Background Community pharmacists have provided healthcare services uninterruptedly throughout the COVID-19 pandemic. However, their public health role is often overlooked. Objectives The purpose of this manuscript is to discuss the roles and the coping mechanisms of community pharmacists working during the COVID-19 pandemic in Puerto Rico. Methods A cross-sectional study, using an electronic survey, was conducted to assess the community pharmacists' response during the COVID-19 Pandemic in Puerto Rico. Two open-ended questions explored community pharmacist's opinions about the pharmacist's role and coping mechanisms during the pandemic. The responses were analyzed following an inductive thematic analysis. Two major themes emerged from their responses: professional and personal experiences. Results Of the 302 participants who completed the survey, 77% of them answered one or both open-ended questions. The answers were diverse, and the respondents went beyond the specific topics asked. In professional experiences , important roles as educators and providing continuity of care and emotional support to their patients were highlighted. They also expressed concerns and frustrations on the profession's shortcomings, feeling overworked yet with a lack of recognition. In personal experience s, most of the respondents were concerned about the impact of having to juggle work and home life. They also reported mental health concerns, expressing feeling stressed, overworked, and worried about the constant risk of exposure and fear of exposing their loved ones. Conclusion Community pharmacists in Puerto Rico ensured the continuation of care, provided education, and managed anxious and stressed patients. Most relied on family members to cope with the extra burden that the COVID-19 pandemic. The lack of recognition created resentfulness among participants. It is essential to listen to our community pharmacists' voices to support and respond to their needs and learn from their experiences as front-line health care workers.
Objective The objective of this study was to assess community pharmacists’ willingness to test, treat and immunize for COVID-19 in Puerto Rico. Methods In this cross-sectional study, a 37-item survey was distributed via email and social media in May 2020 through REDCap online software. All licensed community pharmacists in Puerto Rico (N = 1200) were invited to complete the survey. Retired community pharmacists were excluded. Analysis of frequencies and chi-square tests were performed to evaluate the willingness to test, treat and immunize for COVID-19 and their associations with sociodemographic variables. Key findings The survey response rate was 26% (314/1200). Subjects’ mean age was 42 (±13), 86.1% were female, and most practiced in independent community or specialty pharmacy (62%). Among respondents, 44% reported willingness to test. Top concerns for testing were family (73.4%) and self (66.8%) exposure and ability to manage the workflow (53.3%). Most participants indicated their willingness to treat (88.4%) and to administer the COVID-19 vaccine (76.1%). Study participants who worked in retail pharmacies were more willing to test for COVID-19 (50.9%, P = 0.34) and to immunize (91.2%, P < 0.001). Pharmacists ≤39 years (90.3%), those who graduate in 2000 or later (88.3%), and those with a Pharm.D. degree or higher (88.6%), were more willing to immunize (P < 0.001). Conclusions Most community pharmacists were more willing to treat and immunize, than to perform COVID-19 testing. This underscores the need for training and workflow changes to facilitate the acquisition of this new role. Local pharmacists’ associations should advocate for a safe and manageable work environment. These efforts are vital to empower pharmacists to adopt new roles during a public health emergency.
Objective. To assess the self-reported impact of hurricane Maria on the perceived academic performance of student pharmacists at Nova Southeastern University's (NSU) Puerto Rico Regional Campus. Methods. A 37-item electronic instrument, the Hurricane Impact Survey, was created and sent by email to all student pharmacists $21 years old enrolled at NSU-COP Puerto Rico Campus during the fall 2017 semester. The electronic survey was available through Redcap platform for four weeks. Descriptive statistics, bivariate analysis, and logistic regression were used to analyze students' responses. Qualitative analysis was used to identify emerging themes in the open-ended comments. Results. A total of 150 student pharmacists completed the survey for a response rate of 69% (150/215). More than 70% of student pharmacists perceived that their academic performance was affected after the hurricane. About one third of students reported not being able to function mentally at the same level as they had prior to the storm (n553, 35%) and reported having difficulty sleeping (n554, 36%). Female student pharmacists were more likely than male student pharmacists to report not being able to function at the same level mentally as they had before the hurricane (41% vs 17%). In the multivariate analysis, first-and second-year student pharmacists were more likely to perceive a negative impact on their academic performance compared to third-and fourth-year student pharmacists. Lack of preparedness, gratefulness, and campus management were the themes that emerged from the qualitative analysis. Conclusion. Hurricane Maria had a significant impact on the lives of student pharmacists in Puerto Rico. This led to a perception of diminished academic performance, especially among first-and second-year students. The results can be used to guide preparedness and response to natural disasters in academic settings.
Background: Studies evaluating the risk of developing acute kidney injury (AKI) with different dosing strategies of polymyxin B are limited. Objectives: To compare the incidence of AKI in patients treated with intermittent versus continuous polymyxin B therapy. Secondary objectives included time to onset of AKI, hospital length of stay (LOS), and all-cause hospital mortality. Variables associated with an increased risk of AKI were evaluated. Methods: A retrospective record review was conducted at a single center in Puerto Rico. Adult patients (≥18 years old) treated with polymyxin B (first course) for at least 48 hours from 2013-2015 were evaluated. Patients with a creatinine clearance <10 mL/min and/or on renal replacement were excluded. Results: A total of 69 patients were included: 42 in the continuous infusion and 27 in the intermittent dosing group. Incidence of AKI was not significantly different between the groups (intermittent 41% vs continuous 31%, P = 0.4). No difference was found in the onset of nephrotoxicity, hospital LOS, or all-cause hospital mortality. Variables associated with increased risk of AKI were baseline serum creatinine, age, and intensive care unit admission. Patients with a body mass index (BMI) >25 kg/m2 on polymyxin B via continuous infusion had a significantly higher cumulative incidence of AKI ( P = 0.016). Conclusion and Relevance: No difference in the risk of polymyxin B nephrotoxicity was found between intermittent and continuous infusion administration. Administration of polymyxin B via a continuous infusion may result in a higher risk of AKI in patients with a BMI >25 kg/m2.
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