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Pharmacy, Volume 2, Issue 1 (March 2014), Pages 1-136

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Editorial

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Open AccessEditorial Acknowledgement to Reviewers of Pharmacy in 2013
Pharmacy 2014, 2(1), 86-87; doi:10.3390/pharmacy2010086
Received: 26 February 2014 / Accepted: 26 February 2014 / Published: 26 February 2014
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Abstract The editors of Pharmacy would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2013. [...] Full article

Research

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Open AccessArticle Availability, Uniqueness and Perceived Value of Bachelor of Science in Pharmaceutical Sciences (BSPS) Programs in the United States
Pharmacy 2014, 2(1), 1-16; doi:10.3390/pharmacy2010001
Received: 12 September 2013 / Revised: 15 November 2013 / Accepted: 22 November 2013 / Published: 31 December 2013
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Abstract
We describe the uniqueness of the Bachelor of Science in Pharmaceutical Sciences (BSPS) degree and the factors that contribute to this uniqueness. A total of 18 colleges and schools that offer a BSPS were identified in the literature and compared. A review of
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We describe the uniqueness of the Bachelor of Science in Pharmaceutical Sciences (BSPS) degree and the factors that contribute to this uniqueness. A total of 18 colleges and schools that offer a BSPS were identified in the literature and compared. A review of the current literature and university websites was conducted in order to compare and contrast the different BSPS programs. BSPS program directors’ perceptions were evaluated through a 14-item online survey instrument. Of the 16 programs surveyed, seven (43.8%) responded to the survey. The respondents agreed that most of the BSPS graduates are placed (from the highest to the lowest) at pharmacy school, postgraduate education and in the pharmaceutical industry. This is a timely review of coursework, program lengths and job opportunities for graduates of the BSPS. Currently, the BSPS programs have yet to receive a large amount of attention, but the importance in pharmaceutical education cannot be denied. Full article
Open AccessArticle Pharmacy Simulation: A Scottish, Student-Led Perspective with Lessons for the UK and Beyond
Pharmacy 2014, 2(1), 50-64; doi:10.3390/pharmacy2010050
Received: 12 December 2013 / Revised: 7 January 2014 / Accepted: 26 January 2014 / Published: 10 February 2014
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Abstract
Compared to the nursing and medical professions, simulation-based pharmacy education is a relatively new mode of supporting learning, although one that is growing rapidly to meet the training needs of a new generation of healthcare professionals. Within the UK (and particularly Scotland), access
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Compared to the nursing and medical professions, simulation-based pharmacy education is a relatively new mode of supporting learning, although one that is growing rapidly to meet the training needs of a new generation of healthcare professionals. Within the UK (and particularly Scotland), access to the clinical environment through the more traditional route of placement is limited, and simulation offers a partial solution to this problem. As is well-established, simulation—if used appropriately—also offers excellent opportunities for enhancing patient safety, including allowing the exploration of the science of human factors. Given the high incidence of medication errors, pharmacists need to be included in any intervention for improvement of patient safety. It is true, however, that the “clinical environment” experienced by the practising pharmacist (especially in community pharmacy) is different from the typical nursing or medical situation. This, combined with a lack of understanding of the role of the pharmacist as a member of the wider healthcare team, means that there are additional considerations required when designing simulation-based learning activities. This commentary undertakes a narrative review of the current situation for pharmacy simulation, and considers how this may be developed to support the Scottish healthcare vision, whilst recognising that the issues raised are likely to be relevant across the sector. Full article
(This article belongs to the Special Issue Simulation in Pharmacy Education)
Open AccessArticle Group Project—Learning Research and Generic Skills for Life beyond University
Pharmacy 2014, 2(1), 65-73; doi:10.3390/pharmacy2010065
Received: 20 December 2013 / Revised: 4 February 2014 / Accepted: 8 February 2014 / Published: 13 February 2014
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Abstract
Although research is usually not a goal of Pharmacy students, learning about the research processes is important, as graduates’ development and confidence in professional counseling will depend on critically interpreting the literature about new therapies. In addition to research skills, many universities are
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Although research is usually not a goal of Pharmacy students, learning about the research processes is important, as graduates’ development and confidence in professional counseling will depend on critically interpreting the literature about new therapies. In addition to research skills, many universities are now placing more emphasis on assessable graduate attributes. In an increasingly competitive job market, writing, critical thinking, speaking, leadership and teamwork skills are all essential, as they prepare students for the workforce, especially in regional and remote locations. However their teaching and assessment can be a challenge to embed in content rich subjects. “Group Project” is an elective subject in the final semester of the Bachelor of Pharmacy degree at La Trobe University in Bendigo, Australia. Key features include: self-selection of the project and participating group members, supervision of small student groups, interview-style presentations, weekly reflections on progress and group processes, as well as peer evaluation of group members. Three case studies are discussed to illustrate students’ introduction to research within the support of the group and with guidance from their supervisor. In our experience, supervisor engagement played a large role in students rating the subject highly and their subsequent enthusiasm for research. Full article
(This article belongs to the Special Issue Rural and Regional Pharmacy Education and Leadership)
Open AccessArticle Pharmacist’s Counselling Improves Patient Knowledge Regarding Warfarin, Irrespective of Health Literacy Level
Pharmacy 2014, 2(1), 114-123; doi:10.3390/pharmacy2010114
Received: 8 November 2013 / Revised: 31 January 2014 / Accepted: 24 February 2014 / Published: 7 March 2014
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Abstract
To investigate the health literacy of the population and examine the change in knowledge when patients are administered a questionnaire about warfarin at different time points before and after counselling by a pharmacist. Patients were recruited over eight weeks, from May 2011, in
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To investigate the health literacy of the population and examine the change in knowledge when patients are administered a questionnaire about warfarin at different time points before and after counselling by a pharmacist. Patients were recruited over eight weeks, from May 2011, in a public hospital in Galway, Ireland. Inclusion criteria: (i) newly commenced on warfarin; (ii) 18 years or more; (iii) English as their first language; (iv) absence of visual or hearing difficulties. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to assess health literacy (HL). Warfarin knowledge was assessed using the Anticoagulation Knowledge Assessment (AKA). Both of these tools were administered following provision of the warfarin booklet and one hour’s reading time before pharmacist counselling. The AKA was re-administered 28–56 days after the counselling. Statistical analysis was performed using PASW® v. 18. Results: Forty-three patients (55.8% male), mean (±SD) age 65.7 years (±14.2) scored an average of 58.5/66 (±9.3) in the REALM. Warfarin knowledge improved from a mean of 19/29 (±4.7), prior to verbal counselling, to 23.8 (±3.7), within 24 hours of verbal counselling. This knowledge score decreased to a mean score of 22.8 (±3.7) 28–56 days following counselling. Full article
Open AccessArticle Development of a Survey to Assess the Acceptability of an Innovative Contraception Practice among Rural Pharmacists
Pharmacy 2014, 2(1), 124-136; doi:10.3390/pharmacy2010124
Received: 13 January 2014 / Revised: 4 March 2014 / Accepted: 5 March 2014 / Published: 12 March 2014
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Abstract
Improved access to effective contraceptive methods is needed in Canada, particularly in rural areas, where unintended pregnancy rates are high and specific sexual health services may be further away. A rural pharmacist may be the most accessible health care professional. Pharmacy practice increasingly
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Improved access to effective contraceptive methods is needed in Canada, particularly in rural areas, where unintended pregnancy rates are high and specific sexual health services may be further away. A rural pharmacist may be the most accessible health care professional. Pharmacy practice increasingly incorporates cognitive services. In Canada many provinces allow pharmacists to independently prescribe for some indications, but not for hormonal contraception. To assess the acceptability for the implementation of this innovative practice in Canada, we developed and piloted a survey instrument. We chose questions to address the components for adoption and change described in Rogers’ “diffusion of innovations” theory. The proposed instrument was iteratively reviewed by 12 experts, then focus group tested among eight pharmacists or students to improve the instrument for face validity, readability, consistency and relevancy to community pharmacists in the Canadian context. We then pilot tested the survey among urban and rural pharmacies. 4% of urban and 35% of rural pharmacies returned pilot surveys. Internal consistency on repeated re-phrased questions was high (Cronbach’s Alpha = 0.901). We present our process for the development of a survey instrument to assess the acceptability and feasibility among Canadian community pharmacists for the innovative practice of the independent prescribing of hormonal contraception. Full article
(This article belongs to the Special Issue Rural and Regional Pharmacy Education and Leadership)

Review

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Open AccessReview Systems for Quality Assurance in Pharmacy Education and Training in the European Union
Pharmacy 2014, 2(1), 17-26; doi:10.3390/pharmacy2010017
Received: 17 October 2013 / Revised: 12 December 2013 / Accepted: 13 December 2013 / Published: 2 January 2014
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Abstract
With the changes in the Bologna process and the European directive on sectoral professions, the education and training of the pharmacists in the European Higher Education Area is moving towards a quality system based on competences. In this paper we analyze the existing
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With the changes in the Bologna process and the European directive on sectoral professions, the education and training of the pharmacists in the European Higher Education Area is moving towards a quality system based on competences. In this paper we analyze the existing quality assurance and accreditation systems in 10 countries and examine how far these systems have evolved from a resources and curriculum basis towards a competences basis. This is the first step towards the goal of the PHAR-QA project: establishment of a European quality assurance system based on competences. Existing systems of quality assurance for pharmacy education and teaching are based mainly on resources and management not competences. Furthermore, they are national, obligatory, and do not recognize all the current activities of the pharmacists. The PHAR-QA system that will be developed by the consortium of the same name will be based on competences; it will be European, consultative, and will encompass pharmacy practice in a wide sense. Full article
Open AccessReview Pharmacist’s Use of Screening Tools to Estimate Risk of CVD: A Review of the Literature
Pharmacy 2014, 2(1), 27-39; doi:10.3390/pharmacy2010027
Received: 19 August 2013 / Revised: 29 November 2013 / Accepted: 6 December 2013 / Published: 9 January 2014
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Abstract
To review pharmacist-led screening programmes for estimation of cardiovascular disease (CVD) risk using validated screening tools, studies were identified using a search of the following electronic databases: PubMed, EMBASE, Web of Knowledge and the Cochrane library databases. Each database was searched from inception
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To review pharmacist-led screening programmes for estimation of cardiovascular disease (CVD) risk using validated screening tools, studies were identified using a search of the following electronic databases: PubMed, EMBASE, Web of Knowledge and the Cochrane library databases. Each database was searched from inception to December 2011. The search terms used were: “cardiovascular disease”, “screening”, “risk estimation”, “pharmacist” and “pharmacy”. Titles, abstracts and full manuscripts were screened to determine eligibility. Inclusion criteria were: (i) Pharmacist-led CVD screening; and (ii) Use of validated screening tool or tools for CVD. From each included study information was collected on the following: Study author; year of publication; setting; inclusion and exclusion criteria; tools used and outcomes measured. Articles were grouped and independently verified to ensure they met with the inclusion criteria. Over 7,000 citations were found. Twenty full-length articles were retrieved for analysis, of which twelve were excluded, as they did not meet the inclusion criteria. The eight remaining articles were included in this literature review. Whilst pharmacists undertake screening in their own practice, this approach will only go so far. To have a population-health impact, pharmacists should be involved in proactive screening in a variety of settings. Full article
Open AccessReview A Review of Vitamin D Deficiency in the Critical Care Population
Pharmacy 2014, 2(1), 40-49; doi:10.3390/pharmacy2010040
Received: 30 September 2013 / Revised: 8 November 2013 / Accepted: 22 November 2013 / Published: 9 January 2014
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Abstract
It is well documented that a large percentage of the general population is either vitamin D insufficient or deficient. Vitamin D deficiency adversely affects bone health. More recently, it has been reported that vitamin D is an important component in immune function and
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It is well documented that a large percentage of the general population is either vitamin D insufficient or deficient. Vitamin D deficiency adversely affects bone health. More recently, it has been reported that vitamin D is an important component in immune function and glycemic control Substantial data exist that demonstrate an association between vitamin D insufficiency/deficiency and mortality/clinical outcomes of critically ill patients. The larger clinical trials addressing this association have demonstrated an increased odds ratio for mortality in both vitamin D insufficient and deficient patients when compared to those with sufficient vitamin D. There is also some evidence that vitamin D status worsens during critical illness without supplementation of this vitamin. Supplementation of vitamin D during critical illness of patients with vitamin D deficiency has been studied, but not in great detail. Daily supplementation of the recommended dietary allowance (RDA) of vitamin D does very little to improve the 25(OH)D serum concentrations in the critically ill patients with vitamin D insufficiency or deficiency. There is some evidence that high-dose therapy of vitamin D improves the depressed serum concentrations of this vitamin; however, there are no clinical outcome data available yet. The association between vitamin D insufficiency or deficiency and clinical outcome in the critically ill appears to be important. Supplementation of vitamin D will increase the serum concentrations of this vitamin; however the optimal dose needs to be identified along with an assessment of clinical outcome. Full article
Open AccessReview Posaconazole: A Review of Drug Interactions with HIV Antiretroviral Agents
Pharmacy 2014, 2(1), 98-113; doi:10.3390/pharmacy2010098
Received: 5 December 2013 / Revised: 14 February 2014 / Accepted: 20 February 2014 / Published: 4 March 2014
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Abstract
The purpose of this review is to examine the literature for reports of clinically significant interactions noted amongst HIV antiretroviral medications when coadministered with posaconazole. A literature search was conducted to identify studies addressing drug interactions between posaconazole and HIV antiretroviral medications. Two
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The purpose of this review is to examine the literature for reports of clinically significant interactions noted amongst HIV antiretroviral medications when coadministered with posaconazole. A literature search was conducted to identify studies addressing drug interactions between posaconazole and HIV antiretroviral medications. Two pharmacokinetic studies and three clinical trials involving the administration of posaconazole to HIV-infected patients were identified. The pharmacokinetic studies involved concomitant administration of either a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI). Both studies showed alterations in systemic concentrations of either posaconazole or the HIV antiretroviral when administered together. Of the three clinical trials, all patients were on HIV antiretrovirals. However, their potential interaction with posaconazole was not explored. To date, there is no published literature regarding the interaction between maraviroc or elvitegravir and posaconazole. Dose adjustments for each are recommended when coadministered with strong CYP 3A4 inhibitors or inducers. Currently available literature points to the potential for clinically significant drug interactions when posaconazole is coadministered with HIV antiretrovirals, specifically NNRTIs and PIs. More studies are needed involving a wider range of HIV antiretrovirals to determine the significance of the interaction. Clinicians should be aware of this potentially significant interaction and avoid concomitant administration when possible. When available, consideration should be given to therapeutic drug monitoring of antiretroviral serum concentrations in select patients. Full article

Other

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Open AccessConcept Paper Giving “Best Advice”: Proposing a Framework of Community Pharmacist Professional Judgement Formation
Pharmacy 2014, 2(1), 74-85; doi:10.3390/pharmacy2010074
Received: 31 December 2013 / Revised: 1 February 2014 / Accepted: 12 February 2014 / Published: 19 February 2014
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Abstract
Community pharmacy is often portrayed as a marriage of professional and business roles in a commercial domain, thereby creating a need for, and value in, pursuing the development of professional competencies for use in the community pharmacy business. In context, professional judgement is
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Community pharmacy is often portrayed as a marriage of professional and business roles in a commercial domain, thereby creating a need for, and value in, pursuing the development of professional competencies for use in the community pharmacy business. In context, professional judgement is the application of knowledge, skills and attitudes (competencies) which, when applied to situations where there is no one or obvious right or wrong way to proceed, gives a patient a better likelihood of a favourable outcome than if a lay-person had made the decision. The challenge for community pharmacists is that professional judgement formation is influenced by professional, commercial and personal criteria with inherent interconnected challenges. In community pharmacy practice in the Republic of Ireland (ROI), this challenge is compounded by the fact that advice is normally provided in an environment where the pharmacist provides professional advice “for free” and then may offer to sell the patient a product or service based on that advice, an activity which amounts to a commercial transaction. While there is currently no evidence to confirm whether or not these professional judgement influences are resolved successfully, their very existence poses a risk that their resolution “in the wrong way could compromise patient outcomes or professional standing following the delivery of pharmacy services. It is therefore apparent that a community pharmacist requires skills in identifying and analysing professional/commercial/personal influences in order to appreciate the criteria which may affect both parties’ (patient and pharmacist) decision making. By contemplating the interaction between the pharmacist’s professional competencies and the individual influences on that pharmacist, we can consider the enhancement of professional competencies that underpin the “best” advice being offered to the patient, regardless of whether that advice is offered in the course of dispensing prescriptions or delivering vaccination or other services, culminating in a framework of professional judgement formation. Full article
(This article belongs to the Special Issue Rural and Regional Pharmacy Education and Leadership)
Open AccessDiscussion Complementing a Rural Pharmacy Course with CAM: Reflections from a Decade of Experience
Pharmacy 2014, 2(1), 88-97; doi:10.3390/pharmacy2010088
Received: 27 December 2013 / Revised: 18 February 2014 / Accepted: 19 February 2014 / Published: 4 March 2014
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Abstract
Substantial complementary medicines (CAM) use is reported worldwide. Australian consumers use CAM for health maintenance, minor self-limiting disease states, and also for chronic conditions. The increasing use of CAM has required pharmacists to become increasingly more knowledgeable about CAM and the ethics of
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Substantial complementary medicines (CAM) use is reported worldwide. Australian consumers use CAM for health maintenance, minor self-limiting disease states, and also for chronic conditions. The increasing use of CAM has required pharmacists to become increasingly more knowledgeable about CAM and the ethics of CAM recommendation. When the first Australian non-metropolitan pharmacy program was started at Charles Sturt University, in 1997, it was decided to incorporate two innovative courses to assist rurally educated students to engage with health consumers who expect pharmacists to be able to assist them with CAM. This discussion traces and reflects on the development, implementation and current situation of the Complementary Medicines for Pharmacy course. Over time, this course has evolved from a final year elective with a focus on familiarization to a mandated course with a phytomedicine focus to an integrated topic in final year with a focus on evidence, quality of evidence and professional decision-making demonstrated in a reflective professional portfolio. Of potentially greater importance, however, has been the introduction of complementary medicines as a topic in every year of the course with the goal of facilitating effective professional engagement with health consumers. Full article
(This article belongs to the Special Issue Rural and Regional Pharmacy Education and Leadership)

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