Community Pharmacies and the Needs of Mobile EU Citizens - A study on Finns living in Spain

Migration within the European Union (EU) has increased since the Union was established. Community pharmacies provide open access to health care services and can be the first, most frequently used or even the only contact with a nation s health care system among mobile community residents. In some of the mass-migration areas in Southern Europe, most of the customers may represent mobile citizens of foreign background. This has not always been taken into consideration in the development of community pharmacy services. Mobile patients have been on the EU's health policy agenda, but they have seldom been mentioned in the context of community pharmacies. In most of the EU member states, governments control the specific legislation concerning community pharmacies and there is no harmonised pharmaceutical policy or consistent minimal standards for community pharmacy services in the EU. The aim of this study was to understand medication use, the role of community pharmacies and the symptom mitigation process of mobile community residents. Finns living in Spain were used as an example to examine how community pharmacies in a EU member state meet the needs of mobile community residents. The data were collected by a survey in 2002 (response rate 53%, n= 533) and by five focus group discussions in 2006 (n=30). A large number (70%) of the respondents had moved to Spain for health reasons and suffered from chronic morbidity. Community pharmacies had an important role in the healthcare of mobile community residents and the respondents were mostly satisfied with these services. However, several medication safety risks related to community pharmacy practices were identified: 1) Availability of prescription medicines without prescription (e.g., antibiotics, sleeping pills, Viagra®, asthma medications, cardiovascular medicines, psoriasis medicines and analgesics); 2) Irrational use of medicines (e.g., 41% of antibiotic users had bought their antibiotics without a prescription, and the most common reasons for antibiotic self-medication were symptomatic common colds and sore throats); 3) Language barriers between patients and pharmacy professionals; 4) Lack of medication counselling; 5) Unqualified pharmacy personnel providing pharmacotherapy. A fifth of the respondents reported experiencing problems during pharmacy visits in Spain, and the lack of a common language was the source of most of these problems. The findings of this study indicate that regulations and their enforcement can play a crucial role in actually assuring the rational and safe use of medicines. These results can be used in the development of pharmaceutical and healthcare policies in the EU. It is important to define consistent minimum standards for community pharmacy services in the EU. Then, the increasing number of mobile community residents could access safe and high quality health care services, including community pharmacy services, in every member state within the EU.

Development of a cognitive framework for pharmaceutical care

Pharmaceutical Care is defined as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”. One of the fundamental concepts in understanding needs for pharmaceutical care are Drug-Related Problems (DRPs). As the complexity of medication treatment increases, identification of drug-related problems (DRPs) by healthcare professionals remains vital to patient safety and Quality Use of Medicines(QUM). DRPs have been used by many researchers to evaluate the QUM in different settings. DRPs present, however, a list of potential problems not a strategic framework for assessing a medication regimen.

Tablettien soveltuvuus annosjakeluun

Koneellinen annosjakelu on kasvava lääkehuollon osa-alue, jossa lääkkeet pakataan koneellisesti pieniin annoskertakohtaisiin pusseihin kahden viikon erissä. Aikaisemmin lääkevalmisteiden soveltuvuutta koneelliseen annosjakeluun ei ole systemaattisesti tutkittu. Tutkimus tehtiin yhteistyössä Espoonlahden apteekin annosjakeluyksikön kanssa ja sen tavoitteena oli määrittää annosjakeluprosessin kannalta optimaaliset ominaisuudet annosjaeltavalle tabletille rikkoutumisten ja siirtymien vähentämiseksi. Rikkoutuminen on lääkevalmisteen murentumista, puolittumista tai muuta rikkoutumista annosjakelun aikana. Siirtymä on lääkevalmisteen jakelu väärään annospussiin. Prosentuaalisesti rikkoutumisia ja siirtymiä on jakelumäärästä hyvin vähän, mutta määrällisesti paljon ja koko ajan enemmän koneellisen annosjakelun yleistyessä. Rikkoutumiset ja siirtymät aiheuttavat paljon lisätyötä pussien korjaamisen takia, joten niiden määrää on pyrittävä vähentämään. Lisäksi tavoitteena oli selvittää lääkkeiden valmistajilta kysyttävissä olevat asiat lääkevalmisteiden ominaisuuksista ja säilyvyydestä, jotta voitaisiin päätellä valmisteen soveltuvuus koneelliseen annosjakeluun kirjallisen tiedon perusteella. Tutkimuksen tulosten perusteella rikkoutumisten ja siirtymien vähentämiseksi optimaalinen tablettivalmiste annosjakeluun on pienehkö tai keskisuuri, päällystetty, luja ja jakouurteeton ja optimaalinen ilman suhteellinen kosteustaso annosjakeluyksikön tuotantotiloissa olisi noin 30 – 40 %. Lääkkeiden valmistajilta kysyttäviä seikkoja ovat koon, päällysteen, murtolujuuden ja jakouurteen lisäksi valmisteen säilyvyys alkuperäispakkauksen ulkopuolella sekä valmisteen valo-, lämpö- ja kosteusherkkyys. Rikkoutumisten ja siirtymien lisäksi tutkittiin myös kosteusherkän asetyylisalisyylihappovalmisteen (Disperin 100 mg) säilyvyyttä 25 °C ja 60 % RH olosuhteissa, koska tuotantotilojen ilman kosteustasoa ei ole säädelty. Säilyvyystutkimuksen kesto oli neljä viikkoa. Se on riittävä, koska se on enimmäisaika, jonka tabletit ovat annosjakeluprosessin yhteydessä pois alkuperäispakkauksestaan ennen käyttöä. Tabletteja säilytettiin avoimessa alkuperäispakkauksessa (purkki), suljetussa alkuperäispakkauksessa, annosjakelukoneen kasetissa ja kahdessa erilaisessa annospussissa (uusi ja käytössä oleva materiaali). Tulosten mukaan annosjakelukoneen kasetti suojaa kosteudelta yhtä huonosti kuin avoin purkki. Uusi pussimateriaali sen sijaan suojaa kosteudelta paremmin kuin tällä hetkellä käytössä oleva materiaali. Raman -spektroskopiamittausten perusteella asetyylisalisyylihappotableteissa ei ehdi neljän viikon seurannan aikana tapahtua asetyylisalisyylihapon hajoamista salisyylihapoksi. Kosteus heikentää tablettien murtolujuutta, mikä saattaa aiheuttaa enemmän rikkoutumisia. Kosteustaso olisi hyvä olla säädettävissä vakioksi tuotantotiloissa tai purkaa tabletit kasetteihin mahdollisimman lähellä jakelua rikkoutumisten ehkäisemiseksi, etenkin ilman kosteustason ollessa korkea. Lisäksi tutkittiin lääkevalmisteen lämpöherkkyyttä koska annosjakelukoneen saumauslaite altistaa annospussit noin 75 °C lämmölle, jos annosjakelukone pysäytetään kesken työn. Tutkimus tehtiin XRPD:llä, jolla voidaan säätää näytteen lämpötilaa. Lämpöherkkyystutkimusten perusteella 75 °C lämpö ei ehdi tunnin aikana aiheuttaa muutoksia karbamatsepiinitabletissa (Neurotol 200 mg). Tuloksista selvisi, että tutkitun valmisteen sisältämä karbamatsepiini ei kuitenkaan ole lämpöherkin muoto, joten muita lämpöherkkiä lääkevalmisteita tulisi tutkia lisätiedon saamiseksi lämmön vaikutuksista.

Análise estratificada da atenção à saúde na prevenção secundária da doença coronariana

Trata-se de estudo transversal sem modelo de intervenção, que tem como objeto a atenção à saúde na prevenção secundária da doença coronariana a pacientes com ou sem tratamento ambulatorial especializado. O objetivo primário foi: Avaliar se há diferença na atenção à saúde entre pacientes portadores de doença arterial coronariana em sua forma aguda ou crônica com ou sem acompanhamento ambulatorial especializado. Os objetivos secundários foram: a) apresentar o perfil de cada grupo de pacientes a partir de dados sócio-demográficos e econômicos; b) descrever as característica clínicas dos pacientes e identificar a que fatores de risco cada grupo de pacientes está exposto; c) descrever a regularidade na utilização de medicamentos e como se dá o acesso à mesma; d) identificar o tipo e principais dificuldades enfrentadas pelo paciente para seguir o tratamento. Para a coleta de dados foi utilizado formulário desenvolvido e previamente testado para atender os objetivos propostos para o estudo, além de informações coletadas diretamente do prontuário do paciente. A coleta de dados foi realizada em três unidades públicas de saúde localizadas no município do Rio de Janeiro. A amostra selecionada foi composta por 112 pacientes divididos igualmente entre os dois grupos existentes na pesquisa. Os dados foram transcritos para planilha do programa Statistic Package for the Social Science e análise realizada através dos testes estatísticos de diferença entre proporção, odds-ratio e qui-quadrado. Quanto ao perfil sócio-demográfico e econômico verificou-se diferença estatística significativa quanto ao grau de instrução entre os grupos I e II, com predomínio de pacientes de nível fundamental incompleto para o grupo I e médio completo no grupo II (p=0,0434), foi também verificada diferença significativa entre os grupos relacionada ao rendimento mensal, embora o maior percentual encontrado em ambos os grupos tenha sido observado na faixa de dois salários mínimos, uma vez que o grupo II apresentou maior concentração de renda entre a faixa de dois a três salários mínimos (p=0,0044). Ao que se refere aos fatores de risco para doença coronariana, observou-se diferença estatística entre os grupos para a variável tabagismo (p= 0,0001) e sedentarismo (p=0,0025). Verificou-se para pacientes do grupo I valor estatístico significativo quanto a regularidade em utilizar medicamentos (p=0,0010). Concluiu-se, portanto, que o acompanhamento de pacientes pós-síndrome coronariana aguda em ambulatório especializado de coronariopatias apresentou benefícios significativos quando comparado ao grupo de pacientes não cobertos por este tipo de assistência. Verificou-se ainda que o enfermeiro poderá contribuir e atuar amplamente para a prevenção secundária da doença coronariana, enquanto membro da equipe multidisciplinar.

Improving the safety and security of the pharmaceutical supply chain

This paper discusses various techniques that may be used to combat counterfeiting in the pharmaceutical supply chain. These include the use of electronic pedigrees (to ensure the integrity of the supply chain), together with mass-serialization (to provide for a unique lifecycle history of each individual package) and authentication of the product (to check for any discrepancies in the various attributes of the product and its packaging are as intended for that individual package). Management of the pedigree process and product authentication is discussed in some detail, together with various other learnings from the Drug Security Network, including identification of some remaining vulnerabilities and suggestions for tightening these loopholes. © 2008 Springer-Verlag Berlin Heidelberg.

Perceptions and attitudes of Jordanian paediatricians towards off-label paediatric prescribing

Objective To assess current experiences and attitudes of hospital based paediatricians towards off-label medicine prescribing. Setting Paediatric hospital wards and out-patient clinics. Design A prospective, questionnaire based study. Results A 30 item questionnaire was sent to 300 hospital based paediatricians and 250 (83%) were returned completed. Over 69% of responders were familiar with the term off-label medicines. However, only 28% were knowingly prescribing off-label medicines to children. The majority of respondents (90%) expressed concerns about the safety and efficacy of off-label medicines. Only 15% had observed Adverse Drug Reactions, and 31% a treatment failure. The vast majority of respondents (83%) did not obtain informed consent or tell parents they were prescribing off label medicines to their children. Conclusions Off-label prescribing of medicines to children is a familiar concept to the majority of paediatricians in Jordan although only a smaller number are aware that it is common in their practice. Respondents showed concern about off label prescribing, although the majority do not consider it necessary to inform parents. More comprehensive research is needed in this area in Jordan and other Middle Eastern countries.

A new generation of biocides for control of crustacea in fish farms

Farming of salmon has become a significant industry in many countries over the past two decades. A major challenge facing this sector is infestation of the salmon by sea lice. The main way of treating salmon for such infestations is the use of medicines such as organophosphates, pyrethrins, hydrogen peroxide or benzoylphenyl ureas. The use of these medicines in fish farms is, however, highly regulated due to concerns about contamination of the wider marine environment. In this paper we report the use of photochemically active biocides for the treatment of a marine copepod, which is a model of parasitic sea lice. Photochemical activation and subsequent photodegradation of PDAs may represent a controllable and environmentally benign option for control of these parasites or other pest organisms in aquaculture. 

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care.

METHODS We conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression.

RESULTS All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15–0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50–1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14–0.68; P = .04).

CONCLUSIONS The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally.

Potential of hydrogel-forming and dissolving microneedles for use in paediatric populations

Development of formulations and drug delivery strategies for paediatric use is challenging, partially due to the age ranges within this population, resulting in varying requirements to achieve optimised patient outcomes. Although the oral route of drug delivery remains the preferred option, there are problematic issues, such as difficulty swallowing and palatability of medicines specific to this population. The parenteral route is not well accepted by children due to needle-related fear and pain. Accordingly, a plethora of alternative routes of drug administration have been investigated. Microneedles (MN) breach the stratum corneum (SC), the outermost layer of skin, increasing the number of drug substances amenable to transdermal delivery. This strategy involves the use of micron-sized needles to painlessly, and without drawing blood, create transient aqueous conduits in the SC. In this study, polymeric dissolving MN and hydrogel-forming MN were fabricated incorporating two model drugs commonly used in paediatric patients (caffeine and lidocaine hydrochloride). The potential efficacy of these MN for paediatric dosing was investigated via in vitro and in vivo studies. Views pertaining to MN technology were sought amongst school children in Northern Ireland, members of the UK general public and UK-based paediatricians, to determine perceived benefits, acceptance, barriers and concerns for adoption of this technology. In this study, polymeric MN were shown to substantially enhance skin permeability of the model therapeutic molecules in vitro and in vivo. In particular, hydrogel-forming MN led to a 6.1-fold increase in caffeine delivery whilst lidocaine HCl delivery was increased by 3.3-fold using dissolving MN in vitro. Application of caffeine-loaded MN led to a caffeine plasma concentration of 23.87μg/mL in rats at 24h. This research also highlighted a strong consensus regarding MN technology amongst schoolchildren, paediatricians and the general public, regarding potential use of MN in the paediatric population. Overall, 93.6% of general public respondents and 85.9% of paediatricians regarded the use of MN as a positive approach.

Pharmacy students' use and views on over-the-counter (OTC) medicines; a questionnaire study

Introduction
The role of the pharmacist centers on ensuring the safe and effective use of medicines, including over-the-counter (OTC) medicines. It is important to ascertain pharmacy students’ use and opinions on OTC medicines, given that they are the pharmacists of the future and that this market continues to expand. This study aimed to investigate Queen’s University Belfast (QUB) final year pharmacy students’ use and views on OTC medicines. Scarce work has been conducted in this area to date.

Methods
Following ethical approval and a pilot study, all students (n=155) were invited to participate in a self-completed questionnaire (n=20 questions), distributed at a mandatory class. Descriptive statistics and non-parametric tests (Chi-squared and Mann Whitney U-test) were used for data analyses.

Results
The response rate was 99.4% (154/155). The majority (153/155) reported using OTC medicines; the key consideration during personal product selection was effectiveness. Most [96.1% (147/153)] were in agreement that safety was the over-riding concern during OTC consultations. While 96.1% (149/155) considered that using an evidence-based approach improved the quality of patient care, 68.0% (104/153) would be prepared to sell a product that lacks evidence of effectiveness, provided it would not cause harm.

Conclusions
The importance of evidence of effectiveness was acknowledged, yet many students in this study were prepared to recommend unproven products. Further strategies are required at QUB to ensure this routine consideration alongside safety in practice.

Target identification of situations of improvement through Medication Review in patients type 2 diabetes

Introduction: Prevention, early detection and management of diabetes are fundamental for stopping this present epidemic. Medication review may contribute to the early detection of negative clinical outcomes risk factors associated to the use of medicines. Aims: To use the medication review to identify the situations that may lead to clinical negative outcomes, described as findings, in the process of medicines use in type 2 diabetic patients. To verify if the inclusion criteria list of the Pharmaceutical Society of Australia for medication review allows identifying patients of higher risks of obtaining clinical negative outcomes.

An efficient method for optimal location and sizing of fixed and switched shunt capacitors in large distribution systems

This paper proposes a computationally efficient methodology for the optimal location and sizing of static and switched shunt capacitors in large distribution systems. The problem is formulated as the maximization of the savings produced by the reduction in energy losses and the avoided costs due to investment deferral in the expansion of the network. The proposed method selects the nodes to be compensated, as well as the optimal capacitor ratings and their operational characteristics, i.e. fixed or switched. After an appropriate linearization, the optimization problem was formulated as a large-scale mixed-integer linear problem, suitable for being solved by means of a widespread commercial package. Results of the proposed optimizing method are compared with another recent methodology reported in the literature using two test cases: a 15-bus and a 33-bus distribution network. For the both cases tested, the proposed methodology delivers better solutions indicated by higher loss savings, which are achieved with lower amounts of capacitive compensation. The proposed method has also been applied for compensating to an actual large distribution network served by AES-Venezuela in the metropolitan area of Caracas. A convergence time of about 4 seconds after 22298 iterations demonstrates the ability of the proposed methodology for efficiently handling large-scale compensation problems.

Spatial and harvesting influence on growth, yield, quality and economic potential of Kalmegh (Andrographis paniculata Wall Ex. Nees)

Andrographis paniculata, commonly known as Kalmegh, is used both in Ayurvedic and Unani system of medicines because of its immunological, antibacterial and hepatoprotective properties. This study was carried out to investigate the influence of four harvesting times (120,135,150 days after planting and at seed maturity) and four planting distances (30×15, 30×10, 20×15 and 20×10 cm) on growth, dry herbage biomass, seed yield and quality traits of Andrographis paniculata at CCS Haryana Agricultural University, Hisar, India in the two years 2005 and 2006. The treatments were laid out in a split plot design with three replications. The maximum values for dry herbage biomass yield (5.14 t ha^(-1)), net returns (760.00 EUR ha^(-1)), B:C ratio (2.59), andrographolide content (2.63%) and total yield (135.00 kg ha^(-1)) were detected 135 days after planting with an optimum planting distance of 30×15 cm. However, the maximum iron content was estimated 120 days after planting. The highest dry herbage (4.58 t ha^(-1)) and maximum seed yield (19.7 kg ha^(-1)) were registered at plants that were lined out with a distance of 20×10 cm.