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!