Pharmacy2014, 2(1), 114-123; doi:10.3390/pharmacy2010114 (doi registration under processing) - published online 7 March 2014 Show/Hide Abstract
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 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.
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 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.
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 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.
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 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.
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 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.