Interest in global engagement among schools and colleges of pharmacy in the United States and Asian countries is growing. To develop fruitful relationships and engage in mutually enriching experiences, the cultural aspects of these countries need to be understood and respected. The aim of this paper is to facilitate culturally sensitive interactions between practitioners, faculty members, and students in the United States and those in Asian countries when they engage in health care practice and/or education. This paper introduces general information about China (including Macau and Hong Kong), Japan, South Korea, and Taiwan. Unique characteristics of the health care system and pharmacy education are described for each country. Stereotypes and misconceptions are discussed. Recommendations are included for initiating interactions and developing learning programs and scholarly collaborations while promoting culturally sensitive engagement. These recommendations are provided for US scholars, health care professionals, and students traveling to these countries as well as for those hosting visitors from these countries in the United States.

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of boundaries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic programs. The purposes of this article are to discuss the need for a blended clinical specialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners. (J Am Psychiatr Nurses Assoc [1998]. 4, 48-56) Carol A. Williams is an associate professor in the College of Nursing at the University of South Carolina in Columbia.

BACKGROUNDC hildhood obesity in the United States has increased from 5% in 1980 to over 18% in 2016. 1,2 Obesity is multifactorial, with social norms, the built environment, and policies playing a large role. 3 Thus, the public health, medical, and education communities have called for greater alignment of efforts to prevent childhood obesity. [4][5][6] Multi-component school-based wellness initiatives have been associated with healthier student body mass index (BMI), and are a public health focus to address the obesity epidemic in children for several reasons. [7][8][9] Reach is widespread because most children are enrolled in school and therefore benefit from programing. Also, children spend enough time at school to accommodate half of their daily required physical activity and caloric intake. 6,10 Effective school-based wellness initiatives capitalize on these opportunities while involving stakeholders from the community. 4,6,11

BACKGROUND: Blended roles in advanced practice nursing have generated much discussion but little study. As role modifications emerge in nursing, there is a need to explore their implementation. OBJECTIVE: This descriptive study examined the experiences of nurses who were implementing blended roles as psychiatric clinical specialists and adult nurse practitioners. DESIGN: Four master of science in nursing and 10 postmasters nurses who had been practicing in blended roles for 1 to 2 years were interviewed about their experiences in implementing their roles. Interviews were tape recorded, transcribed, and content analyzed. RESULTS: Respondents believed they were practicing holistically, were able to appropriately integrate physical and psychological care of the patient, and found chronic psychiatric patients to have more complex physical illnesses than they had anticipated. In addition, the advanced practice nurses were satisfied with their roles, felt supported by their physician preceptors, and described cross-consultation with physicians and nonpsychiatric nurse practitioners. CONCLUSIONS: There are roles for advanced practice nurses who blend clinical specialist and adult nurse practitioner skills in the care of psychiatric and primary care patients.

BACKGROUND: Associations between school participation in an academic medical center-supported school-based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. METHODS:This was an observational study of 103 K-12 South Carolina schools over school years 2014-2018, classified as participating (n = 87 schools, 27,855 students) or non-participating (n = 16 schools; 3608 students). Associations between students' BMI z-score (BMIz) and school participation were evaluated by linear multilevel mixed-effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. RESULTS:One-third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p = .026) and increased in non-participating schools (p = .004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p = .002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p < .05).CONCLUSION: Implementation of similar comprehensive school-based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities.

An 11-year-old African American female with history of adoption, asthma, and known peanut allergy presented after martial arts class for medical attention with abdominal distension, diffuse colicky abdominal pain, and one episode of nonbloody, nonbilious emesis. She denied abdominal trauma or recent nonsteroidal anti-inflammatory drug (NSAID) use. In the emergency department, an abdominal radiograph showed significant gas throughout the entire gastrointestinal tract without evidence of acute obstruction. Labs including comprehensive metabolic panel, complete blood count, amylase, lipase, and urinalysis were all within normal limits. Given significant distention and exquisite tenderness to palpation, she was admitted for further investigation.On hospital day 1, an attempt was made to place a nasogastric (NG) tube for gastric decompression. Within 3 to 5 minutes of the attempt, the patient was noted to develop lip swelling with complaints of tongue and throat tingling. Physical examination was notable for mild hypotension (92/49), mild tachypnea (RR 22), otherwise hemodynamically stable without evidence of wheezing. She received epinephrine, intravenous (IV) methylprednisolone, ranitidine, and diphenhydramine with some relief of facial angioedema. Later that evening, the patient was scheduled for an abdominal/pelvic computed tomography (CT) scan with contrast to further evaluate abdominal distension. Ten to 15 minutes after receiving the IV iohexol contrast, she developed throat swelling and tightness, wheezing, shortness of breath, and worsening abdominal pain. She required 3 doses of epinephrine, a dose of diphenhydramine, and several albuterol nebulization treatments before stabilization. Given the escalation of her symptoms, the patient was transferred to the pediatric intensive care unit (PICU) for increased care.In the PICU, she was given scheduled methylprednisolone. Over the next 12 hours, the patient experienced improvement in respiratory symptoms and was transferred back to the general pediatrics floor. Because of persistent and unimproved abdominal distension, there was concern for abdominal angioedema. Thus, allergy/ immunology and gastroenterology were consulted.The pediatric allergist suggested labs including tryptase, C3, C4, C1 esterase inhibitor function and level, tissue transglutaminase (TTG) IgA antibody, serum IgA, and serum IgE. Labs were reassuring. Tryptase was normal at 3.6 µg/L, C3 and C4 were not decreased, C1 esterase inhibitor level was normal at 28 mg/dL, and C1 esterase inhibitor function was normal at 101%. TTG IgA antibody and serum IgA were normal (0.5 units/mL and 171 mg/dL respectively). Total serum IgE was elevated at 283.9 IU/mL. Serum specific IgE testing to a variety of foods was notable for elevated IgE levels to wheat, corn, peanut, soybean, and tomato.The pediatric gastroenterologist suggested magnetic resonance enterography in addition to the previously obtained CT. Both imaging modalities showed no evidence of bowel inflammation or edema. Over the course of several days,...

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