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Rockich-Winston N, Robinson A, Arif SA, Steenhof N, Kellar J. The Influence of Intersectionality on Professional Identity Formation among Underrepresented Pharmacy Students. Am J Pharm Educ 2023; 87:100108. [PMID: 37597916 DOI: 10.1016/j.ajpe.2023.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The objective of this study is to explore professional identity formation (PIF) among student pharmacists from underrepresented groups (URGs). METHODS In this qualitative study, 15 student pharmacists from the University of Georgia and Midwestern University Colleges of Pharmacy were recruited for interviews to explore the influence of intersectionality of race, ethnicity, and gender on PIF. Interview data were analyzed using constructivist grounded theory to identify themes and then further analyzed using Crenshaw's theory of intersectionality, namely structural, political, and representational intersectionality. RESULTS Intersectionality of identities created situations where participants expressed advantages belonging to certain social categories, while simultaneously being disadvantaged belonging to other social categories. This awareness led to strategies to overcome these collective obstacles for themselves and their communities. Participants then described ways to shift perceptions of how society depicts pharmacists and the pharmacy profession. The results depict these processes and how intersectionality influences PIF for URG student pharmacists. CONCLUSION The sociocultural aspects of race, ethnicity, and gender influence the PIF of student pharmacists who belong to URGs. Intersectionality helps us better understand the ways in which inequality compounds itself, and this results in URG student pharmacists creating opportunities for belongingness and representation. Resultantly, URGs create opportunities for inclusivity and representation. To continue to facilitate this it is essential for educators and university systems to promote ways to foster and incorporate PIF in student pharmacists.
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Affiliation(s)
| | | | - Sally A Arif
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | - Naomi Steenhof
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
| | - Jamie Kellar
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
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Sihota A, Barrett B, Bonell C, Chehade A, Dhaliwal J, Kani M, Kellar J, Kwong C, Ravinatarajan P, Schwartz KL, Smith S, Thiffault J, Woit C, Vaisman A. SARS-CoV-2 rapid diagnostic testing: Canadian consensus guidance for pharmacists. Can Pharm J (Ott) 2023; 156:128-136. [PMID: 37197090 PMCID: PMC10116221 DOI: 10.1177/17151635231164631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
| | - Brett Barrett
- School of Pharmacy, University of Waterloo and
Grand River Hospital, Kitchener, Ontario
| | - Cameron Bonell
- Interior Health Authority and Faculty of
Pharmaceutical Sciences, University of British Columbia, Kelowna, British
Columbia
| | | | | | | | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of
Toronto, Toronto, Ontario
| | - Conny Kwong
- Rexall Pharmacy Group Ltd., Winnipeg,
Manitoba
| | | | - Kevin L. Schwartz
- Dalla Lana School of Public Health, University
of Toronto, Toronto, Ontario
- Division of Infectious Diseases, Unity Health
Toronto, St. Joseph’s Health Centre, Toronto, Ontario
| | | | | | | | - Alon Vaisman
- Department of Medicine, University of Toronto,
Toronto, Ontario
- Division of Infectious Diseases, University
Health Network, Toronto, Ontario
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Kellar J, Martimianakis MA, van der Vleuten CPM, Oude Egbrink MGA, Austin Z. Factors Influencing Professional Identity Construction in Fourth-Year Pharmacy Students. Am J Pharm Educ 2023; 87:ajpe9110. [PMID: 36270661 PMCID: PMC10159543 DOI: 10.5688/ajpe9110] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/08/2022] [Indexed: 05/06/2023]
Abstract
Objectives. To explore the key factors that influence professional identity construction in fourth-year pharmacy students enrolled in a Doctor of Pharmacy program.Methods. A single-site instrumental case study of current fourth-year pharmacy students from the Leslie Dan Faculty of Pharmacy, University of Toronto, was used. Thirteen students participated in semistructured interviews. Poststructural social identity theories were used to analyze the data and identify themes that influence identity construction in pharmacy students.Results. Data analysis identified five overarching themes that influence pharmacy student professional identity construction: path to pharmacy, curriculum, environment, preceptors, and patient interactions. The Leslie Dan Faculty of Pharmacy curriculum prioritized the health care provider identity, which influenced the students desire to "become" clinicians. Based on their internalized health care provider identity, they rejected preceptors and practice environments that negatively impacted their ability to embody this identity.Conclusion. The findings of this study suggest that pharmacy students align themselves strongly with health care provider identities at the cost of other potentially relevant identities. Pharmacy education programs may benefit from curricular reforms that incorporate and legitimize multiple pharmacist identities to ensure a strong pharmacy workforce for the future.
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Affiliation(s)
- Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Kellar J, Austin Z. The only way round is through: Professional identity in pharmacy education and practice. Can Pharm J (Ott) 2022; 155:238-240. [PMID: 36081919 PMCID: PMC9445508 DOI: 10.1177/17151635221115370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 08/06/2023]
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Surkic N, Mathers A, Kellar J, MacCallum L, Dolovich L. Exploring the perspectives and strategies of Ontario community pharmacists to improve routine follow-up for patients with diabetes: A qualitative study. Can Pharm J (Ott) 2021; 154:342-348. [PMID: 34484484 PMCID: PMC8408913 DOI: 10.1177/17151635211018479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
Background: Medication reviews are a fundamental activity carried out as part of comprehensive care delivered by pharmacists. Varying programs that reimburse pharmacists for conduct of medication reviews are in place in different jurisdictions in Canada and other countries around the world. The MedsCheck Diabetes (MCD) program is a publicly funded service in Ontario, Canada, offered to patients with type 1 or type 2 diabetes. Through this service, pharmacists can complete a focused medication review with advice, training, monitoring and follow-up diabetes education. Although pharmacists can be reimbursed for patient follow-up activities, a low number of follow-up medication reviews are billed through this program. Methods: The study explores the barriers and facilitators that community pharmacists in Ontario experience in conducting routine monitoring and follow-up of patients with diabetes. Using a descriptive content analysis approach study, semistructured interviews were conducted with a convenience sample of 8 community pharmacists working in Ontario. Results: Three main themes emerged: the design of the MCD program, the state of community pharmacy and collaboration and relationships. These themes demonstrate challenges and potential strategies recognized by community pharmacists to conduct routine diabetes follow-up through the MCD program. Conclusion: This study found that the design of the MedsCheck Diabetes program, the community pharmacy environment and the relationships between pharmacists, patients and prescribers can pose a challenge in the conduct of routine monitoring and follow-up through the MedsCheck Diabetes program.
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Affiliation(s)
- Natali Surkic
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto
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Kellar J, Singh L, Bradley-Ridout G, Martimianakis MA, van der Vleuten CPM, Oude Egbrink MGA, Austin Z. How pharmacists perceive their professional identity: a scoping review and discursive analysis. Int J Pharm Pract 2021; 29:299-307. [PMID: 33978740 DOI: 10.1093/ijpp/riab020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/12/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The objectives of this scoping review were to (a) explore how pharmacists perceive their professional roles and identities and (b) describe factors impacting which professional roles or identities pharmacists embody in different pharmacy practice settings. METHODS A scoping review using a deductive approach was undertaken for this study. Systematic searches were conducted in five databases: Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO Cumulative Index to Nursing and Allied Health and Scopus (Elsevier). Key words searched included pharmacist, identity, professional role and one variations of these. Results were double-blind screened for relevance by two authors. Data extraction was facilitated by the web-based software platform COVIDENCE. Foucauldian critical discourse analysis was used to deconstruct how pharmacists perceive their professional roles and identities. KEY FINDINGS In total, 21 701 articles were retrieved in the search. Following de-duplication and screening, 23 studies from 11 different countries were included. Five major identity themes were identified: Clinician, Dispenser, Business Person, Patient Counsellor and Physician Supporter. The dispenser identity was the most widespread, but it was viewed by many pharmacists as undesirable. The clinician identity also had a strong presence but was viewed as an identity that pharmacists aspire to embody. CONCLUSIONS This scoping review illustrates that pharmacists do not uniformly perceive themselves to be clinicians. A significant gap exists between the profession's desired identity and that embodied by practicing pharmacists. The resulting dissonance may be a contributing factor to the lack of wide-scale practice change that the profession has been seeking for decades.
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Affiliation(s)
- Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada M5S 3M2.,Department of Pediatrics and Wilson Centre, Faculty of Medicine, University of Toronto, ON, Canada M5S 3M2.,School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lachmi Singh
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada M5S 3M2
| | | | - Maria Athina Martimianakis
- Department of Pediatrics and Wilson Centre, Faculty of Medicine, University of Toronto, ON, Canada M5S 3M2
| | - Cees P M van der Vleuten
- School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Mirjam G A Oude Egbrink
- School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada M5S 3M2
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Neubert A, Kellar J, Miller D, Kulasegaram K(M, Paradis E. Relational professional identity: How do pharmacy students see themselves in relation to others? Can Pharm J (Ott) 2021; 154:36-41. [PMID: 33598058 PMCID: PMC7863286 DOI: 10.1177/1715163520964500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the pharmacy profession moves towards patient-centred care, pharmacy schools have updated their curricula to prepare students for a full scope of practice. A critical objective of the new curricula is the professional socialization of pharmacy students into relational aspects of the profession: how pharmacists should interact with patients and other health care professionals. Through an examination of how one cohort of pharmacy students perceives its relationship to patients and physicians, this study aims to determine how these relational aspects of professional identity evolve with time spent in the program. METHODS At 3 time points over a 2-year period, pharmacy students were asked to detail in writing how they would communicate with a physician concerning a hypothetical drug allergy scenario. A directed content analysis of their responses was conducted based on 3 main analytic categories: patient-centredness, physician collaboration and physician deference. These categories were further divided into 6 subcategories that were used as the variables for analysis. Statistical analyses examined longitudinal group trends for these variables. RESULTS Over the 2 years of observation, an examination of the proportion of messages demonstrating the subcategories of interest showed that the only measure of the pharmacy students' relational professional identity that changed significantly over time occurred for the perception of a sense of shared care for the patient. All other aspects of their relational identity were stagnant and did not change as they progressed through training (χ2; 12.772, df = 2, p < 0.002). CONCLUSION Our results suggest that the relational professional identity of participants was poorly developed with regards to both patients and physicians. Pharmacy educators must reexamine the methods currently being employed to foster students' professional identity development to ensure that new graduates are prepared to meet the challenges of a changing scope of practice. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Daniel Miller
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | - Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto
- The Wilson Centre, Toronto, Ontario
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Kellar J, Paradis E, van der Vleuten CP, oude Egbrink MG, Austin Z. A Historical Discourse Analysis of Pharmacist Identity in Pharmacy Education. Am J Pharm Educ 2020; 84:ajpe7864. [PMID: 33012797 PMCID: PMC7523677 DOI: 10.5688/ajpe7864] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/27/2020] [Indexed: 05/13/2023]
Abstract
Objective. To determine the discourses on professional identity in pharmacy education over the last century in North America and which one(s) currently dominate. Methods. A Foucauldian critical discourse analysis using archival resources from the American Journal of Pharmaceutical Education (AJPE) and commissioned education reports was used to expose the identity discourses in pharmacy education. Results. This study identified five prominent identity discourses in the pharmacy education literature: apothecary, dispenser, merchandiser, expert advisor, and health care provider. Each discourse constructs the pharmacist's professional identity in different ways and makes possible certain language, subjects, and objects. The health care provider discourse currently dominates the literature. However, an unexpected finding of this study was that the discourses identified did not shift clearly over time, but rather piled up, resulting in students being exposed to incompatible identities. Conclusion. This study illustrates that pharmacist identity constructs are not simple, self-evident, or progressive. In exposing students to incompatible identity discourses, pharmacy education may be unintentionally impacting the formation of a strong, unified healthcare provider identity, which may impact widespread practice change.
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Affiliation(s)
- Jamie Kellar
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
- Maastricht University, School of Health Professions Education, Netherlands
| | - Elise Paradis
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | | | | | - Zubin Austin
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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9
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MacCallum L, Mathers A, Kellar J, Rousse-Grossman J, Moore J, Lewis GF, Dolovich L. Pharmacists report lack of reinforcement and the work environment as the biggest barriers to routine monitoring and follow-up for people with diabetes: A survey of community pharmacists. Res Social Adm Pharm 2020; 17:332-343. [PMID: 32327399 DOI: 10.1016/j.sapharm.2020.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Medications with lifestyle are the cornerstone of diabetes management and routine monitoring and follow-up are essential to the delivery of quality care. Documented follow-up rates by pharmacists for people with diabetes are low despite good uptake of initial medication assessments in medication review programs. OBJECTIVES Identify the barriers and facilitators to routine monitoring and follow-up for people with diabetes by community pharmacists. METHODS Pharmacists were invited to complete a survey designed using the Theoretical Domains Framework Version 2 TDF (v2) consisting of 39 questions based on the 14 domains of the TDFv2 with quantitative response options using a 7 point Likert scale and 2 open-ended questions. Baseline information about the respondents and their practice sites were summarized using descriptive statistics. Mean scores and standard deviations were calculated for each of the Likert scale responses. Responses to open-ended questions were analyzed and coded using an inductive thematic approach. RESULTS 346 pharmacists completed the survey (4.76% response rate). The TDF domains found to be positively influencing the delivery of routine monitoring and follow-up activities were beliefs about consequences for people with diabetes (6.08 ± 1.13), pharmacist knowledge (5.93 ± 0.99), pharmacist skills (5.44 ± 1.44), social influences (5.36 ± 1.32) and optimism (5.20 ± 1.58). The domains found to be negatively influencing were reinforcement (3.0 ± 1.89) and environmental context and resources (3.30 ± 1.81). Themes emerging from the thematic analysis included time and competing priorities, reimbursement, patient engagement, workflow and human resources, access to labs and clinical information, information technology and support from the owner/manager. CONCLUSIONS Our research concludes that pharmacists report that their knowledge, skills, and beliefs about their role and responsibility, social influences and optimism are positive influences on routine monitoring and follow-up while reinforcement and the environmental context/resources are the greatest negative influences. Strategies to improve follow-up should be focused in these areas.
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Affiliation(s)
- Lori MacCallum
- Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth St. 12E 252, Toronto, Ontario, M5G 2C4, Canada; Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada; Leslie Dan Faculty of Pharmacy University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada.
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Jeremy Rousse-Grossman
- Leslie Dan Faculty of Pharmacy University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Julia Moore
- The Center for Implementation, 20 Northampton Dr., Toronto, ON, M9B 4S6, Canada
| | - Gary F Lewis
- Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth St. 12E 252, Toronto, Ontario, M5G 2C4, Canada; Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
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Affiliation(s)
- Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Jennifer Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Naomi Steenhof
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Desselle S, Lake J, Lake J, Steenhof N, Kellar J, Austin Z. Letter to the Editor: "Development and validation of key performance indicators for medication management services provided for outpatients" [Res Social Adm Pharm 15 (9) (2019) 1080-7]. Res Social Adm Pharm 2019; 15:1494. [PMID: 31585785 DOI: 10.1016/j.sapharm.2019.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shane Desselle
- Research in Social and Administrative Pharmacy, Touro University College of California, Vallejo, CA, United States
| | - Jennifer Lake
- 839- 144 College Street, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M4S3M2, Canada.
| | - Jennifer Lake
- Faculty of Medicine, Leslie Dan Faculty of Pharmacy, Institute for Health Policy Management & Evaluation, University of Toronto, Canada
| | - Naomi Steenhof
- Leslie Dan Faculty of Pharmacy, University of Toronto, University Health Network, Canada
| | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Zubin Austin
- Centre for Practice Excellence, Leslie Dan Faculty of Pharmacy, Institute for Health Policy Management & Evaluation, Faculty of Medicine, University of Toronto, Canada
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Foong AL, Grindrod KA, Patel T, Kellar J. Demystifying serotonin syndrome (or serotonin toxicity). Can Fam Physician 2018; 64:720-727. [PMID: 30315014 PMCID: PMC6184959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To review the symptoms of serotonin toxicity (commonly referred to as serotonin syndrome) and the causative drugs and their mechanisms of action, and to equip primary care providers with practical strategies to prevent and identify serotonin toxicity. QUALITY OF EVIDENCE PubMed and Google Scholar were searched for relevant articles on serotonin toxicity, the causes, and the differential diagnosis using search terms related to serotonin toxicity (serotonin syndrome, serotonin toxicity, serotonin overdose), causes (individual names of drug classes, individual drug names), and diagnosis (differential diagnosis, neuroleptic malignant syndrome, anticholinergic toxicity, discontinuation syndrome, malignant hyperthermia, serotonin symptoms). Experts in psychiatric medicine, psychiatric pharmacy, clinical pharmacology, and medical toxicology were consulted. Evidence is level II and III. MAIN MESSAGE Serotonin toxicity is a drug-induced condition caused by too much serotonin in synapses in the brain. Cases requiring hospitalization are rare, and mild cases caused by serotonin-mediated side effects are unlikely to be fatal. Patients present with a combination of neuromuscular, autonomic, and mental status symptoms. Serotonin-elevating drugs include monoamine oxidase inhibitors, serotonin reuptake inhibitors, and serotonin releasers. Most cases involve 2 drugs that increase serotonin in different ways; the most concerning combination is a monoamine oxidase inhibitor with a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor. CONCLUSION Family physicians play a key role in identifying and preventing serotonin syndrome by teaching patients to recognize symptoms and monitoring patients throughout therapy.
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Affiliation(s)
- Ai-Leng Foong
- Completed her Doctor of Pharmacy degree at the University of Waterloo School of Pharmacy in Ontario
| | - Kelly A Grindrod
- Assistant Professor in the University of Waterloo School of Pharmacy and a clinical pharmacist at the Kitchener Downtown Community Health Centre.
| | - Tejal Patel
- Assistant Clinical Professor in the University of Waterloo School of Pharmacy, part-time Assistant Clinical Professor in the Michael G. DeGroote School of Medicine at McMaster University, a clinical pharmacist with the Memory Clinic at the Centre for Family Medicine Family Health Team in Kitchener, a research scientist at the Schlegel-University of Waterloo Research Institute for Aging, and an affiliate researcher with the Waterloo Institute for Complexity and Innovation
| | - Jamie Kellar
- Assistant Professor and Acting Director of the Doctor of Pharmacy program at the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario, an advanced practice hospital pharmacist at the Centre for Addiction and Mental Health in Toronto, a doctoral candidate in the School of Health Professions Education at Maastricht University in the Netherlands, and a research fellow at the Wilson Centre in Toronto
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Foong AL, Grindrod KA, Patel T, Kellar J. [Not Available]. Can Fam Physician 2018; 64:e422-e430. [PMID: 30315031 PMCID: PMC6184969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Passer en revue les symptômes de la toxicité sérotoninergique (communément appelée le syndrome sérotoninergique), les médicaments causatifs et leurs mécanismes d’action, et proposer aux médecins de soins primaires des stratégies pratiques pour prévenir et dépister la toxicité sérotoninergique. Qualité des données Une recherche documentaire a été effectuée dans PubMed et Google Scholar pour trouver des articles pertinents sur la toxicité sérotoninergique, ses causes et les diagnostics différentiels, à l’aide d’expressions de recherche liées à la toxicité sérotoninergique (serotonin syndrome, serotonin toxicity, serotonin overdose), à ses causes (noms individuels de classes de médicaments, noms individuels de médicaments), et à son diagnostic (differential diagnosis, neuroleptic malignant syndrome, anticholinergic toxicity, discontinuation syndrome, malignant hyperthermia, serotonin symptoms). Des experts en médecine psychiatrique, en pharmacie psychiatrique, en pharmacologie clinique et en toxicologie médicale ont été consultés. Les données probantes sont de niveaux II et III. Message principal La toxicité sérotoninergique est un problème induit par des médicaments, qui est causé par la présence de trop de sérotonine dans les synapses du cerveau. Les cas qui exigent une hospitalisation sont rares, et il est peu probable que les cas bénins dus aux effets secondaires médiés par la sérotonine soient fatals. Les patients présentent une combinaison de symptômes neuromusculaires, du système nerveux autonome et de l’état mental. Parmi les médicaments qui augmentent la sérotonine se trouvent les inhibiteurs de la monoamine oxydase, les inhibiteurs de la recapture de la sérotonine et les libérateurs de sérotonine. Dans la plupart des cas, 2 médicaments qui augmentent la sérotonine de façons différentes sont en cause; la combinaison la plus inquiétante est un inhibiteur de la monoamine oxydase avec un inhibiteur sélectif de la recapture de la sérotonine ou un inhibiteur de la recapture de la sérotonine-noradrénaline. Conclusion Les médecins de famille jouent un rôle important dans la détection et la prévention du syndrome sérotoninergique en enseignant aux patients à reconnaître les symptômes et en surveillant les patients durant toute leur thérapie.
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Affiliation(s)
- Ai-Leng Foong
- Obtenu son doctorat en pharmacie de la Faculté de pharmacie de l'Université de Waterloo (Ontario)
| | - Kelly A Grindrod
- Professeure adjointe à la Faculté de pharmacie de l'Université de Waterloo et pharmacienne clinicienne au Centre de santé communautaire du centre-ville de Kitchener.
| | - Tejal Patel
- Professeure clinicienne adjointe à la Faculté de pharmacie de l'Université de Waterloo, professeure clinicienne à temps partiel à la Faculté de médecine Michael G. DeGroote de l'Université McMaster, pharmacienne clinicienne à la Clinique de la mémoire du Centre de l'équipe de santé familiale de Kitchener, chercheure scientifique à l'Institut de recherche Schlegel sur le vieillissement de l'Université de Waterloo, chercheure associée au Waterloo Institute for Complexity and Innovation
| | - Jamie Kellar
- Professeure adjointe et directrice par intérim du programme de doctorat en pharmacie de la Faculté de pharmacie Leslie Dan de l'Université de Toronto (Ontario), pharmacienne en pratique avancée en milieu hospitalier au Centre for Addiction and Mental Health à Toronto, candidate au doctorat à la Faculté de l'éducation en professions de la santé de l'Université Maastricht aux Pays-Bas et boursière de recherche au Wilson Centre à Toronto
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Thompson A, Paradis E, Kellar J, Zhao R, Dan L. How are competency frameworks perceived and taught? An exploratory study in the context of pharmacy education. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paradis E, Zhao R, Kellar J, Thompson A. How are competency frameworks perceived and taught? : An exploratory study in the context of pharmacy education. Perspect Med Educ 2018; 7:200-206. [PMID: 29704169 PMCID: PMC6002293 DOI: 10.1007/s40037-018-0432-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Faculties of Pharmacy worldwide have to adapt their curriculum to accreditation criteria. The present study explored how the Association of Faculties of Pharmacy of Canada's (AFPC's) 2010 Educational Outcomes are perceived and taught at the Leslie Dan Faculty of Pharmacy (LDFP). These outcomes were adapted from the CanMeds Physician Competency Framework which describes both medical expert and non-expert roles. METHODS We wondered if pharmacy would struggle, as medicine has, to integrate these roles into curricula in meaningful ways, given the absence of previous studies from Pharmacy. We conducted an exploratory interview study with 10 core faculty members in charge of courses where non-expert roles were taught. Data were analysed using conventional content analysis. RESULTS Faculty members understood that the AFPC Outcomes are important for students, patients, and the profession of pharmacy, and some saw the roles as knowledge-based and teachable using content from academic disciplines. However, most saw them as skills taught informally or through clinical experience. They used the roles as a framing device to legitimize their course content and relied on informal role modelling to do most of the teaching. The few faculty members who taught content related to these roles had postgraduate education in a social science or humanities discipline. DISCUSSION Similar to studies of Faculties of Medicine, our study highlights the difficulty of translating a role-based, competency framework into concrete, integrated curricula for students. Competency development should be explicitly embedded into the curriculum and cannot be left to individual instructors.
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Affiliation(s)
- Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
| | - Rebecca Zhao
- Faculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada
| | - Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Alison Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Ai-Leng Foong
- University of Waterloo School of Pharmacy, Waterloo, Ontario
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Waterloo, Ontario
| | - Jamie Kellar
- University of Waterloo School of Pharmacy, Waterloo, Ontario
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Mills A, Kellar J. Should a PGY-1 Residency Be Mandatory for All Hospital Pharmacists in the Era of Entry-Level Doctor of Pharmacy Programs? Can J Hosp Pharm 2015; 68:342-5. [DOI: 10.4212/cjhp.v68i4.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Spadaro A, Kellar J, Remington G, Sproule B, Al-Sukhni M, Chaiet A. Evaluation of an Educational Program for Clinical Pharmacists to Conduct Standardized Assessments for Medication-Induced Movement-Related Disorders. Can J Hosp Pharm 2015; 68:258-64. [PMID: 26157190 DOI: 10.4212/cjhp.v68i3.1461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandra Spadaro
- RPh, BScPhm, ACPR, is with the Centre for Addiction and Mental Health, Toronto, Ontario
| | - Jamie Kellar
- RPh, BScPhm, PharmD, is with the Centre for Addiction and Mental Health, Toronto, Ontario
| | - Gary Remington
- PhD, MD, FRCPC, is with the Centre for Addiction and Mental Health, Toronto, Ontario
| | - Beth Sproule
- RPh, BScPhm, PharmD, is with the Centre for Addiction and Mental Health, Toronto, Ontario
| | - Mayce Al-Sukhni
- RPh, BScPhm, PharmD, is with the Centre for Addiction and Mental Health, Toronto, Ontario
| | - Albert Chaiet
- RPh, BScPhm, MScPhm, MBA, is with the Centre for Addiction and Mental Health, Toronto, Ontario
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Kellar J, Mittmann N, von Heymann C, Zingaro J, Kuriakose B, Li A. Costs of Employees with Treatment-Resistant Depression Based on a Canadian Private Claims Database. Value Health 2014; 17:A456-A457. [PMID: 27201265 DOI: 10.1016/j.jval.2014.08.1252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Kellar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - N Mittmann
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - J Zingaro
- Cubic Health Inc., Toronto, ON, Canada
| | | | - A Li
- Janssen Inc, Toronto, ON, Canada
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Vunnam S, Ankireddy K, Kellar J, Cross W. Highly transparent and conductive Al-doped ZnO nanoparticulate thin films using direct write processing. Nanotechnology 2014; 25:195301. [PMID: 24763438 DOI: 10.1088/0957-4484/25/19/195301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Solution processable Al-doped ZnO (AZO) thin films are attractive candidates for low cost transparent electrodes. We demonstrate here an optimized nanoparticulate ink for the fabrication of AZO thin films using scalable, low-cost direct write processing (ultrasonic spray deposition) in air at atmospheric pressure. The thin films were made via thermal processing of as-deposited films. AZO films deposited using the proposed nanoparticulate ink with further reducing in vacuum and rf plasma of forming gas exhibited optical transparency greater than 95% across the visible spectrum, and electrical resistivity of 0.5 Ω cm and it drops down to 7.0 × 10(-2) Ω cm after illuminating with UV light, which is comparable to commercially available tin doped indium oxide colloidal coatings. Various structural analyses were performed to investigate the influence of ink chemistry, deposition parameters, and annealing temperatures on the structural, optical, and electrical characteristics of the spray deposited AZO thin films. Optical micrographs confirmed the presence of surface defects and cracks using the AZO NPs ink without any additives. After adding N-(2-Aminoethyl)-3-aminopropylmethyldimethoxy silane to the ink, AZO films exhibited an optical transparency which was virtually identical to that of the plain glass substrate.
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Affiliation(s)
- S Vunnam
- Program of Nanoscience and Nanoengineering, South Dakota School of Mines and Technology, Rapid City, SD 57701, USA
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Scott A, Zepeda C, Garber L, Smith J, Swayne D, Rhorer A, Kellar J, Shimshony A, Batho H, Caporale V, Giovannini A. The concept of compartmentalisation. REV SCI TECH OIE 2006; 25:873-9, 881-7, 889-95. [PMID: 17361758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The rationale for establishing trade 'regions' and 'zones' is based on principles of epidemiological science and risk analysis that assess and manage animal disease risks so that the safety of trade can be ensured. However, the boundaries of geographical regions and zones may readily be breached through numerous epidemiological pathways. The concept of a 'compartment' extends the application of a 'risk boundary' beyond that of a geographical interface and considers all epidemiological factors that can contribute to the creation of an effective boundary. The fundamental requirement for application of either concept (regions/zones or compartments) is that the population considered for trade is maintained within management or geographical boundaries which allow clear epidemiological differentiation to be made between those animals and surrounding populations of higher risk. Seven factors are presented that an exporting country might use to guide the identification and documentation of a compartment. Additionally, the steps that would be undertaken to implement trade based on the compartmentalisation concept are discussed.
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Affiliation(s)
- A Scott
- United States Department of Agriculture, Animal and Plant Inspection Services, Veterinary Services, Centres for Epidemiology and Animal Health, 2150 Centre Avenue, Building B, Mail stop 2E7, Fort Collins, Colorado 80526, USA
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Zepeda C, Salman M, Thiermann A, Kellar J, Rojas H, Willeberg P. The role of veterinary epidemiology and veterinary services in complying with the World Trade Organization SPS agreement. Prev Vet Med 2005; 67:125-40. [PMID: 15737427 DOI: 10.1016/j.prevetmed.2004.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The agreement on the application of sanitary and phytosanitary measures (SPS agreement) was one of the major products of the GATT's Uruguay round of multilateral trade negotiations, signed in Marrakesh on 15 April 1994. This agreement and others are part of the treaty that established the World Trade Organization (WTO). The WTO superseded the GATT as the umbrella organization for international trade (WTO, 1998a). The SPS agreement's main intent is to provide guidelines and provisions to member countries to facilitate trade while taking measures to protect human, animal or plant life or health. The agreement dictates that all sanitary measures must be scientifically based and not more restrictive than required to avoid the risk identified. The agreement recommends the use of international standards from the World Organization for Animal Health (OIE), Codex Alimentarius (CAC) and the International Plant Protection Convention (IPPC) as the basis for import requirements. If a country chooses to apply more restrictive measures than those in the international standards, it has to justify its position through a risk analysis, thus avoiding the use of sanitary and phytosanitary measures as unjustified barriers to trade. More than ever, veterinary services worldwide are faced with having to fulfill a crucial role in protecting their country's animal health status, provide sound surveillance information on the occurrence of diseases within their territories, and conduct scientifically valid risk analyses to establish justified import requirements. During the past two decades, most countries have experienced resource reduction in their veterinary services. The effect of these policies has been severe, in many cases leading to an inability of veterinary services to conduct their disease prevention and control duties. There is a clear inconsistency between the demands placed on veterinary services and the current level of funding and support they are receiving, particularly in the developing world. This paper analyzes the implications in complying with the SPS agreement and explores the role of veterinary epidemiology in developing viable alternatives that can enhance the veterinary services' ability to perform under the current economic reality. The key provisions of the SPS agreement are regionalization, risk analysis, harmonization, equivalence and transparency. The paper focuses on the contribution of epidemiology in each of these areas in the effective implementation of the SPS agreement.
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Affiliation(s)
- C Zepeda
- USDA-APHIS-VS Centers for Epidemiology and Animal Health/Animal Population Health Institute, Colorado State University, Fort Collins, CO 80526, USA.
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Kellar J, Inch C. The Canadian Animal Health Network: Canada's response to the World Trade Organization. Can Vet J 1998; 39:217-24. [PMID: 9559212 PMCID: PMC1540369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J Kellar
- Science Advisory and Management Division, Canadian Food Inspection Agency, Nepean, Ontario
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Panzarino PJ, Kellar J. Integrating outcomes, quality and utilization data for profiling behavioral health providers. Behav Healthc Tomorrow 1994; 3:27-30. [PMID: 10141030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Profiling the performance of mental health providers can be done on the basis of performance indicators derived from outcomes research, quality assurance and utilization review. By focusing on collaboration and data-driven accountability, the authors have attempted to use provider profiling to rebalance the relationship between payor, provider and managed care organization, while avoiding the perception of a punitive grading system. Outcomes data thus are directly tied into provider profiling, in addition to their more customary uses in assessing and improving the quality of treatment results.
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Kellar J, Marra R, Martin W. Brucellosis in Ontario: a case control study. Can J Comp Med 1976; 40:119-28. [PMID: 826309 PMCID: PMC1277534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Data from cattle herds infected with brucellosis and from control (noninfected) herds were collected and analyzed using case control techniques. It appeared that herds located close to other infected herds and those herds whose owners made frequent purchases of cattle had an increased risk of acquiring brucellosis, particularly those who made purchases from other herds or from cattle dealers. Infected herds had a lower level of vaccination than noninfected herds. However, the percentage vaccinated was highly variable in each group. Vaccination per se did not appear to adversely influence the interpretation of serological test results nor did it appear to protect the individual animal. Once infected, the time required to become free of brucellosis was increased by large herd size and/or loose housing. Closed herds also took longer to become brucellosis free than more open herds. The percentage of animals removed from the herd was increased by active abortion. Those herds with multiple serological reactors (positives and questionables) at the first herd test after the imposition of quarantine had the highest percentage of cattle removed.
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