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Development of Pharmacist Independent Prescribing Clinics to Treat Opioid Analgesic Dependence in NHS Lanarkshire 在拉纳克郡NHS治疗阿片类镇痛药物依赖的药剂师独立处方诊所的发展
Pub Date : 2019-08-22 DOI: 10.3390/pharmacy7030119
Duncan R. Hill, Elizabeth T. Marr, Clair Smith
There has been an increase in opioid analgesic prescribing in general practice (GP). This is causing some concern around this contributing to dependency. NHS Lanarkshire have attempted to reduce the prescribing from GP surgeries through the development of specialised Pharmacist Independent Prescriber clinics being delivered from the practices. This article looks at the development of these services with pharmacist independent prescribers and the results from developing the services. The article aims to provide advice and recommendations for the development of other services and strategies to minimise the risks associated with Opioid Analgesic Dependence for patients.
阿片类镇痛药处方在全科医生(GP)中有所增加。这引起了一些对依赖性的担忧。NHS拉纳克郡已经试图减少处方从全科医生手术通过发展专业药剂师独立处方诊所正在交付的做法。本文着眼于这些服务的发展与药剂师独立开处方者和从发展服务的结果。本文旨在为其他服务和策略的发展提供建议和建议,以尽量减少与阿片类镇痛药依赖相关的风险。
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引用次数: 8
Impact of Completion of a Pre-Pharmacy Biochemistry Course and Competency Levels in Pre-Pharmacy Courses on Pharmacy Student Performance 药剂学预科生物化学课程的完成和药剂学预科课程的能力水平对药学学生表现的影响
Pub Date : 2019-08-16 DOI: 10.3390/pharmacy7030117
Ruth Vinall, P. Khansari, Jason McDowell, L. Ried, E. Kreys
Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal of the current study was to determine whether completion of a pre-pharmacy biochemistry course and/or performance on a biochemistry competency test (administered at the beginning of the pharmacy program) are associated with pharmacy student performance in foundational science courses and overall academic performance. A secondary goal was to determine whether performance in pre-pharmacy courses and/or student demographics are associated with pharmacy student performance. Prospective univariate analyses (n = 75) determined that completion of a pre-pharmacy biochemistry course is not associated with pharmacy student performance. However, performance on a biochemistry competency test was associated with performance in Biochemistry and Cell&Molecular Biology (p = 0.002). Furthermore, post-hoc analyses determined that pre-pharmacy cumulative chemistry GPA correlates with performance in both the Biochemistry and Cell&Molecular Biology and Medicinal Chemistry foundational science courses (p = 0.002 and p = 0.04, respectively) and can predict first year GPA (p = 0.002). The combined data indicate that further assessment of the impact of pre-pharmacy competency in biochemistry and chemistry on pharmacy student success is warranted.
基础科学课程通常在药学学校的第一年或第二年进行,表现不佳可能会产生一些负面后果,包括学生退学率的增加以及解雇和补救学生数量的增加。本研究的主要目的是确定药学预科生物化学课程的完成和/或生物化学能力测试的表现(在药学课程开始时进行)是否与药学学生在基础科学课程中的表现和整体学术表现有关。第二个目标是确定药学预科课程的表现和/或学生人口统计学是否与药学学生的表现有关。前瞻性单变量分析(n = 75)确定药学预科生物化学课程的完成与药学学生的表现无关。然而,生物化学能力测试的表现与生物化学和细胞与分子生物学的表现相关(p = 0.002)。此外,事后分析表明,药学前累积化学GPA与生物化学、细胞与分子生物学和药物化学基础科学课程的成绩相关(分别为p = 0.002和p = 0.04),并且可以预测第一年的GPA (p = 0.002)。综合数据表明,有必要进一步评估生物化学和化学的药学预科能力对药学学生成功的影响。
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引用次数: 1
Exploring the Implications of a Needs-Based Pharmacy Education Framework Modelled on Population Health: Perspective from a Developing Country 探索以人口健康为模型的以需求为基础的药学教育框架的含义:来自发展中国家的视角
Pub Date : 2019-08-14 DOI: 10.3390/pharmacy7030116
A. Bheekie, M. van Huyssteen, R. Coetzee
Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized. An evaluation framework to determine the pharmacy school’s effectiveness in strengthening the health system could be applied. A needs-based pharmacy educational approach modeled on population health could: Integrate resources from education, service, and research activities; follow a monitoring and evaluation framework that tracks educational outcomes; and engage with external stakeholders in curricular development and assessment.
在全球范围内,卫生教育改革正在指导通过卫生教育和卫生服务之间的合作加强卫生系统的努力。然而,发达国家和发展中国家之间的合作努力因卫生需求、经济限制和资源可得性不同而有所不同。在发展中国家,对资源分配的权衡有利于有利于大多数人口的干预措施。出现的问题是:健康教育、服务和研究活动如何(重新)协调,以优化卫生系统和整个社会的投资回报?本文针对南非等发展中国家的人口健康问题,提出了一种以需求为基础的药学教育方法。综述了以系统为基础的卫生专业教育改革方法和全球药学教育框架的文献。一个以需求为基础的药学教育方法,人口健康模型,支持健康结果测量,以衡量教育机构的有效性,是背景。可以应用评估框架来确定药学院在加强卫生系统方面的有效性。以人口健康为模型的基于需求的药学教育方法可以:整合教育、服务和研究活动的资源;遵循跟踪教育成果的监测和评估框架;与外部利益相关者一起参与课程开发和评估。
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引用次数: 10
Impact of the 2016 Policy Change on the Delivery of MedsCheck Services in Ontario: An Interrupted Time-Series Analysis 2016年政策变化对安大略省MedsCheck服务交付的影响:中断时间序列分析
Pub Date : 2019-08-12 DOI: 10.3390/pharmacy7030115
A. Shakeri, L. Dolovich, Lori MacCallum, J. Gamble, Limei Zhou, S. Cadarette
MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound patients (MCH), and residents of long-term care homes (MCLTC). The Ontario government introduced an abrupt policy change effective 1 October 2016 that added several components to all MC services, especially those completed in the community. We used an interrupted time series design to examine the impact of the policy change (24 months pre- and post-intervention) on the monthly number of MedsCheck services delivered. Immediate declines in all services were identified, especially in the community (47%–64% drop MC, 71%–83% drop MCD, 55% drop MCH, and 9%–14% drop MCLTC). Gradual increases were seen over 24 months post-policy change, yet remained 21%–76% lower than predicted for MedsCheck services delivered in the community, especially for MCD. In contrast, MCLTC services were similar or exceeded predicted values by September 2018 (from 5.1% decrease to 3.5% increase). A more effective implementation of health policy changes is needed to ensure the feasibility and sustainability of professional community pharmacy services.
MedsCheck (MC)是一项由社区药剂师提供的年度药物审查服务,自2007年以来由安大略省政府资助,针对服用三种或三种以上慢性病药物的居民。2010年,MC扩大到包括糖尿病患者(MCD)、居家患者(MCH)和长期护理院(MCLTC)的居民。安大略省政府于2016年10月1日突然出台了一项政策变化,增加了所有MC服务的几个组成部分,特别是那些在社区完成的服务。我们采用中断时间序列设计来检验政策变化(干预前和干预后24个月)对每月提供的MedsCheck服务数量的影响。所有服务都立即下降,特别是在社区(MC下降47%-64%,MCD下降71%-83%,MCH下降55%,MCLTC下降9%-14%)。在政策改变后的24个月内,MedsCheck服务的数量逐渐增加,但仍比预测的低21%-76%,尤其是MCD。相比之下,到2018年9月,MCLTC服务与预测值相似或超过预测值(从5.1%下降到3.5%)。需要更有效地执行卫生政策改革,以确保专业社区药房服务的可行性和可持续性。
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引用次数: 5
Clinical Care Pharmacists in Urgent Care in North East England: A Qualitative Study of Experiences after Implementation 英格兰东北部急诊临床护理药师:实施后经验的质性研究
Pub Date : 2019-08-09 DOI: 10.3390/pharmacy7030114
Jody Nichols, Rosie England, Stuart Holliday, J. Newton
Our objective was to explore the implementation of a novel NHS England (NHSE)-funded pilot project aimed at deploying clinical pharmacists in an integrated urgent care (IUC) setting including the NHS 111 service. Eight integrated urgent care clinical pharmacists (IUCCPs) within the participating North East of England Trusts. Individuals participated in semi-structured 1-to-1 interviews by an experienced qualitative researcher, either face-to-face or via the telephone. Each recording was transcribed, and the five stages of framework analysis (familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation) took place to establish emerging themes. All interviews took place between November 2018–February 2019. Four higher-order themes were identified: 1. Personality Traits, 2. Integration, 3. Benefits, 4. Training. The IUCCP programme is an innovative NHSE initiative. It provides an opportunity to extend the role of clinical pharmacists into the hard-pressed clinical environment of urgent and emergency care. Our evaluation has highlighted the potential for this professional group to contribute clinically in this area. Better communications, standard operating procedures and induction will improve how individuals develop in these novel roles.
我们的目标是探索实施一项新的NHS英格兰(NHSE)资助的试点项目,旨在部署临床药剂师在综合紧急护理(IUC)设置,包括NHS 111服务。八个综合紧急护理临床药剂师(IUCCPs)在参与东北英格兰信托。个人参加由经验丰富的定性研究人员进行的半结构化一对一访谈,面对面或通过电话。每段录音都被转录,并进行了框架分析的五个阶段(熟悉、确定主题框架、索引、制图、制图和解释),以确定新出现的主题。所有面试都是在2018年11月至2019年2月期间进行的。确定了四个高阶主题:1。2、个性特征;集成、3。好处,4。培训。IUCCP计划是一项创新的NHSE倡议。它提供了一个机会,扩大临床药师的作用,进入迫切和紧急护理的临床环境。我们的评估强调了这个专业小组在这一领域的临床贡献潜力。更好的沟通、标准的操作程序和引导将改善个人在这些新角色中的发展。
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引用次数: 2
A Cross-Sectional Investigation for Verification of Globalization of Falsified Medicines in Cambodia, Indicated by Tablets of Sildenafil Citrate 核实柬埔寨假药全球化的横断面调查,以枸橼酸西地那非片为例
Pub Date : 2019-08-09 DOI: 10.3390/pharmacy7030111
Naoko Yoshida, Miku Yuasa, T. Sovannarith, Eav Dararth, T. Keila, H. B. Kiet, H. Tsuboi, T. Tanimoto, K. Kimura
Medicine falsification is a global issue. Viagra, an erectile dysfunction therapeutic (EDT) medicine consisting primarily of sildenafil citrate, is the most commonly falsified medicine worldwide. Recently falsified EDTs have been reported multiple times in developing countries. The globalization of falsified EDTs has become a concern. In the present study, we selected sildenafil citrate tablets as an indicator and examined samples from a developing country, Cambodia, to investigate the availability of falsified sildenafil tablets in Cambodia and verify the current globalization status of falsified medicines from the standpoint of a developing country. Six samples of the originator Viagra, and 68 samples of generic sildenafil products were purchased from private drug outlets and wholesalers in Phnom Penh, Svay Rieng, and Battambang. The samples’ manufacturers were contacted to authenticate the samples. The quantities and dissolution rates of active ingredients were measured by a high-performance liquid chromatography system with photodiode array. Five generic samples were strongly suspected to be falsified medicines because of their extremely low quality; however, there was little distribution and no falsified medicine alleged to be produced by the originator of Viagra, which charges high prices. That finding indicates that falsification reflects local economic circumstances.
药品造假是一个全球性问题。伟哥是一种治疗勃起功能障碍(EDT)的药物,主要由柠檬酸西地那非组成,是世界上最常见的假药。最近在发展中国家多次报道了伪造的edt。伪造电子邮件的全球化已成为一个问题。在本研究中,我们选择柠檬酸西地那非片作为指标,并检查了来自发展中国家柬埔寨的样品,以调查伪造西地那非片在柬埔寨的可用性,并从发展中国家的角度验证假药的全球化现状。从金边、世良和马德望的私人药品销售点和批发商处购买了6个原产伟哥样品和68个非专利西地那非产品样品。我们联系了样品的生产厂家对样品进行鉴定。采用光电二极管阵列高效液相色谱法测定有效成分的含量和溶出率。5个仿制药样品因质量极低而被强烈怀疑是假药;然而,几乎没有销售,也没有据称是伟哥原厂生产的假药,伟哥的价格很高。这一发现表明,造假反映了当地的经济情况。
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引用次数: 3
Training and Toolkit Resources to Support Implementation of a Community Pharmacy Fall Prevention Service 培训和工具包资源,以支持实施社区药房跌倒预防服务
Pub Date : 2019-08-09 DOI: 10.3390/pharmacy7030113
Jessica M. Robinson, C. Renfro, Sarah J Shockley, S. Blalock, A. Watkins, S. Ferreri
Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow.
社区药房是管理高风险药物和筛查有跌倒风险的老年人的理想场所。在这种情况下,需要适当的培训和资源来成功地实施服务。本文的目的是确定支持实施预防跌倒服务的关键培训、工具和资源。这项服务是在北卡罗来纳州的一个社区药房网络中实施的。为药店提供了船上和纵向培训,以及一名项目教练。工具包包含收集药物信息、识别高风险药物、制定处方并与处方者分享建议、推广服务和教育患者的资源。每家药房的项目倡导者都收到了一份包含九个问题的基于网络的调查(质量),以确定培训和资源的有效性。定量资料采用描述性统计进行分析。31家社区药房实施了这项服务。23名项目负责人(74%)完成了干预后的调查。综合船上培训被认为比纵向培训更有用。识别高风险药物、制定建议并与处方医生分享建议的资源被认为是最有用的。通过提供适当的培训和资源,以支持跌倒预防服务,社区药剂师可以改善病人护理作为其日常工作流程的一部分。
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引用次数: 11
Overview and Insights into Carbapenem Allergy 碳青霉烯类过敏的概述和见解
Pub Date : 2019-08-08 DOI: 10.3390/pharmacy7030110
Yuman Lee, Nicole Bradley
Understanding antibiotic allergies and the risk of cross-sensitivity between and within antibiotic classes can have a substantial impact on patient care. The purpose of this review article is to provide insight into carbapenem allergies, describing the overall incidence, risk factors, and in-class cross-sensitivity. A PubMed search was conducted using the following search terms: carbapenem, allergy, cross-sensitivity, incidence, imipenem/cilastatin, meropenem, ertapenem, and doripenem. Article bibliographies and relevant drug monographs were also reviewed. The overall reported incidence of carbapenem allergy is 0.3%–3.7%. Risk of cross-sensitivity between penicillins and carbapenems is less than 1% in patients with a positive penicillin skin test. Data on cross-sensitivity between cephalosporins and carbapenems are limited; however, the risk appears to also be low. No clinical studies have described cross-sensitivity between the carbapenem agents thus far. The limited data available from case reports demonstrates a lack of cross-sensitivity between the individual carbapenems, suggesting that an alternative carbapenem may cautiously be used in patients with a reported carbapenem allergy.
了解抗生素过敏以及抗生素种类之间和内部交叉敏感的风险可以对患者护理产生重大影响。这篇综述文章的目的是提供对碳青霉烯类过敏的深入了解,描述总体发生率、危险因素和同级交叉敏感性。PubMed检索使用以下检索词:碳青霉烯、过敏、交叉敏感、发生率、亚胺培南/西司他汀、美罗培南、厄他培南和多利培南。并对文献参考书目和相关药物专著进行了综述。总体报告的碳青霉烯类过敏发生率为0.3%-3.7%。青霉素皮试阳性患者青霉素类和碳青霉烯类交叉敏感的风险小于1%。关于头孢菌素和碳青霉烯类之间交叉敏感性的数据有限;然而,风险似乎也很低。迄今为止,还没有临床研究描述碳青霉烯类药物之间的交叉敏感性。从病例报告中获得的有限数据表明,单个碳青霉烯类之间缺乏交叉敏感性,这表明在报告碳青霉烯类过敏的患者中,可谨慎使用替代碳青霉烯类。
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引用次数: 13
The Creation of a Practice-Based Network of Pharmacists Working in Family Medicine Groups (FMG) 基于实践的家庭医学团体药师网络的创建
Pub Date : 2019-08-05 DOI: 10.3390/pharmacy7030108
A. Maheu, M. Vanier, Léonie Rouleau, Nicolas Dugré, L. Guénette
A needs assessment study of pharmacists working in family medicine groups (FMG) demonstrated the necessity to build a practice-based network. This network would foster a faster integration into FMG and a more efficient collaborative practice. It would also take advantage of an existing practice-based research network (PBRN)—the STAT (Soutien Technologique pour l’Application et le Transfert des pratiques novatrices en pharmacie) network. A working group of nine FMG pharmacists from the different regions of the province of Quebec, Canada, and a committee of partners, including the key pharmacy organizations, were created. Between January 2018 and May 2019, nine meetings took place to discuss the needs assessment results and deploy an action plan. The practice-based network first year activities allowed identifying pharmacists working in FMGs across the province. A directory of these pharmacists was published on the STAT network. The vision, mission, mandate, name («Réseau Québécois des Pharmaciens GMF») and logo were developed. The first few activities include: Bi-monthly newsletters; a mentorship program; short evidence-based therapeutic letters (pharmacotherapeutic capsules) and a start-up kit to facilitate integration of these pharmacists. The Quebec FMG pharmacist practice-based network has been launched. It is planned to evaluate the members’ satisfaction in late Spring 2020 with regards to activities and resources provided.
一项针对在家庭医学团体(FMG)工作的药剂师的需求评估研究表明,有必要建立一个基于实践的网络。这一网络将促进更快地融入FMG和更有效的协作实践。它还将利用现有的基于实践的研究网络(PBRN) - STAT (Soutien technology pour l 'Application and le transfer des pratiques novatrices en pharmacy)网络。成立了一个由来自加拿大魁北克省不同地区的9名FMG药剂师组成的工作组,以及一个包括主要药房组织在内的合作伙伴委员会。2018年1月至2019年5月期间,举行了9次会议,讨论需求评估结果并部署行动计划。基于实践的网络第一年活动允许识别在全省fmg工作的药剂师。这些药剂师的目录已在国家统计局网络上公布。制定了愿景、使命、任务、名称(“转基因生物”)和标志。最初的几个活动包括:双月通讯;导师计划;简短的循证治疗信件(药物治疗胶囊)和启动工具包,以促进这些药剂师的整合。魁北克FMG药剂师实践为基础的网络已经启动。计划在2020年春末评估会员对所提供的活动和资源的满意度。
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引用次数: 4
A Review of Guidelines/Guidance from Various Countries Around the World for the Prevention and Management of Travellers’ Diarrhoea: A Pharmacist’s Perspective 审查世界各国预防和管理旅行者腹泻的指南/指南:药剂师的观点
Pub Date : 2019-08-04 DOI: 10.3390/pharmacy7030107
G. Hitch
International travel is growing and pharmacists are well placed to provide travel health services for the prevention and management of travellers’ diarrhoea (TD). Legislation changes in many countries has enabled pharmacists to access prescription only medicines and vaccinations to provide advice and over the counter medicines for the prevention and management for travel health services; this makes sense since pharmacies are easily accessible to the public and are the patient’s first port of call in the event of any illness. Currently, whilst many guidelines/guidance exist worldwide for the prevention and management of TD, there is no review that focuses on similarities and differences between these and between guidelines on TD and travel related and non-travel related acute diarrhoea. There is also a lack of publication on legislation and the need for evidence based training for all prescribers to provide travel health services. The aims of this work were to review guidelines/guidance for the prevention and management of TD from across the world which were compared with each other as were the TD guidelines compared to that for travel related and non-travel related acute diarrhoea for similarities and differences, with a focus on any relevant pharmacy legislation, needs assessments and training that may impact upon provision of travel health services by pharmacists focusing mainly on TD in adults. The PubMed, Google Scholar and Cochrane database were used to carry out an online search for publications on TD, acute diarrhoea and the guidance pharmacists have in the prevention and management of diarrhoea. The literature reviewed in this article indicates that where no specific guidelines/guidance existed, some pharmacists used the WHO guidelines (WHO), highlighting a need for local, regional and national evidence based guidelines in these countries.
国际旅行日益增多,药剂师完全有能力为预防和管理旅行者腹泻提供旅行保健服务。许多国家的立法变化使药剂师能够获得处方药和疫苗接种,以提供咨询意见,并获得预防和管理旅行保健服务的非处方药物;这是有道理的,因为药店对公众来说很容易到达,而且是病人生病时的第一站。目前,虽然世界各地存在许多预防和管理腹泻的指南/指南,但没有审查侧重于这些指南之间的异同,以及腹泻与旅行相关和非旅行相关急性腹泻指南之间的异同。也没有关于立法和为所有开处方者提供旅行保健服务的循证培训必要性的出版物。这项工作的目的是审查世界各地预防和管理腹泻的指导方针/指南,并将其与旅行相关和非旅行相关急性腹泻的指导方针进行比较,以了解其异同,重点是可能影响药剂师提供旅行卫生服务的任何相关药学立法、需求评估和培训,主要关注成人腹泻。使用PubMed、Google Scholar和Cochrane数据库对TD、急性腹泻和药剂师在预防和管理腹泻方面的指导出版物进行在线搜索。本文回顾的文献表明,在没有具体指南/指南的地方,一些药剂师使用世卫组织指南(WHO),强调这些国家需要制定地方、区域和国家循证指南。
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引用次数: 9
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Pharmacy: Journal of Pharmacy Education and Practice
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