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Pharmacy, Volume 6, Issue 3 (September 2018)

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Open AccessDiscussion Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles
Pharmacy 2018, 6(3), 102; https://doi.org/10.3390/pharmacy6030102
Received: 28 July 2018 / Revised: 12 September 2018 / Accepted: 13 September 2018 / Published: 18 September 2018
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Abstract
The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers’ literature, would protect patients
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The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers’ literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients’ signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals’ responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs. Full article
(This article belongs to the Special Issue Patient Safety and Adverse Drug Events in Medication Practice)
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Open AccessArticle A National Survey of Community Pharmacists on Smoking Cessation Services in Thailand
Pharmacy 2018, 6(3), 101; https://doi.org/10.3390/pharmacy6030101
Received: 12 August 2018 / Revised: 12 September 2018 / Accepted: 13 September 2018 / Published: 17 September 2018
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Abstract
Providing smoking cessation services is one role of community pharmacists in Thailand. This cross-sectional study aimed to investigate activities and barriers related to smoking cessation services provided in community pharmacies in Thailand, as well as to compare these activities and barriers between those
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Providing smoking cessation services is one role of community pharmacists in Thailand. This cross-sectional study aimed to investigate activities and barriers related to smoking cessation services provided in community pharmacies in Thailand, as well as to compare these activities and barriers between those pharmacists providing and those not providing smoking cessation services. A postal questionnaire was conducted to collect information from community pharmacists across Thailand. In all, 413 valid responses were received from 5235 questionnaires, giving a 7.9% response rate. Of the 413 respondents, 152 (37%) pharmacists provided smoking cessation services in their pharmacy. The activities of smoking cessation services varied. Time for counseling each smoker varied, a mean of 15.1 ± 10.9 min (range 1–60) per person for the first time, and 8.9 ± 6.7 min (range 1–30) for each follow-up visit. Community pharmacists, providing smoking cessation services, were more likely to have pharmacist assistants, be a member of the Thai Pharmacy Network for Tobacco Control, and have more than 1 pharmacist on duty. The most dispensed pharmaceutical product for smoking cessation was nicotine gum. Their most perceived barriers were being unable to follow-up and inadequate staff. In conclusion, only a minority of community pharmacists in Thailand are engaged in smoking cessation activities, even though some perceived barriers existed. Full article
(This article belongs to the Special Issue Communication in Pharmacy Practice)
Open AccessArticle Inappropriate Medication Use in Hospitalized Patients Diagnosed with Parkinson’s Disease
Pharmacy 2018, 6(3), 100; https://doi.org/10.3390/pharmacy6030100
Received: 30 August 2018 / Revised: 12 September 2018 / Accepted: 12 September 2018 / Published: 15 September 2018
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Abstract
The purpose of this study was to evaluate the rate at which potentially inappropriate medications were administered for patients diagnosed with Parkinson’s disease (PD). This is a single-center, retrospective, case cohort study with data collected at an academic medical center between January 2010
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The purpose of this study was to evaluate the rate at which potentially inappropriate medications were administered for patients diagnosed with Parkinson’s disease (PD). This is a single-center, retrospective, case cohort study with data collected at an academic medical center between January 2010 and December 2013. Participants included all adult patients with admission diagnosis codes for PD. Included patients were screened for administrations of 27 potentially inappropriate medications and two potentially appropriate medications to be used for comparison. There were 1736 patients who met inclusion criteria with 175 documented administrations of potentially inappropriate medications to 77 patients. Patients who received potentially inappropriate medications had a longer mean duration of stay than the baseline population of PD patients (3.3 days vs. 1.9 days, p-value < 0.001). Despite recommendations to avoid certain medications in PD patients, a substantial number of administrations still occurred. The use of these medications can have clinical implications and our findings demonstrate increases in duration of stay. The findings from this study can assist in developing technological alerts to reduce inappropriate prescribing to PD patients. Larger prospective studies are warranted to further investigate the administration of inappropriate medications to patients diagnosed with PD. Full article
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Open AccessArticle User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen
Received: 11 August 2018 / Revised: 28 August 2018 / Accepted: 11 September 2018 / Published: 13 September 2018
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Abstract
Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community
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Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community pharmacies in Aden city, from the users’ perspective. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. The majority of interviewees were male (n = 11/15) with an age range of 21–40 years. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor. Full article
(This article belongs to the Special Issue Misuse and Abuse of Medicines)
Open AccessArticle What Do Customers Demand from Drug Stores in Japan? Construct Validity and Factor Structure of a Cross-Sectional Survey
Received: 27 July 2018 / Revised: 2 September 2018 / Accepted: 4 September 2018 / Published: 6 September 2018
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Abstract
Studies concerning patient demands are mainly conducted at hospitals and pharmacies, whereas few surveys have been conducted on drug stores. The demand for drug stores is estimated to be increasing with growing needs for self-medication. Thus, conducting a customer survey at drug stores
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Studies concerning patient demands are mainly conducted at hospitals and pharmacies, whereas few surveys have been conducted on drug stores. The demand for drug stores is estimated to be increasing with growing needs for self-medication. Thus, conducting a customer survey at drug stores is thought to be valuable. The aim of the current study was to clarify the structure of customers’ demands for drug stores. The survey was conducted on 190 customers of 19 drug stores in Japan. The questionnaire consisted of 24 items using a 9-point Likert scale. The IBM SPSS Statistics version 23 (IBM Japan, Tokyo, Japan) and Amos version 5 (IBM Japan, Tokyo, Japan) were utilized to perform factor analysis. Gender did not influence the response to each question. Factor analysis showed that the structure of customers’ demands consisted of three factors: (1) an explanation about medicine, (2) staff’s manners, and (3) location of drug stores. Because fit indices suggested a good fit, this three-factor solution was adopted as the final factor structure. This study demonstrated the structure of customers’ demands for drug stores, with the potential for use in promotion of self-medication. Full article
(This article belongs to the Section Pharmacy Education and Student / Practitioner Training)
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Open AccessArticle Eating Disorders in Relationship with Dietary Habits among Pharmacy Students in Romania
Received: 26 July 2018 / Revised: 23 August 2018 / Accepted: 31 August 2018 / Published: 1 September 2018
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Abstract
Changing dietary habits of university students is due to personal, social, educational or religious factors. The relationship between dietary habits and presence of eating disorders among university students is less known in Romania. Material and Methods: Ninety-one pharmacy students (91.21% women) were
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Changing dietary habits of university students is due to personal, social, educational or religious factors. The relationship between dietary habits and presence of eating disorders among university students is less known in Romania. Material and Methods: Ninety-one pharmacy students (91.21% women) were included in the research. Socio-demographic, anthropometric, medical, and psychological data were collected. Dietary self-declared habits were registered. The analysis of data was done using SPSS, v23. Results: A total of 69.2% of students had normal weight, 64.84% preferred to have lunch, and 23.08% eat during nights. The majority of subjects (95.6%), stated that they eat snacks daily. More than one-third of students keep diets to reduce their weight. Younger students tend to eat more main meals per week, snack more, and eat later after getting up in the morning. Subjects with high body dissatisfaction tended to have fewer main meals (r = −0.265, p = 0.011) and to skip breakfasts (−0.235, p = 0.025) and dinners (r = −0.303, p < 0.001). Pharmacy students that presented higher rate of emotional problems tend to sleep less and skip breakfast. Conclusions: Female pharmacy students had higher mean scores on all subscales than those found among Romanian women. A strong relationship between dietary habits and eating disorders was identified. Full article
Open AccessArticle An Investigation into the Quality of Medicines in Yangon, Myanmar
Received: 28 July 2018 / Revised: 23 August 2018 / Accepted: 24 August 2018 / Published: 30 August 2018
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Abstract
Many poor-quality medicines are supplied to patients mainly in developing countries. No systematic survey on counterfeit medicines has been conducted in Myanmar since 1999. The purpose of this study was to investigate the current situation of substandard or counterfeit medicines in Myanmar. Samples
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Many poor-quality medicines are supplied to patients mainly in developing countries. No systematic survey on counterfeit medicines has been conducted in Myanmar since 1999. The purpose of this study was to investigate the current situation of substandard or counterfeit medicines in Myanmar. Samples of oral medicines, cefuroxime axetil (CXM), donepezil hydrochloride (DN) and omeprazole (OM), and injections, ceftriaxone sodium (CTRX), and gentamicin sulfate (GM), were collected from pharmacies, hospitals, and wholesalers in Yangon, Myanmar in 2014. Authenticity and quality were verified. There were 221 (94%) foreign medicines among 235 collected samples. Five samples of GM and 1 DN sample were not registered with the Food and Drug Administration, Myanmar. In quality analysis, 36 samples out of 177 (20.3%) did not pass quantity tests, 27 samples out of 176 (15.3%) did not pass content uniformity tests, and 23 out of 128 samples (18.0%) did not pass dissolution tests. Three of the unregistered GM samples failed in both identification and microbial assay tests. Counterfeit GM is being sold in Yangon. Also, the quality of OM is a matter of concern. Poor-quality medicines were frequently found among the products of a few manufacturers. Regular surveys to monitor counterfeit and substandard medicines in Myanmar are recommended. Full article
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Open AccessReview Patient Safety and Pro Re Nata Prescription and Administration: A Systematic Review
Received: 11 July 2018 / Revised: 20 August 2018 / Accepted: 24 August 2018 / Published: 29 August 2018
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Abstract
PRN is the acronym for ‘pro re nata,’ written against prescriptions whose administration should be based on patients’ needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN
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PRN is the acronym for ‘pro re nata,’ written against prescriptions whose administration should be based on patients’ needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN prescription and administration. Electronic databases including Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically searched to retrieve articles published from 2005 to 2017. Selection criteria: we included all randomized controlled trials (RCTs) and studies with comparison groups, comparing PRN prescription and administration with scheduled administration, where safety issues and adverse events were reported. The authors independently assessed titles, abstracts and full-texts of retrieved studies based on inclusion criteria and risk of bias. Results were summarised narratively. The search identified 7699 articles. Title, abstract and full-text appraisals yielded 5 articles. The included studies were RCTs with one exception, a pre-test post-test experimental design. Patient populations, interventions and outcomes varied. Studies compared patient-controlled or routine administration with PRN and one trial assessed the effect of a practice guideline on implementation of PRN administration. More analgesia was administered in the patient-controlled than the PRN arms but pain reduction was similar. However, there was little difference in administration of psychotropic medicines. No differences between patient-controlled and PRN groups were reported for adverse events. The PRN practice guideline improved PRN patient education but non-documentation of PRN administration increased. This systematic review suggests that PRN safety issues and adverse events are an under-researched area of healthcare practice. Variations in the interventions, outcomes and clinical areas make it difficult to judge the overall quality of the evidence. Well-designed RCTs are needed to identify any safety issues and adverse events associated with PRN administration. Full article
(This article belongs to the Special Issue Patient Safety and Adverse Drug Events in Medication Practice)
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Open AccessArticle Pharmacists’ Activities to Reduce Medication Waste: An International Survey
Received: 26 July 2018 / Revised: 14 August 2018 / Accepted: 23 August 2018 / Published: 29 August 2018
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Abstract
Aim: To identify activities that pharmacists undertake to reduce medication waste, and to assess the extent to which these activities are implemented, their importance for waste-reduction and feasibility for broad implementation. Methods: A two-phase survey was conducted among community and hospital pharmacists working
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Aim: To identify activities that pharmacists undertake to reduce medication waste, and to assess the extent to which these activities are implemented, their importance for waste-reduction and feasibility for broad implementation. Methods: A two-phase survey was conducted among community and hospital pharmacists working in different developed countries. Phase one used an open-ended questionnaire to identify activities undertaken by pharmacists. Answers were thematically analysed to construct a list of medication waste-reducing activities. In phase two, a questionnaire was disseminated among pharmacists from different countries, to assess if these activities are implemented (yes/no), their importance and feasibility (1 to 5 ranking scale). Results: In phase one, 53 pharmacists participated and 14 activities were identified. These were categorized into the pharmaceutical supply chain: prescribing, dispensing (pharmacy/patient-related) and leftover stage. In phase two, 89 pharmacists participated. Most activities were implemented by a minority of pharmacists. Reducing medication amounts in stock was most frequently implemented (dispensing stage pharmacy-related; 86%), followed by collecting unused medications (leftover stage; 77%) and performing a medication review (dispensing stage; 68%). Waste-reducing activities in the dispensing stage activities were both considered most important and feasible (ranked 4). Overall, most activities scored higher on importance than on feasibility. Conclusions: Pharmacists have various opportunities to reduce medication waste throughout the pharmaceutical supply chain, however, not all are broadly implemented. Pharmacists consider waste-reducing activities important, but they are less certain about the feasibility for implementation in practice. Full article
(This article belongs to the Special Issue Medication Wastage)
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Open AccessArticle Outcomes When Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients
Received: 6 August 2018 / Revised: 21 August 2018 / Accepted: 22 August 2018 / Published: 28 August 2018
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Abstract
Objective: Compare the duration of mechanical ventilation between patients receiving sedation with continuous infusions of propofol alone or combination with the use of dexmedetomidine and propofol. Design: Retrospective, propensity matched (1:1) cohort study, employing eight variables chosen a priori for matching. Timing of
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Objective: Compare the duration of mechanical ventilation between patients receiving sedation with continuous infusions of propofol alone or combination with the use of dexmedetomidine and propofol. Design: Retrospective, propensity matched (1:1) cohort study, employing eight variables chosen a priori for matching. Timing of exposure to dexmedetomidine initiation was incorporated into a matching algorithm. Setting: Level 1, university-based, 32-bed, adult, mixed trauma and surgical intensive care unit (SICU). Continuous sedation was delivered according to a protocol methodology with daily sedation vacation and spontaneous breathing trials. Choice of sedation agent was physician directed. Patients: Between 2010 and 2014, 149 SICU patients receiving mechanical ventilation for >24 h received dexmedetomidine with propofol. Propensity matching resulted in 143 pair cohorts. Interventions: Dexmedetomidine with propofol or propofol alone. Measurements and Main Results: There was no statistical difference in SICU length of stay (LOS), with a median absolute difference of 5.3 h for propofol alone group (p = 0.43). The SICU mortality was not statistically different (RR = 1.002, p = 0.88). Examining a 14-day period post-treatment with dexmedetomidine, on any given day (excluding days 1 and 14), dexmedetomidine with propofol-treated patients had a 0.5% to 22.5% greater likelihood of being delirious (CAM-ICU positive). In addition, dexmedetomidine with propofol-treated patients had a 4.5% to 18.8% higher likelihood of being above the target sedation score (more agitated) compared to propofol-alone patients. Conclusions: In this propensity matched cohort study, adjunct use of dexmedetomidine to propofol did not show a statistically significant reduction with respect to mechanical ventilation (MV) duration, SICU LOS, or SICU mortality, despite a trend toward receiving fewer hours of propofol. There was no evidence that dexmedetomidine with propofol improved sedation scores or reduced delirium. Full article
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Open AccessReview Antibiotic Stewardship in Community Pharmacies: A Scoping Review
Received: 31 March 2018 / Revised: 4 August 2018 / Accepted: 14 August 2018 / Published: 23 August 2018
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Abstract
The increase in antibiotic resistance has frequently been linked to unrestrained antibiotic dispensing. This review was conducted to mainly assess the perception and attitudes of community pharmacists towards antibiotic dispensing. This scoping review was performed between June 2016 and September 2016 to identify
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The increase in antibiotic resistance has frequently been linked to unrestrained antibiotic dispensing. This review was conducted to mainly assess the perception and attitudes of community pharmacists towards antibiotic dispensing. This scoping review was performed between June 2016 and September 2016 to identify published studies related to the perception and attitudes of community pharmacists towards antibiotic dispensing. The combination of terms such as ‘antibiotic dispensing’, ‘antimicrobial resistance’, ‘community pharmacy’, and ‘community pharmacists’ were searched in electronic databases such as PubMed, ProQuest, Google Scholar, and Science Direct. Only published articles within the last 12 years were included. A total of 13 studies were identified. In general, community pharmacists have good awareness and knowledge of antibiotic dispensing. However, the majority of them are still selling antibiotics to their customers and/or patients for unjustified reasons. The community pharmacists seem well aware of the antimicrobial resistance crisis and considered it a significant health issue. However, many embraced the concept that dispensing antibiotics without medical prescription (DAwMP) can be one of the key features in the dissemination of multidrug resistant bacteria. Full article
(This article belongs to the Special Issue Impact of Pharmacists in the Community Setting)
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Open AccessBrief Report Evaluation of Home Medication Reconciliation by Clinical Pharmacists for Adult and Pediatric Cystic Fibrosis Patients
Received: 6 August 2018 / Revised: 17 August 2018 / Accepted: 20 August 2018 / Published: 23 August 2018
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Abstract
Medication reconciliation is an important aspect of a patient’s care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered,
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Medication reconciliation is an important aspect of a patient’s care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered, non-controlled, cross-sectional study at four CF Foundation-accredited centers in the United States to evaluate the medication reconciliation process for adult and pediatric CF patients by documenting the number of home medications reconciled by clinical pharmacists and the number of patients with home medications that did not align with the current CF guidelines published in 2013. There were 105 adult patients and 72 pediatric patients included in the study analysis with a mean number of medications reconciled by clinical pharmacists of 17.4 (standard deviation (SD) 6.7) for adults and 13 (SD 4.6) for pediatric patients. The mean number of discrepancies from guidelines per patient was 1.61 (SD 1.2) for adult patients and 0.63 (SD 0.9) for pediatric patients. Pharmacists play an essential role in identifying and managing medication interactions and further research is necessary to investigate pharmacist impact on medication reconciliation. Full article
Open AccessArticle Australian Pharmacists’ Perceptions and Practices in Travel Health
Received: 9 August 2018 / Revised: 14 August 2018 / Accepted: 20 August 2018 / Published: 22 August 2018
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Abstract
Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel
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Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel health for pharmacists in Australia, as well as the perceived barriers, including training needs, for the provision of services. A survey was developed and participation was sought from a representative sample of Australian pharmacists, with descriptive statistics calculated to summarise the frequency of responses. A total of 255 participants, predominantly female (69%), below 50 years (75%) and registered less than 30 years completed the survey. Although over two-thirds (68%) provided travel-related advice in their current practice, the frequency of advice provision was low (less than 2 travellers per week) and limited to responding to travellers questions. Although Australian pharmacists are currently unable to administer travel vaccines and prescription only medications without prescription, they still consider travel health to be an appropriate role and that their clients would seek travel health advice from pharmacies if offered. Currently, key roles for Australian pharmacists are advising travellers who do not seek advice from other practitioners, reinforcing the advice of other health practitioners and referring travellers needing vaccinations and antimalarials. In order to expand these services, the barriers of workload, time, staffing and the need for training in travel health need to be addressed. In summary, the travel health services provided by pharmacies in Australia still have a way to go before they match the services offered by pharmacies in some other countries, however Australian pharmacist are keen to further develop their role in this area. Full article
(This article belongs to the Special Issue Travel Medicine)
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Open AccessArticle Pharmacy Practice and Education in Croatia
Received: 25 July 2018 / Revised: 10 August 2018 / Accepted: 10 August 2018 / Published: 21 August 2018
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Abstract
The PHARMINE (“Pharmacy Education in Europe”) project examined the organisation of pharmacy practice and education in the European Union (EU). An electronic survey was sent out to community, hospital, and industrial pharmacists, and university staff and students. This paper presents the
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The PHARMINE (“Pharmacy Education in Europe”) project examined the organisation of pharmacy practice and education in the European Union (EU). An electronic survey was sent out to community, hospital, and industrial pharmacists, and university staff and students. This paper presents the results of the PHARMINE survey for Croatia. We examined to what extent harmonisation with EU norms has occurred, whether this has promoted mobility, and what impact it has had on healthcare. Full article
Open AccessReview Deprescription in Advanced Cancer Patients
Received: 3 June 2018 / Revised: 15 August 2018 / Accepted: 18 August 2018 / Published: 21 August 2018
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Abstract
The use of multiple drugs is often referred to as polypharmacy, although this term has not been precisely defined. Frequently, drugs are used unwisely in multiple combinations increasing the risk of adverse reactions, or for the long-term prevention of diseases in patients with
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The use of multiple drugs is often referred to as polypharmacy, although this term has not been precisely defined. Frequently, drugs are used unwisely in multiple combinations increasing the risk of adverse reactions, or for the long-term prevention of diseases in patients with a short life expectancy who, therefore, will not benefit from them. The reflection on this has led to the introduction of the concept of deprescription. There are many reasons for the inappropriate drug prescription and barriers to reduce medications. Tools were developed to help prescribers to limit the number of prescribed drugs that patients are taking. Several studies have shown that deprescription of some drugs is possible and safe and can even have a positive influence on wellbeing, cognitive function, falls, and admission to a hospital. Deprescription should be individualized and carried out, as far as possible, in agreement with patients and their families. A six-step method for deprescription is proposed. Full article
(This article belongs to the Special Issue Deprescribing)
Open AccessCommunication A Qualitative Study Exploring the Role of Pharmacists in Medical Student Training for the Prescribing Safety Assessment
Received: 8 June 2018 / Revised: 24 July 2018 / Accepted: 17 August 2018 / Published: 21 August 2018
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Abstract
Five years after the introduction of the Prescribing Safety Assessment (PSA) in the UK, the role pharmacists play to help prepare medical students for this challenge is uncertain. Our study explored pharmacists’ perceptions about their role in undergraduate medical training for the Prescribing
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Five years after the introduction of the Prescribing Safety Assessment (PSA) in the UK, the role pharmacists play to help prepare medical students for this challenge is uncertain. Our study explored pharmacists’ perceptions about their role in undergraduate medical training for the Prescribing Safety Assessment (PSA). One hundred and seventy-nine prospective participants from UK hospitals and education and training boards were emailed an interview schedule aimed at ascertaining their current involvement in undergraduate medical education, particularly the preparation for PSA. Responses received via email were thematically-analysed. A total of 27 hospital pharmacists and 3 pharmacists from local education and training boards participated in the interviews. Pharmacists were positive about their involvement in medical student training, recognising the added value they could provide in prescribing practice. However, respondents expressed concerns regarding resource availability and the need for formal educational practice mentoring. Despite a low response rate (17%), this research highlights the potential value of pharmacists’ input into medical education and the need for a discussion on strategies to expand this role to maximise the benefits from having a pharmacist skill mix when teaching safe prescribing. Full article
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Open AccessCommunication Medication-Related Problems Identified Through Continuous Medication Monitoring
Received: 12 July 2018 / Revised: 13 August 2018 / Accepted: 17 August 2018 / Published: 20 August 2018
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Abstract
Community pharmacists performing Continuous Medication Monitoring (CoMM) systematically monitor each new prescription and refill dispensed for medication-related problems. The objectives for this study were to describe medication-related problems identified through CoMM and drug classes involved in problems. This 12-month pilot study used dispensing
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Community pharmacists performing Continuous Medication Monitoring (CoMM) systematically monitor each new prescription and refill dispensed for medication-related problems. The objectives for this study were to describe medication-related problems identified through CoMM and drug classes involved in problems. This 12-month pilot study used dispensing and clinical records from a single independent U.S. community pharmacy. Clinical records contain medication-related problems documented by the pharmacists. Problems identified for patients filling at least one prescription at the pharmacy and having at least one medication-related problem during the study period were included. A total of 8439 medication-related problems were identified for 1566 patients, an average of 5.4 problems per patient. Over 63% of problems were nonadherence. The drug class most often involved in problems was the central nervous system and analgesic class. Community pharmacists performing CoMM identified medication-related problems that might otherwise have gone undetected. Full article
Open AccessArticle Medication-Related Burden among Patients with Chronic Disease Conditions: Perspectives of Patients Attending Non-Communicable Disease Clinics in a Primary Healthcare Setting in Qatar
Received: 25 June 2018 / Revised: 30 July 2018 / Accepted: 8 August 2018 / Published: 13 August 2018
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Abstract
This study aimed to assess perceived medication-related burden among patients with multiple non-communicable diseases (NCDs) and to investigate the association between perceived burden and adherence to medication therapy. Using a cross-sectional study in three primary care clinics in Qatar, medication-related burden was measured
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This study aimed to assess perceived medication-related burden among patients with multiple non-communicable diseases (NCDs) and to investigate the association between perceived burden and adherence to medication therapy. Using a cross-sectional study in three primary care clinics in Qatar, medication-related burden was measured using the Living with Medicines Questionnaire (LMQ) among adults with diabetes, with or without other comorbidities. Adherence was measured using the Adherence to Refills and Medications Scale (ARMS). Two hundred and ninety-three eligible patients participated in the study. The majority of them reported experiencing minimal (66.8%) to moderate (24.1%) medication-related burden. There was a significant positive correlation between the scores of the LMQ (medication-related burden) and ARMS (medication adherence), rs (253) = 0.317, p < 0.0005. Full article
(This article belongs to the Special Issue The Burden of Medicines)
Open AccessArticle Validation and Feasibility of the Medication Acceptability Questionnaire to Investigate Tablet and Liquid Alendronic Acid with Older Hospital Patients
Received: 17 May 2018 / Revised: 13 July 2018 / Accepted: 9 August 2018 / Published: 11 August 2018
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Abstract
The effects of formulation characteristics on acceptability are poorly understood. This study evaluated the validity and feasibility of using the Medication Acceptability Questionnaire (MAQ) to investigate factors influencing acceptability of tablet compared with liquid alendronic acid. Written consent was obtained from eligible patients
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The effects of formulation characteristics on acceptability are poorly understood. This study evaluated the validity and feasibility of using the Medication Acceptability Questionnaire (MAQ) to investigate factors influencing acceptability of tablet compared with liquid alendronic acid. Written consent was obtained from eligible patients on Older People’s Medicine wards. MAQ face and content validity were evaluated through cognitive interviews while internal consistency and criterion validity were investigated by calculating Cronbach’s alpha and correlation of MAQ items with visual analogue scale (VAS) responses. MAQ data were obtained from 33 and 25 participants for tablet and liquid formulations respectively. Cognitive interviews indicated MAQ face and content validity. The domains of appearance, efficacy, and tolerability demonstrated adequate internal consistency and suitable refinements were identified for the domains of convenience and taste with Cronbach’s alpha <0.7. Significant positive correlations were identified between all MAQ domains and VAS. The liquid trended towards performing better for taste, appearance and tolerability and the tablet for convenience and efficacy. It is feasible to capture patient acceptability of a medication by questionnaire. Interpatient variation in acceptability for two formulations indicates that medication characteristics should be considered during prescribing and medication reviews to match patient preference with the appropriate formulation. Full article
(This article belongs to the Special Issue Medication Adherence)
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Open AccessArticle Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines
Received: 24 June 2018 / Revised: 25 July 2018 / Accepted: 30 July 2018 / Published: 10 August 2018
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Abstract
Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to
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Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines. Full article
Open AccessArticle Training Needs of Manitoba Pharmacists to Increase Application of Assessment and Prescribing for Minor Ailments into Practice: A Qualitative and Quantitative Survey
Received: 21 June 2018 / Revised: 30 July 2018 / Accepted: 1 August 2018 / Published: 4 August 2018
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Abstract
Current literature demonstrates the positive impact of pharmacists prescribing medication on patient outcomes and pharmacist perceptions of the practice. The aim of this study was to understand the factors affecting prescribing practices among Manitoba pharmacists and identify whether additional training methods would be
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Current literature demonstrates the positive impact of pharmacists prescribing medication on patient outcomes and pharmacist perceptions of the practice. The aim of this study was to understand the factors affecting prescribing practices among Manitoba pharmacists and identify whether additional training methods would be beneficial for a practice behavior change. A web-based survey was developed and participation was solicited from pharmacists in Manitoba. Descriptive statistics were calculated to summarize the frequency of demographic characteristics. Chi-square tests were used to explore possible correlations between variables of interest and thematic analysis of qualitative data was completed. A total of 162 participants completed the survey. The response rate was 12.3%. Of those who had met the requirements to prescribe, none were doing so on a daily basis and 23.5% had not assessed or prescribed since being certified. Respondents identified the top barriers for providing this service as a lack of sufficient revenue and a lack of time. Qualitative analysis of responses identified additional barriers including a limiting scope and inadequate tools. Approximately half (54.4%) of respondents expressed that additional training would be of value. The themes identified from the survey data suggest that practice-based education would help pharmacists apply skills. In addition, expansion of prescribing authority and strategies addressing remuneration issues may help overcome barriers to pharmacists prescribing within Manitoba. Full article
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Open AccessArticle A Randomized Crossover Comparison between Team-Based Learning and Lecture Format on Long-Term Learning Outcomes
Received: 6 July 2018 / Revised: 31 July 2018 / Accepted: 2 August 2018 / Published: 4 August 2018
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Abstract
There are limited data evaluating the effectiveness of different teaching pedagogies to maintain gains in learning achieved over the short term. The purpose of this study is to compare long-term learning outcomes between two different teaching pedagogies, team-based learning (TBL) and lecture. Within
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There are limited data evaluating the effectiveness of different teaching pedagogies to maintain gains in learning achieved over the short term. The purpose of this study is to compare long-term learning outcomes between two different teaching pedagogies, team-based learning (TBL) and lecture. Within a therapeutic elective course a randomized crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). Six months following completion of the course, 47 assessment questions (application and recall multiple-choice questions) were re-administered to 16 students from the class with no prior announcement of the assessment. The results showed no significant difference in long-term assessment scores between TBL and lecture formats (67 ± 14% vs. 63 ± 16%, p = 0.2, respectively). In addition, there was a significant (p < 0.0001) and similar decline in short-term gains for TBL (90 ± 9% vs. 67 ± 14%) and lecture (86 ± 11% vs. 63 ± 16%) in assessment scores. In conclusion, there was no advantage gained by employing an active-learning pedagogy when assessing multiple-choice questions six months following end of a therapeutics course in a limited sample size. Neither pedagogy was able to maintain short-term gains in learning outcomes as assessed by multiple-choice questions. Full article
(This article belongs to the Section Pharmacy Education and Student / Practitioner Training)
Open AccessArticle Impact of Clinical Decision Support on Time to Order Resolution for Patients with Documented Allergies
Received: 18 June 2018 / Revised: 26 July 2018 / Accepted: 27 July 2018 / Published: 3 August 2018
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Abstract
Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017,
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Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was –21 min (95% CI (confidence interval), –39 to –2.9; p = 0.02). The difference in median time to order resolution for orders, based on pharmacist work shift was, –21 min for the first shift (95% CI, –41.2 to –0.8; p = 0.04), –50 min for the second shift (95% CI, –109.8 to 9.8; p = 0.10), and +3 min for the third shift (95% CI, –36.1 to 30.1; p = 0.85). Orders with an allergy intervention by a pharmacist were 2.75 times more likely (adjusted odds ratio = 2.75; 95% CI, 0.98 to 7.7; p = 0.06) to have a therapy change than orders without allergy interventions. Based on the results, when information about antibiotic allergies lacks details, it takes more time for pharmacists to resolve alerted orders. Full article
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Open AccessEditorial Qualitative Methods in Pharmacy Research
Received: 25 July 2018 / Accepted: 27 July 2018 / Published: 2 August 2018
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Abstract
Over the past years, there has been an increase in the use of qualitative methods in health services research, including pharmacy research. Pharmacy practice researchers can use these methods to understand, explain, discover, and explore both patients’ and health care practitioners’ thoughts, perceptions,
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Over the past years, there has been an increase in the use of qualitative methods in health services research, including pharmacy research. Pharmacy practice researchers can use these methods to understand, explain, discover, and explore both patients’ and health care practitioners’ thoughts, perceptions, and feelings. Qualitative research can also be used for the “democratisation” of research methods through research that is inclusive, collaborative, and involves partnerships and co-production. There is a wide spectrum of qualitative research methods that might be used in pharmacy research. This Special Issue showcases five articles in different settings and countries with diverse participants that seek to develop, explore, describe, and identify. These articles provide further insights into important pharmacy questions with the ultimate goal of helping improve health and well-being. Full article
(This article belongs to the Special Issue Qualitative Methods in Pharmacy Research)
Open AccessArticle An Opportunity for Pharmacists to Help Improve Coordination and Continuity of Patient Health Care
Received: 25 April 2018 / Revised: 18 June 2018 / Accepted: 30 June 2018 / Published: 1 August 2018
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Abstract
Pharmacist workforce researchers are predicting a potential surplus of pharmacists in the United States that might result in pharmacists being available for engagement in new roles. The objective for this study was to describe consumer opinions regarding medication use, the health care system,
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Pharmacist workforce researchers are predicting a potential surplus of pharmacists in the United States that might result in pharmacists being available for engagement in new roles. The objective for this study was to describe consumer opinions regarding medication use, the health care system, and pharmacists to help identify new roles for pharmacists from the consumer perspective. Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Out of the representative sample of 36,673 respondents living in the United States, 80% (29,426) submitted written comments at the end of the survey. Of these, 2178 were specifically about medicines, pharmacists or health and were relevant and usable for this study. Thematic analysis, content analysis, and computer-based text mining were used for identifying themes and coding comments. The findings showed that 66% of the comments about medication use and 82% about the health care system were negative. Regarding pharmacists, 73% of the comments were positive with many commenting about the value of the pharmacist for overcoming fears and for filling current gaps in their healthcare. We propose that these comments might be signals that pharmacists could help improve coordination and continuity for peoples’ healthcare and could help guide the development of new service offerings. Full article
(This article belongs to the Special Issue The Labor Market for Pharmacists)
Open AccessArticle An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure
Received: 14 June 2018 / Revised: 21 July 2018 / Accepted: 24 July 2018 / Published: 26 July 2018
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Abstract
Aim: To develop and validate a procedure for self-management of medication by patients whilst in hospital. Background: Self-management of medication allows patients to self-manage their medication in a controlled and supportive hospital environment. This practice is encouraged worldwide, yet an evidence-based procedure to
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Aim: To develop and validate a procedure for self-management of medication by patients whilst in hospital. Background: Self-management of medication allows patients to self-manage their medication in a controlled and supportive hospital environment. This practice is encouraged worldwide, yet an evidence-based procedure to evaluate the ability of patients to self-manage and to monitor and support self-management are absent. Methods: The evidence-based procedure for self-management of medication (SelfMED) was developed based on previous conducted qualitative research, literature review, and the current regulation. It was validated by healthcare providers and a multidisciplinary expert meeting. Questions within the procedure that could be biased were tested for inter-rater reliability. Results: First, the SelfMED procedure was developed. It consists of a stepped assessment of patient’s competencies for self-management performed by healthcare providers and the patient. When self-management is allowed, the SelfMED monitoring tool monitors the patient’s intake of self-managed medication. Secondly, the procedure was revised for clarity, appropriateness, and face validity by five healthcare providers and a multidisciplinary expert meeting, resulting in the final version. Thirdly, three questions from the final version were tested for interrater reliability. Cohen’s Kappa showed moderate to strong levels of agreement. Conclusions: The developed SelfMED procedure provides an evidence based approach of facilitating self-management of medication. The content of the procedure was found valid to evaluate the patient’s ability to self-manage and to monitor them while self-managing. Full article
Open AccessArticle Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing
Received: 1 June 2018 / Revised: 14 July 2018 / Accepted: 18 July 2018 / Published: 25 July 2018
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Abstract
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence
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Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%–99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients. Full article
(This article belongs to the Special Issue Deprescribing)
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Open AccessCommunication A Questionnaire Study to Investigate Stress among Future Pharmacists by Gender and Year Group
Received: 25 June 2018 / Revised: 14 July 2018 / Accepted: 22 July 2018 / Published: 25 July 2018
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Abstract
Background: This work aimed to ascertain future pharmacists’ stressors and stress-coping practices. Methods: Queens’ University Belfast Year 2 and 4 pharmacy students were invited to participate in an ethically approved, pre-piloted questionnaire study. Section A was the 10-item Perceived Stress Scale, Sections B
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Background: This work aimed to ascertain future pharmacists’ stressors and stress-coping practices. Methods: Queens’ University Belfast Year 2 and 4 pharmacy students were invited to participate in an ethically approved, pre-piloted questionnaire study. Section A was the 10-item Perceived Stress Scale, Sections B and C related to stressors and stress-coping mechanisms, and Section D gathered non-identifiable demographic information. Data analysis largely took the form of descriptive statistics. Results: A response rate of 94.2% (213/226) was obtained. The mean Perceived Stress Scale score was 19.94 [standard deviation (SD) 6.37], with females having a higher mean score than males (20.55 SD 5.67 versus 18.16 SD 7.42). Common general stressors were career choice, employment opportunities, and finance. Common degree-specific stressors were particular assessments (objective structured clinical examinations and one-off written examinations) and the amount of course material. Popular stress-coping practices included getting emotional support from friends and family and using self-distractions. Conclusion: Stress appears to be an issue among these future pharmacists, and potentially more so for females. While the main stressors are unsurprising, this UK data enables comparisons to be made and helps inform support mechanisms within the university. Full article
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Open AccessCommunication Pilot Study on the Utility and Feasibility of a House-Call Checkup of the Medicine Cabinet
Received: 7 June 2018 / Revised: 5 July 2018 / Accepted: 20 July 2018 / Published: 24 July 2018
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Abstract
The storage at home of medicines is a poorly researched topic, but it can be a major source of medication errors and other unsafe practices. In this pilot-study, we wanted to get an idea of the scope of the problem and research the
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The storage at home of medicines is a poorly researched topic, but it can be a major source of medication errors and other unsafe practices. In this pilot-study, we wanted to get an idea of the scope of the problem and research the feasibility and acceptability of a home-based intervention by a pharmacist. In a convenience sample of 48 households, we encountered numerous problems in a sizable percentage of households. Medicines were frequently not stored out of reach of children, usage instructions and indications were unknown, organization was absent, and there were a plethora of expired medicines present. Refrigeration was less of a problem. Acceptability and perception of utility of the intervention were generally very high. We developed a protocol-based intervention to be used in future research to increase the safe use of medicines at home. Full article
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Open AccessArticle Young Muslim Women Living with Asthma in Denmark: A Link between Religion and Self-Efficacy
Received: 28 May 2018 / Revised: 18 July 2018 / Accepted: 19 July 2018 / Published: 23 July 2018
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Abstract
Asthma is a chronic respiratory disease that can be controlled with appropriate medicinal treatment. Adherence to pharmacological treatment is therefore critical. Self-efficacy plays a key role in adherence to medicine in chronic diseases, including asthma. Additionally, ethnic minorities have poor adherence to medicines.
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Asthma is a chronic respiratory disease that can be controlled with appropriate medicinal treatment. Adherence to pharmacological treatment is therefore critical. Self-efficacy plays a key role in adherence to medicine in chronic diseases, including asthma. Additionally, ethnic minorities have poor adherence to medicines. However, the impact of religion on self-efficacy and adherence is understudied. Therefore, the aim of this study was to explore the role of self-efficacy in adherence to asthma medicine treatment and the influence of religion on self-efficacy among young, Muslim minority women. A focus group and individual interviews with 10 Muslim minority women (14–24 years of age) living in Denmark were conducted. Data analysis was deductive using Bandura’s theory of self-efficacy and modes of agency. Overall, religion was shown to affect self-efficacy. The women reported changes in self-perceived self-efficacy during the holy month of Ramadan. In addition, praying was used as an alternative to medicine for controlling asthma symptoms. However, the women did not perceive religion and treating asthma with medicine as mutually exclusive, but rather as coexisting for the shared goal of controlling asthma symptoms. It is important for healthcare professionals (HCPs) to be aware of the link between self-efficacy, religion and adherence to asthma medicine treatment. This awareness can aid HCPs in giving advice regarding adherence to asthma treatment, and when monitoring treatment to improve the quality of asthma care for young Muslim minority women. Full article
(This article belongs to the Special Issue Medication Adherence)
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