Magister Pharmaceuticae - MPharm / Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinic based training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. Aims The primary and secondary aims of the study were to: • Assess current practice patterns of TBI/HIV at primary healthcare clinics in the Western Cape, • Assess the need for a clinic-based TBIHIV training among final year pharmacy students in UWC. Objectives To achieve the primary aim the researcher; 1. Conducted a baseline study at Ravensmead Community Health Centre(CHC) to assess current TBIHIV practice among HCP's and co-infected patients, 2. Assessed current practice patterns at Delft South ARV clinic and Elsies River TB clinic (pre-intervention), 3. Designed and implemented a clinic-based TBIHIV intervention tool for potential use by pharmacists at Delft South and Elsies River clinics (intervention phase), 4. Evaluated patient receptivity of the intervention tool amongst patients at Delft South and Elsies River clinics (post-intervention phase). Results and discussion Findings from the baseline study indicate the need for involvement of a trained pharmacist in TB and HIV management. Even though three-quarters (77.8%; 14) of the patients preferred receiving their TB information from the clinic nurse, almost two-thirds (63.2%; 12) of the patients believed that pharmacists assisted with their treatment provision. Patient data obtained from the clinic record card showed that almost two-thirds of the patients reported that they had experienced side effects (64.4%); the therapy of more than one-quarter (26.4%) showed drug-drug interactions and onset of adverse effects (1.1 %). Post-intervention, the data showed that patients' viewed the pharmacist's role more positively. Almost all responses (97.5%; 39) favoured the services of a pharmacist in the clinic. In conclusion, findings from the post-intervention patient study clearly underpin that a clinic-based role for the pharmacist is imminent. All seven (100%) of the experimental students passed the assessment and had marks in the range between 26 and 45 and more than three-quarters (78.4 %; 29) of the control students passed with marks within this range. Conclusion A trained pharmacist would be competent to work alongside nursing staff in optimizing care provision in the clinical management of TB and HIV in patients. The existing clinic based TB/HIV programme could be supplemented with theoretical concepts in the final year of undergraduate pharmacy training.

Safety net clinics across the country struggle with a lack of resources to tackle the needs presented. Screening programs set up for children and elderly have proven to be effective in triaging need, prioritizing care, and maximizing resources. These programs do not currently exist for working uninsured adults. Research was initiated to answer the question: Does the screening process improve patient care for the community clinic? During a 6-week pilot study a licensed dental hygienist performed 30 screenings in the community clinic setting. Findings were recorded and coded according to patient’s level of need identified. Pre- and posttest data for patient care factors were attained. Statistical tests showed a significant effect on patient care factors. While the evidence existed to support the implementation of screening, more research would quantify the specific impact on this population.

The purpose of this study was to perform an indoor air quality (IAQ) investigation at the Center for Applied Reproductive Science (CARS) to assess whether VOCs exist at levels dangerous to embryo. Formaldehyde, n-hexane, benzene, and styrene concentrations were measured at six locations. Formaldehyde concentrations were comparable to office and residential indoor air. N-hexane, benzene, and styrene were not detected. In addition, acetaldehyde, ethanol, and isopropyl alcohol were detected. IAQ parameters (carbon dioxide, temperature, humidity, pressure, and particulates) were measured at 22 sites monthly for one year. Temperature and humidity readings were within Environmental Protection Agency recommendations. Particulate concentrations were below Occupational Safety and Health Administration standards. Pressure readings indicated the facility was under a negative pressure. Carbon dioxide concentrations exceeded recommendations established by American Society for Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE). Recommendations include assessing air intakes to assure dampers are adjusted to allow 15 ft3/min/person of fresh air established by ASHRAE.

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The aim of this presentation is to describe the development, implementation, and one-year outcomes of a team-delivered, evidence-based protocol to identify and address postpartum depression in a pediatric primary care clinic. The presentation will include: 1) a description of the development process based on implementation science, 2) engaging activities for the audience such as a video illustration of the protocol itself, and providing an opportunity to learn and practice administering the Ecomap, an evidence-based assessment for social determinants of health, and 3) data from a records review showing outcomes. Additionally, this presentation will illuminate barriers and facilitators at varying levels to team-based healthcare in general and within this specific clinic. At the conclusion of this presentation, participants will be able to: Explain the inception and development of a stepped-care protocol set within a pediatric primary care clinic as conceptualized by the Consolidated Framework for Implementation Research. Describe the function and utility of an Ecomap to understand a family's social determinants of health. Apply the RE-AIM model to evaluate a clinical intervention implemented within an interdisciplinary pediatric primary care clinic.

The birth of a child can be a stressful time accompanied by an array of emotions including depression. Postpartum depression (PPD) affects approximately 1 out of 7 new mothers. It can affect a new mother’s sleep, appetite, mood, and bond with her baby, as well as impact child development and well-being, if left untreated. Beginning in March, 2013, ETSU Pediatrics deployed an evidence based screening tool, the Edinburgh Postpartum Depression Scale (EPDS), to identify mothers of newborns with PPD. Mothers attending well-visits with their baby from birth to six months of age who score above an eight on the screener are provided with education about PPD, referrals, brief on-site counseling, and phone-call follow- up. Many of these mothers express concerns about resources and social factors that impact their health and mood. An Ecomap is a visual representation of strengths and stressors of a patient’s relationship with their environment, social supports, and resources. The awareness of a patient’s relationships and support within their environment can be useful for assessment of needs and intervention on their behalf. The objective of this study is to pilot the utility of the Ecomap to illuminate common stressors of the social determinants contributing to or exacerbating symptoms of PPD, in order to provide brief solution-focused interventions and referrals to alleviate the stressors. Although Ecomaps have been utilized in clinic settings, there is a lack of research on their effectiveness in identifying social determinants of mothers with PPD. We hypothesized that implementing the Ecomap with mothers that present with an elevated EPDS score will identify a significant number of social determinates that are actionable by social workers on staff. When a mother presented with a score of eight or above on the EPDS administered during a well-child check, the social work staff completed an Ecomap with mothers via a warm handoff. The social determinants identified on the Ecomaps were then categorized and counted to determine biggest social needs of mothers at the ETSU Pediatric clinic from 11/13/2015 through 02/28/2016. The clinic completed 27 ecomaps with mothers who scored 7 or above at well child checks. Transportation and mental health services presented as the most common domains that social work was able to effectively act to rectify. Overall, the utilization of the Ecomap was successful in identifying social determinants contributing to or exacerbating symptoms of PPD. Addressing these stressors through resource allocation and brief solution-focused therapies may contribute to a reduction of PPD symptoms. Future research, therefore, should examine whether addressing these social stressors reduces symptoms of PPD above and beyond targeting depressive symptoms alone in mothers presenting at pediatric clinics.

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A nurse-managed clinic in Northeast Tennessee that mainly serves unstably housed patients launched a process improvement project to evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) implementation and use. These findings could guide future SBIRT efforts among vulnerable groups.

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