essential to be skeptical and to question what you read. When in doubt, check with your healthcare provider. You’ve got no real idea of what to expect when you act on 1 hour of online research. There’s a bit more leeway when you follow the advice of someone trained to give standardized care.

I think it’s excellent that people look things up for themselves. It's empowering to take control of our own health, and there's certainly a lot of well-written information out on the web. However, we've got to be responsible in how we handle that information. 

As always, please feel free to provide me with any comments or feedback. Otherwise, I’ll see you in my next post!

A note on keeping it brief

It’s Ashu Randhawa, checking in again at the half-way mark of my rotation. My predecessors weren’t kidding when they said that time flies by here.

My time here so far has been unique. It’s worlds away from the quiet intensity of hospital or the organized chaos of community. It’s tranquil and friendly and fun.

The work gives me an opportunity to practice some valuable skills. Keeping things short and sweet is the name of the game, here. Gathering information is easy. Distilling it into something concise that flows well is harder. To reflect on a larger scale: the point of writing or speaking is to communicate something. If your target doesn’t understand you, then what was accomplished? I think Blaise Pascal put it best when he said, “I’m sorry that this was such a long letter. I didn’t have the time to write you a short one.”

Or if I can double dip, Shakespeare. “Brevity is the soul of wit.”

As pharmacists, it’s easy to write pages of medical information when we have resources like UpToDate or clinical guidelines or even Wikipedia at our fingertips. It’s easy to use big words, but that doesn’t mean we should. Even when dealing with other healthcare professionals, I think we should first and foremost try to make sure we’re understood.

I hope my MSFY and e-Newsletter reflect this ideal when they’re released, but you can be the judge of that. As always, feel free to leave any comments or suggestions you have for me. Otherwise, stay tuned!

Batter Up!

I’m Ashu Randhawa, a pharmD student from University of Toronto. Over the next 5 weeks, I’m going to find myself walking the road that so many other pharmacy students have taken before here at mdBriefCase.

It’s shaping up to be a novel experience. I’ve largely had exposure to community pharmacy (with a pinch of hospital, courtesy of my latest rotation), so I’m appreciative of the learning opportunities here. The work seems simple in concept, if not so much in execution; past bloggers have implied that there’s a lot of background work that goes into writing CME. Fortunately, there’s a comprehensive, week-by-week manual and some very friendly staff to guide me through this rotation. If all goes well, you’ll be seeing an eNewsletter and medSchool For You pages from me soon!

My strongest interests in the world of healthcare lie with fitness & diet, obesity and diabetes. There’s something appealing to me about the idea that simple, consistent lifestyle choices have large effects on health. Outside of healthcare, my hobbies include fitness and console gaming.

I also really enjoy reading and writing (mostly fiction), so I’m prepared for the inevitable flow of red corrections that’ll accompany my draft work. Rome wasn’t built in a day, after all.

If you have any questions or suggestions, feel free to send them my way. Otherwise, stay tuned for more posts!

e-Learning: An Era of Innovation

As I head into my last couple day at mdBriefCase, I reflect on how fast these past 5 weeks have gone. I am grateful to have had the opportunity to experience a rotation in such a unique environment, with such a great team of people. I learned a lot about medical writing and content development, but I also learned what goes into getting all of the content we see on mdBriefCase’s websites. Week by week, I was exposed to more and more pieces of the puzzle, and by the end everything made sense and came together. 

I was fortunate enough to have the opportunity to attend the e-Learning Alliance of Canadian Hospital (eACH) Conference. I participated in sessions on innovations in learning and ways to engage your learner. In the spirit of the conference and my entire mdBriefCase rotation, I decided to write my last blog on the benefits and barriers to e-Learning.

The Benefits

 Healthcare professionals are required to complete several course credits every year in order to maintain their status as an active practitioner.¹ This is so important because what is considered a “best practice” in the profession of healthcare can change drastically.  Traditional classroom approaches are associated with many drawbacks, such as high costs, lack of time, and failure to keep up with the quickly changing trends.1

Delivering continuing education material online eliminates all three of these drawbacks. e-Learning is a timely, remote, cost-effective way of delivering continuing education.¹ It allows healthcare professionals to take courses at their own pace, whenever they can fit them into their busy schedules. It involves very low costs to setup, update, and run compared to traditional classroom-based courses.¹ e-Learning can also be a more effective way of learning, incorporating many different learning styles into the delivery of the content and enabling more of an interactive learning experience.

The Barriers

The barriers mainly surround the integration of e-Learning into practice and shifting people’s mindsets from traditional styles of learning to more modern ways of learning. e-Learning challenges us to think about innovative ways to deliver content, while still being able to get the main message across. Like anything else in healthcare (and in life), implementing and undergoing change can be challenging. However, with something as big as technology, it is going to evolve over time whether we want it to or not. Look at the evolution of cell phones and computers. These devices can practically outsmart us now. 

Learning is a lifelong process, and finding new ways to deliver content to keep learners engaged is rapidly advancing, so we better get used to it!

References

1. Andriotis, N. (2014). E-learning in the healthcare industry. Retrieved from:  http://www.efrontlearning.net/blog/2014/12/e-learning-healthcare-industry.html
2. David, O., Salleh, M., & Iahad, N. The impact of E-learning in workplace: focus on organizations and healthcare environments. International Arab Journal of e-Technology. 2012; 2(4): 203-208.  

Hospitals can be hazardous environments for older adults

Elderly patients are much more vulnerable to the various insults associated with hospitalization compared to their younger counterparts. Some common adverse events we see in hospitalized elders include: functional decline, delirium, undernutrition, and polypharmacy.¹ It is estimated that 1 in 7 older adults experience an adverse event during their hospital stay.¹ 27% of these patients end up going on to develop multiple related adverse events.¹ Many of these patients have a hard time recovering after they have been hit with the insults associated with hospitalization.

How are we dealing with this?

Over the past decade, hospitals in Canada have been trying to adapt their models of care to become more tailored to the needs of older adults. This is surfacing through the formation of a specialized hospital unit for geriatric patients called the Acute Care for Elders (ACE) unit. ACE units focus on “recognizing the needs of acutely ill older patients and modifying common medical practices and standards to best meet these needs.”⁴

ACE hospital units have been shown to have many positive effects for both the hospital and the patient, including reduced costs, decreased length of stay, improvement in functional abilities, decreased need for antipsychotic drug use, reduced duration of urinary catheter use, reduced hospital readmissions, and reduced adverse events related to hospitalization.²

Where does the pharmacist fit in?

A substantial number of hospitalizations among the elderly are attributable to medications. Almost 50% of older adults who take five or more medications have been hospitalized as a result of adverse drug events, errors related to taking the wrong medication, the wrong dose of medication, or interactions between medications³. Most of these adverse events are preventable.³ Pharmacists can play a role in preventing hospital admissions by ensuring safe and efficacious medication use, promoting adherence, assessing for drug interactions and adverse drug reactions, and by providing appropriate discharge counselling so patients know what new medications they are starting and what old ones they are stopping after a hospital admission.

As the role of a pharmacist expands, physicians and patients will rely more and more on pharmacists to optimize medication management for the elderly, both in hospital and in the community. The bottom line is that there is a huge role for pharmacists to play in helping to keep older adults away from the threats of the hazardous hospital environment.

References

1. Today’s geriatric medicine. (2015). ACE unit improve complex patient management. Retrieved from: http://www.todaysgeriatricmedicine.com/archive/090913p28.shtml
2. Physicians Weekly. (2013). Analyzing the effect of ACE units for older people. Retrieved from: http://www.physiciansweekly.com/acute-care-for-older-patients/  
3. Healthy Debate. (2014). Improving medication safety for the elderly. Retrieved from: http://healthydebate.ca/2014/12/topic/managing-chronic-diseases/medication-safety  
4. Accreditation Canada. (2013). Acute care for elders (ACE) unit – medicine. Retrieved from: https://www.accreditation.ca/acute-care-elders-ace-unit-%E2%80%93-medicine  

Another new face

Hi blog readers!

My name is Cassandra Turchet. I am the new fourth-year pharmacy student doing a rotation at mdBriefCase. Like my predecessors, I will be developing an eNewsletter (on the topic of frailty in the elderly), an FAQ module (on the topic of migraines), and critically appraising one of the rxBriefCase programs. 

I have a strong interest in geriatrics and cardiology and hope to pursue these topics further during my few short weeks here.

The culture at mdBriefCase so far is very welcoming and made for a great first couple of days. This being the first rotation of my fourth year brought a mixed bag of emotions: a little anxiety, a few nerves, and even more excitement. I look forward to learning more about the great things that mdBriefCase has to offer and working with a wide variety of people throughout the process! 

Stay tuned for more blog posts on my experiences, updates on my projects, and maybe a little something about my love for the elderly! 

The Colourful World of Medical Writing

Stop # 1: mdBriefCase Group Inc

I cannot believe that I only have a few days left here! I’ve had such an incredible experience, and I am extremely appreciative of the skill set I have started to develop over these last 5 weeks.

In my final blog, I would like to share with you what I’ve learned about medical writing. I am extremely proud of the work I have produced. There is an enormous difference in the writing quality of the first draft compared to the final copy. I am very, very, very thankful for the team’s support and feedback throughout this process.

My rxPassport eNewsletter (check your inbox!) is entitled: “What C.A.R.E. can you provide to help prevent Colorectal Cancer?” The eNewsletter highlights:      

• The scope of the issue
• Colorectal cancer risk factors
• Methods of targeting modifiable risk factors, with a focus on colorectal cancer screening
• The C.A.R.E Model

“It’s your newsletter. The freedom is yours. Pick a topic you feel passionate about, and take it in any direction you wish. Make it meaningful and make it practical.”

In so many words, that’s the message that was relayed to me from my pharmacy mentor on Day 3 of my rotation, which underpinned my entire writing process. As I thought about what topic to choose, I was propelled into the world of oncology. My grandmother lost her battle to leukemia last year. Being a part of her journey inspired me to make a positive impact on the journey of others. 

As I began to write my eNewsletter, I really thought about that key pieces of information I wanted to include. 

Information overload was a term I frequently used in pharmacy school, when too much information was provided to me at once. Needless to say, this was not conducive to effective learning. My goal was to write an eNewsletter containing carefully selected information. I integrated links to external sources, should the reader desire additional detail. My hope was that this would allow the reader to take away valuable and practical information which can be integrated into their current practice. The freedom of medical writing allowed me to do just that.

Yes, every therapeutic area has core “facts” which makes medical writing “science”. However, what makes it “art” is how you choose to present these facts. As a student, I found the easiest way to solidify learning was to link related ideas together in a creative way. Mnemonic techniques help our brain encode and recall important information by allowing more efficient internalization ¹. So I decided to create an acronym for the reader, to help solidify my overarching objective. 

Pharmacists can play an extraordinary role in colorectal cancer prevention through the C.A.R.E. that they can provide to their patients:

• Communicate the importance of colorectal cancer screening
• Assess the patient’s colorectal cancer risk level
• Relay information on ways to reduce this risk
• Educate on screening procedures to alleviate anxiety and dispel myths

In summary, I cannot express how wonderful this rotation has been. Not only have I learned about the role of pharmacists’ in medical writing, I’ve developed another style of learning, which is highly transferable across all pharmacy practice domains.

I’m beginning to look at therapeutic areas through a different lens; one that requires careful consideration of the facts. By extracting and presenting key pieces of information, the recipient (patient or coworker) will be in a much better position to effectively internalize this information

Thank you mdBriefCase!

References

1. http://psychcentral.com/lib/memory-and-mnemonic-devices/ 

Sun, Sand, Sea along with Hepatitis A and B? A Brief Overview of Travel Medicine

So far I have written two blogs, both outlining my personal experience at mdBriefCase. This blog is a little different. I thought it would be nice to review an rxBriefCase program, and present highlights from a pharmacy student's perspective. By no means is this blog intended to be a comprehensive report on travel medicine; it’s simply just a bird’s eye view of the topic (no pun intended). 

After searching through the program directory, I decided to explore Stay Safe, Play Safe: Topics in Travel Medicine.

Why? Well, for a couple of reasons.

Firstly, I have the travel bug. So at a personal level, this topic seemed relevant and interesting. My most memorable travel destination thus far would have to be the beautiful island of Tenerife. Check it out! 

Secondly, as a future pharmacist, I believe it is very important to have knowledge in the area of travel medicine. As one of the most accessible health care professionals, pharmacists are likely the first to receive questions from patients related to their travel health. As pharmacists, it is even more important to know where to find travel health information. Not only is this body of knowledge quite cumbersome, travel advisory warnings are dynamic over time. 

Overview of Travel Health

In 2012, Canadians made about 1.6 million overnight trips to Mexico, over 1 million trips to Cuba and over 900,000 trips to the Dominican Republic ¹. However, only 4% of those Canadians conducted online research for travel advisory warnings ². Compare that to the 35% who researched things to do while at their destination ². Shocking!

Travelers are often quick to assume that there is little to no risk of infectious disease associated with travel to popular vacation destinations. However it is important to remember that in addition to turtles, dolphins and birds of paradise…bacteria, viruses and parasites are all the more present.

Pre-Travel Health Assessment

I’m pretty confident in stating that all pharmacy students love mnemonics! Personally, I find them useful as mini mental check-lists, guiding me through patient interactions.

A pre-travel health assessment contains three parts…so commit these to memory and you will ACE every patient encounter! 

1. Assessment of the traveler’s risk: through collection of detailed information related to the traveler’s health status AND the travel itinerary
2. Communication of this risk to the traveler
3. Execution of a travel plan: including information on ways to reduce risk, as well as manage undesirable outcomes should they occur

The Centers for Disease Control and Prevention has excellent summary tables which can help guide your pre-travel health risk assessment.

Recommended Vaccines

Vaccines can be divided into three categories. Remember them as the 3 R’s: 

1. Routine:  recommended for all Canadians irrespective of travel, according to provincially authorized schedules
2. Recommended: specifically recommended based on the particular travel destination, the details of the travel itinerary and the traveler’s health status
3. Required: the traveler must have these vaccines in order to be granted entry into the visiting country

As mentioned, recommended vaccines are advised to travelers in part, based on the particular travel location. For example, you wouldn't recommend a patient receive a typhoid vaccine if the destination they are travelling to is not endemic to typhoid fever. 

Two excellent sources of information outlining country specific travel advisories are:

1. The World Health Organization International Travel and Health Interactive Map
2. The Government of Canada's travel section outlining Country Travel Advice and Advisories

TIP: Conducting a pre-travel health assessment provides a window of opportunity to help identify patients whose routine vaccinations are not up-to-date. Capitalize on this time to provide information on routine vaccination schedules, which can be found on the Public Health Agency of Canada's website. There are also great apps (i.e. Immunize Canada) which are available to help your patients keep track of their immunization record...much more convenient than little pocket cards which frequently get misplaced.

Hepatitis A and Hepatitis B

Hepatitis A and B are considered travel concerns in many popular tourist destinations, yet they are often overlooked as such by travelers. Therefore, I have decided to provide some information on ways to decrease the risk of contracting this virus during travel. 

Hepatitis A ³

One of the ways in which Hepatitis A can be transmitted is through intake of food or water which has been contaminated with the virus. Some food and water precautionary tips include:

• Encourage:
• eating freshly cooked food that is served hot
• drinking water from sealed water bottles or drinking carbonated water
• Avoid:
• eating from buffets (especially outdoors, where food is exposed to milder temperatures for an extended period of time)
• eating foods washed with non-portable water (i.e. unpeeled raw fruits and vegetables)
• consuming raw or under-cooked meat and/or seafood
• drinking non-portable water (i.e. water that is not in a sealed bottle) 

Vaccination becomes paramount in order to prevent Hepatitis A. There are three monovalent vaccines available in Canada; the Canadian Immunization Guide provides dosages and schedules.

Hepatitis B ³

Hepatitis B is transmitted through direct or indirect contact with infected blood or body fluids. To reduce the risk of Hepatitis B, it is very important to avoid partaking in risky behaviours such as:

• unprotected sexual contact
• sharing of needles and/or equipment
• cosmetic procedures using improperly sterilized tools (i.e. tattooing, piercing, manicuring)

Similar to Hepatitis A, vaccination becomes paramount in order to prevent contraction. There are two monovalent vaccines available in Canada; the Canadian Immunization Guide provides dosages and schedules.

Don't Forget About Mosquitoes

We know too well the struggle of enjoying a peaceful evening outside, while trying to swat away mosquitoes. However, in addition to being annoying, they can also carry serious health risks.

Chikung-whata? Chikungunya!

The Chikungunya virus is carried by very aggressive daytime biting mosquitoes (Aedes mosquito) and symptoms such as fever and polyarthritis typically appear within 3 to 7 days after the bite ³.The virus was first identified in Tanzania in the early 1950s ⁴. It can now be identified in nearly 40 countries, which means that even travelers to the Caribbean, Central or South America, Mexico and the United States, should be educated on mosquito avoidance tips ^4,5. 

Did you know? The recent outbreak of 2013 caused more than 1,600 travelers to return to the United States with chikungunya fever ⁵. 

Mosquito Avoidance Tips ³

Physical Barriers

• If your working or accommodations are outdoors, protect your area with screen and/or net coverings on all doors and windows
• If your working or accommodations are indoors, keep the room cool with air conditioning, as mosquitoes do not prefer cooler temperatures
• If you will be outdoors after dusk, wear light coloured clothing (i.e. white or beige), as mosquitoes are more attracted to bright colours

Chemical Barriers

• Use mosquito repellents (i.e. DEET 30%)

TIP: If your patient is applying both sunscreen and mosquito repellent on their skin, encourage them to apply the sunscreen first, wait 15 minutes, then apply the mosquito repellent. This allows for maximum sun protection and minimum mosquito repellent absorption.

One Final Word...Vaccine Hesitancy

The topic of vaccination always receives a lot of media attention. Many individuals receive unsubstantiated claims which have been disseminated by social media. It is our task, as health care professionals, to dispel these false reports while continuing to show empathy in responding to patient concerns. The Canadian Immunization Guide provides great tips on Principles of Effective Communication. 

References

1.     Statistics Canada. Travel by Canadians to foreign countries, top 15 countries visited (2012). Available at:http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/arts37a-eng.htm. Accessed June 1, 2015.

2.     EKOS Research Associated Inc. Survey of Travellers on Key Issues Relating to Travel Health. (2008). Accessed June 1, 2015. http://www.ekospolitics.com/articles/0688.pdf

3.     Centres for Disease Control. CDC Health Information for International Travel 2014. The Yellow Book. Available at http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014. Accessed June 1, 2015.

4.     World Health Organization. Chikungunya. Available at http://www.who.int/denguecontrol/arbo-viral/other_arboviral_chikungunya/en/. Accessed June 1, 2015.

5.     Centres for Disease Control. CDC Newsroom: Chikungunya Outbreak Progresses in Caribbean, Central and South America. Available at http://www.cdc.gov/media/releases/2014/p1106-chikungunya-outbreak.html. Accessed June 1, 2015

Check-in

Time for the mid-point check-in!

Have I mastered the art of Reflective Practice since my last blog? Not entirely, but that is a skill which is constantly being refined throughout life..

Thanks to the warm welcome of the staff, I have become more familiar with my environment. They have also provided me with presentations highlighting their scope of work. 

I have also delved into working on my own projects:

1. Critical Appraisal of "When and How to Start and Intensify Insulin in your patients withType 2 Diabetes"
2. Content Development for an eNewsletter on the importance of mitigating risk factors of colorectal cancer, with a focus on screening (watch for it in your inbox!)
3. medSchoolForYou questions and answers surrounding smoking cessation

Having a minor in philosophy, I assumed that medical writing would be easy. However, I've come to realize it is COMPLETELY different from philosophical writing. I’ve learned that my writing needs to be less thought provoking or open to interpretation, and  more targeted or practical. The reader should be able to take away tangible information and apply it to their current practice.

In the weeks ahead, the "fun" part begins…editing! I cannot help but recall an image of my high school essay covered in red marks. Somehow I turned that colourful sheet back into black ink on a white background. After 7 years of university, we come full circle, and time to do it again! I look forward to the challenge, but even more so to the end result!

Reflective Practice

The traditional learning environment of pharmacy school has come to an end. Gone are the days of didactic lectures.

As I begin my first Advanced Pharmacy Practice Experience (APPE) at mdBriefCase, I quickly realized that the working environment requires learning from others in a different way. In order to succeed, I must adopt the skill of Reflective Practice.

So, what is Reflective Practice and why is it important? Reflective Practice involves “paying critical attention to the meaning behind everyday actions, leading to developmental insights” (Bolton, 2010).  In a traditional educational environment, I found reflective practice to be less important, as I essentially downloaded the information that was presented to me. However, the professional working environment is cluttered with ambiguity. If you combine this with the human propensity to “feel first” and “think after”, you have a recipe for disaster. As such, Reflective Practice is essential in order to mentally organize my environment, and more importantly learn from it.

Now that I have explained the importance behind Reflective Practice, how am I going to actually perform it?  One model that has been proposed is Gibbs’ model of reflection (1988). It begins with a description of an event that has happened, and the associated thoughts and feelings during that event. This is followed by an evaluation of the experience, outlining both the positive and negative aspects. Through evaluation, analyzing the situation and attempting to make sense of what happened, will guide me to a conclusion and subsequent action plan. At this point, I can begin to reflect on what else I could have done in the same situation, what I can do if the situation happens again in the future, and what I can learn and take away from this experience.

My personal developmental challenge: make the leap from practicing reflection, to reflective practice. Reflect in such a way that will bring me new found knowledge and understanding.

References

1. Bolton, G. Reflective Practice: Writing and Professional Development (3^rd Edition). Los Angeles: Sage, 2010.
2. Austin, Zubin. “Reflective Practice.” University of Toronto, Leslie L. Dan Faculty of Pharmacy. Toronto, Ontario. 04. May 2015.  Lecture.