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5 posts from November 2013

11/21/2013

Occupational Therapy Students Publish CAPs

We have 12 CAP Publications!


The American Occupational Therapy Association (AOTA), through its Evidence Exchange database, calls for papers on a regular basis. AOTA recently expanded its body of evidence to include Critically Appraised Papers (CAPs). CAPs are article critiques that assist practitioners in applying research to practice. 

AOTA published 12 CAPs completed by USciences students in Spring 2013. 

You can see them here: CAP Publications

Recognition of scholarship goes out to the following occupational therapy students:

  • Robyn Blankenhagen
  • Jeanne Brooks
  • Danielle Cooney
  • Mary Eblacker
  • Carolyn Edwards
  • Daniel Fichter
  • Erin Livingston
  • Stephanie McAllister
  • Paula Ortiz-Lozano
  • Lauren Six
  • Palak Sutaria
  • Seoyoung Yoon

Special recognition also goes to faculty advisors Dr. Colleen Maher, OTR/L, CHT, OTD and Dr. Rochelle Mendonca, PhD, OTR/L

11/20/2013

USciences' Karin Richards Becomes a Newly Certified Vivobarefoot Running Coach

This interview was conducted by Reginald Myers, a public relations intern at the University.

KarinIn the sport of running, where a large majority of participants suffer from various injuries due to conventional but poor running technique, an old art is resurfacing. The popularity of minimalist or “barefoot running” is on the rise. This style helps runners achieve a quicker turnover since there is less time between strides because runners are running on their forefoot, which in turn leads to a lower rate of injury.  Runners participating in barefoot running wear no shoes or low cushion shoes, causing the brain to instruct the feet to strike on the forefoot instead of the heel.

There are currently only 58 certified Vivobarefoot running coaches in the world, and one of them is USciences’ Karin Richards, interim chair of the Department of Kinesiology and program director of health sciences, as well as an American Council on Exercise (ACE) certified personal trainer and group exercise instructor. I caught up with Richards to learn more about the practice as well as to discuss her recent achievement and future plans.


1.    How did you learn about barefoot running, and how does barefoot running differ from conventional running?

I knew about the concept of barefoot running, but I didn’t start seriously investigating it until the ACE, which has an educational partnership with the Department of Kinesiology, announced it was looking for candidates to be certified as Biomechanically Correct Running Coaches. Conventional running is performed with a cushioned shoe to decrease shock absorption. Most conventional “untrained” runners run with a heel strike, which slows the turnover rate and causes as many as 80% of runners to suffer injuries (van Gent et al, 2010). Cushioned shoes can also lead to Morton’s neuroma and bunions (Saxby, 2013).  Barefoot or minimalist running offers a forefoot strike with shorter strides and quicker turnover of the feet.

2.    What piqued your interest in barefoot running?

Aside from wanting to become a coach, I was ready to explore something new. Being a marathon runner myself, I have suffered many of the common running injuries including tight Iliotibial band syndrome (ITBS), runner’s knee, partial tear of the soleus, etc. I knew heel strikes are actually “breaking” motions, which are counterproductive when running. Barefoot running changes the posture and rhythm of the runner to improve the efficiency, relaxation and enjoyment of running.

3.    How much research did you do before officially making the decision?

I did a significant amount of research. However, the intense, hands-on training and education I received in San Diego from Vivobarefoot backed by distinguished Harvard professors such as Dan Lieberman, professionals Lee Saxby, the “father” of barefoot running, and Ben Le Vesconte solidified my desire to pursue Barefoot Coaching. I knew I had to pursue it, especially since the data was backed by distinguished Harvard professors such as Dan Lieberman.

4.    How long have you been certified?

I became certified on Saturday, Sept. 28 as a Master Trainer for the American Council on Exercise for Biomechanically Correct Running Technique, and then on Nov. 6 as a Vivobarefoot Coach.

5.    What was the process to becoming a coach like?

The process involved five very intense, eight-hour days and hands-on educational and participatory sessions. Coaches “master the skill of barefoot running, learn proper techniques to diagnose and correct running form, and undergo extensive training in biomechanics to comprehend the physical and mental components” (Vivobarefoot Training Clinic, 2013). We learned everything about barefoot running including the correct running technique, kinetics and kinematics of running, jumping, squatting, and all of the other exercises involved in barefoot running. At the end, all of the participants have to pass a rigorous written and practical exam to get certified.

6.    What do you plan to do now since you are certified? Do you plan to do anything at the University involving barefoot running?

I will be teaching at training clinics in the Northeast through ACE to educate other runners in the proper biomechanics of running. At the University, I will be conducting research with our students and sports teams.

7.    Where do you see barefoot running in one year? Where do you see it in five?

Barefoot running will continue to increase in popularity as it is a simple and inexpensive activity. Starting with a 5K race to a marathon, running is a sport everyone can do.  As Vivobarefoot coach Lee Saxby states, “Running is a skill…and humans were made for endurance running.”


To learn more about barefoot running, visit Vivobarefoot's website or the training clinic website.

Why Don’t You Take Your Medication? Part II

In our previous blog, we delved into how fear and confusion can negatively impact medication adherence. Now we will examine how health beliefs and finances can influence patients and a service we as pharmacists can provide to improve outcomes.

Health Beliefs. A difficult barrier pharmacists must overcome to improve adherence is the health beliefs our patients have towards medications, their disease states, and health care in general. A study examined how health beliefs impacted medication adherence in patients being treated for HIV/AIDs and discovered that those patients who were asymptomatic were more likely to be non-adherent, while those who experienced negative effects from their disease were more likely to be adherent to avoid such negative effects. Pharmacists must stress that even if a patients are feeling well and does not physically feel sick, they must continue to take their medications. This challenge arises with disease states like hypertension or mental illness where the person may feel fine after taking their medication for a while and then discontinue there medications thinking that they are now cured.

Financial Constraints. An estimated 14 million Americans with chronic medical conditions cannot afford their medications. Doctors may not consider the price of a drug when prescribing and as pharmacists, we are at the point of care when a patient must make the difficult decision to pay for this month’s supply of medication or food for their family. Pharmacists must take due diligence to discover whether their patients are adherent as result of financial hardship. It can be a difficult subject to approach, but there are some questions that can be asked to indirectly ascertain this information; examples of such questions include: “Are there circumstances that make it difficult to fill your prescriptions?" or "Are you testing blood glucose less often because you're trying to conserve supplies?" If it is discovered that a patient cannot afford their prescriptions, we as pharmacists could contact the prescribing physician and request a generic alternative or contact the pharmaceutical company for possible discount/assistance programs. Medication adherence is a significant barrier to achieving positive therapeutic outcomes in our patients, but there is a tool that has been developed over the last several years that will make the task of overcoming these barriers much more attainable.

Medication therapy management (MTM) was developed in response to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. MTM provides pharmacists the unique opportunity to be the ‘medication expert’ and improve patient adherence, and thus outcomes. With pharmacists now becoming more integral in the health care team, and being able to interact with patents in a more prominent role, we are now in a great position to correct the factors that interfere with a patient being adherent. By using tools like the interview a pharmacist can glean valuable information from their patient and make adjustments when necessary before the patient is potentially harmed. Communication and information gathering are valuable in improving overall outcomes and MTM gives pharmacists the necessary means to not only communicate but do something about it.

It is our role as pharmacists to communicate, educate, and in turn ensure that our patients take their medications as prescribed. We’ve discussed why a patient might not take their medications and how to counter such obstacles to adherence as well as the ever evolving role of MTM in healthcare.

Mackenzie F. Blair, PharmD ‘15

11/13/2013

Why Don’t You Take Your Medication?

It is a question that thousands of pharmacists and health care professionals ask their patients on an almost constant basis; but many times this inquiry falls on deaf ears and the patient remains noncompliant. It is a frustrating reality that approximately 50% of patients are non-adherent to their medication regimens. It is common knowledge that these patients can’t achieve their therapeutic goals if they don’t take their medications as prescribed and adherence is the key mediator between medical practice and patient outcomes. As pharmacists, we should take a closer look at WHY our patients don’t take their medications, and what we can do about it.

Fear:   While modern medicine can save lives and cure disease, the fears many have towards medications can prevent these people from being helped. Fear is a powerful influencer and it can manifest itself in many ways. A patient could be afraid of a startling side effect, the risk of drug addiction, fear of needles, or even the negative stigma that taking a medication has in society as is the case for drugs associated with mental illnesses. Culture can even have an impact if the prescribed medicine is in contradiction to the patient’s religious beliefs.. As pharmacists, it is important for us to interact with patients and assess their attitude towards their therapeutic plan. It is vital to identify fears they may have and help alleviate their anxiety or hesitation. For example, if a patient is frightened of a rare side effect, framing the risk of developing the side effect with real data may reduce the fear.  If the patient has a phobia of needles it might be possible to alter the therapy so that injections or needles can be avoided. While it is unrealistic that we can calm all the fears patients may have, it is possible that with proper communication and education, many of these fears can be minimized.

Confusion and poor health literacy:   "Take two tablets by mouth twice daily." To a trained pharmacist or student like myself, those instructions appear clear and concise, yet a study revealed that nearly half of all people who read them misunderstood them. And with 81% of older adults taking one medication with 29% of them using five or more prescription medications, confusion can easily arise from multiple drug regimens and multiple disease states. It is the pharmacist’s responsibility to limit confusion as much as possible. This can be achieved by writing simple instructions on prescription labels and communicating with the patient in a counseling session. Nothing should be assumed and every aspect of the medication should be addressed with the patient. It should be stressed to the patient that there is no such thing as a stupid question. It is a fact that a poor patient-pharmacist/physician relationship hurts the chances of patients actually taking their medicine as prescribed.

Fear and confusion are only a few of the barriers that pharmacists encounter when trying to improve medication adherence. In the next blog we will examine and discuss health beliefs as a barrier to medication adherence and what we as pharmacists can do to improve outcomes.

Mackenzie F. Blair, PharmD ‘15

11/08/2013

Obtaining Health Insurance that Isn't Understood Using a System that Isn't Working - And the Situation Will Get Worse if there is not Compromise!

By Dr. Daniel A. Hussar, the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.


The "old" health care system had serious deficiencies. Almost every participant (e.g., pharmaceutical companies, hospitals, physicians, pharmacists) could determine the prices to be charged for products and services and expect to be compensated in the amounts requested. However, there were valid questions as to whether this health-care model was financially sustainable. In addition, there was little or no attention given to assessing the quality of health care provided and the outcomes for patients.

The "new" health care system (i.e., the Affordable Care Act [Obamacare]) that is being implemented has serious deficiencies. The health-care providers who provide services, care, and products for patients have little participation or influence in the determination of the scope and terms of the program or the compensation they will be provided. Instead, government agencies, insurance companies, and organizations such as pharmacy benefit managers are making these decisions. The scope and services of the new system raise valid questions as to whether this health-care model is financially sustainable. In addition, there is inadequate attention given to assuring the quality of health care provided and the outcomes for patients.

The old and new systems are markedly different, yet many of the questions and concerns are very similar. Is progress really being made or have we just replaced one set of problems with other problems of equal or greater importance? I do not defend or advocate the return of the old system. However, the new system is seriously flawed and will collapse as a consequence of the problems and concerns with which it is burdened unless major changes are made. We can and must do better!

Continuing concerns: The current problems that individuals have encountered in attempting to learn more about the health-care benefit options and to choose a particular type of coverage are just the latest of a long series of concerns regarding the parameters and implementation of Obamacare. Indeed, the secrecy surrounding the development and approval of the legislation that has enabled the changes in the health care system was an early indicator of the problems ahead (Please see my editorial, "Health Care Reform - Let's Start Over and Do It Right!" in the January 2010 issue of The Pharmacist Activist).

The current problems have, however, greatly increased the awareness of the public of the challenges that exist. These challenges include, but are not limited to, employers reducing the number of full-time positions and increasing the number of part-time positions; decisions of employers to change health benefit programs for employees and retirees; insurance companies canceling policies; the President making changes in the terms and implementation of the program without accompanying legislative authority; whether individuals can continue to use the same physicians and pharmacies; other terms of the health coverage options; access to needed information using the online network; and the cost of the coverage options.

Positives of Obamacare: The sharp differences of opinion that exist regarding certain provisions of Obamacare have polarized discussions and precluded consideration of areas of agreement and constructive change. I would identify the following as components of the legislation for which I feel there is strong support:

  • The opportunity for many individuals who do not currently have health insurance to obtain such coverage at an affordable cost or, if necessary, have the coverage subsidized.
  • The provision that individuals with pre-existing conditions would be able to obtain health insurance at an affordable cost.
  • The increased age at which young adults are permitted to be included in their parents' health insurance coverage.
I would like to think that a focus on these areas of general agreement could be a starting point for constructive discussion of the issues on which there is disagreement. However, the acrimony and polarization that have resulted from the differing philosophical, ideological, and political positions on these issues, make it difficult to be optimistic that agreement regarding a health care system can be reached.

Is compromise possible?: To date, it has not been possible to reconcile the two markedly different positions regarding Obamacare. Advocates extol the benefits and claim the authority of the legislation that established it. Opponents have such strong concerns that they strive to defund the program and/or repeal the legislation. There is seemingly no hope for compromise. However, this impasse is a "lose-lose" situation for both advocates and opponents, Democrats and Republicans.

Advocates for Obamacare have the position of strength and some feel there is no need for any compromise. But hardly a day goes by without an announcement that a large employer is making substantial changes in its health-care benefits or that an insurance company is canceling thousands of policies. Does anyone really think that these changes will be of greater benefit for employees and/or individual policy holders? Of course not! The employers and insurance companies are making these changes to protect their own interests.

The implementation of the early phases of Obamacare has revealed serious conceptual and operational flaws and limitations. And consumers are not yet even close to learning the options regarding health care providers and services and the cost of the insurance coverage. In my opinion, there will be additional problems that will be worse than the ones that are recognized now. The problems and challenges may be of a magnitude that the program will fail. Advocates for the program must be willing to compromise.

Opponents of Obamacare must also be willing to compromise. Their criticisms of the program have not been accompanied by suggested revisions or recommendations of viable alternatives. Their position would maintain the present system, and that should no longer be considered acceptable. There is an important need for progressive changes in the provision of health care services and insurance, and compromise will be essential for the attainment of this goal.

I would like to think that there are legislators who have the personal character to rise above partisan politics and provide bipartisan leadership for the Congress and Administration in forging a compromise on these issues. To not do so risks the failure of Obamacare and the possible development of alternative health care systems and insurance coverage that are even more problematic and divisive.

Where are the health care providers?: Health care services and insurance coverage for such are of the greatest importance for the recipients of these services. But these issues are also of great importance for the providers of health care services (e.g., pharmacists, physicians, nurses). To what extent have health care providers and our professional organizations been involved in the development and implementation of Obamacare, as well as active participants in the discussion/debate regarding the benefits and deficiencies of the program? Our involvement and influence have been limited at best. Some would suggest nonexistent or ineffective.

Our organizations of health professionals must do more! We are in the best position to identify the parameters of a program that would assure the effectiveness, safety, and quality of health care. We can work effectively with those with administrative and financial expertise in developing those components of the program. However, experience has demonstrated that when health professionals are not involved and/or effective in the development of health care benefit programs, important decisions are made by others and we must cope with the consequences.

If the current impasse among our legislators continues and a compromise is not reached, there could be an even greater opportunity for our organizations of health professionals to fill the void with progressive recommendations.

Even if the legislators do reach a compromise, it is essential that our organizations become more involved, both independently and in collaboration. To address just one of the important issues, I recommend that the American Pharmacists Association and the American Medical Association work together to introduce and seek support for a provision that patients have freedom of choice in selecting their physicians and pharmacies in health care programs that are funded by the government. I am certain that there would be strong public support for this recommendation.

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