Pharmacy — Open Access Journal of Pharmacy Education & Practice

New tasks are being developed for pharmacy technicians in community practice. The objectives of this study were to (1) assess the willingness of community pharmacy technicians to perform new tasks, and (2) to identify factors affecting technicians in assuming new tasks in community pharmacy practice. An online survey asked about the respondent characteristics, involvement in pharmacy technician tasks, willingness to perform emerging pharmacy technician tasks, and influences on pharmacy technicians’ performance of emerging tasks. Descriptive statistics were calculated for all items. A total of 639 usable surveys from community pharmacy technicians were used in the analyses. The respondents reported a mean of 11.5 years working as a pharmacy technician, with 79.2% working full time. Technicians reported high willingness to perform four emerging tasks, moderate willingness for six tasks, and low willingness to perform two tasks. The low willingness tasks were administering a vaccination and drawing a blood sample with a finger stick. Four workplace influences on willingness to perform emerging tasks were insufficient staffing, insufficient time to complete additional tasks, employers not classifying technicians based on specialized skills, and usually feeling stress at work. It appears likely that pharmacy technicians will be willing to perform the new tasks needed to support the emerging patient care services in community pharmacies. Full article

There is an imminent need to identify and develop new ambulatory care practice sites with the increase in the number of colleges of pharmacy across the nation. This manuscript provides recommendations to help clinical faculty determine whether a potential pharmacy practice site will be able to provide adequate resources and support to establish a successful practice. This may be challenging to pharmacy practice faculty in settings where clinical pharmacy services have never been utilized. Topics include the pre-work needed prior to approaching a new practice site, assessing the need for physical requirements, meeting key personnel, marketing clinical skills and services, implementing, and evaluating practice site. Preparation includes having a clear vision of the pharmacist services, ensuring that stakeholders have an understanding of the pharmacy services inquiring the site support and resources for the pharmacist, and regularly communicating. Full article

Teicoplanin is now increasingly used as a first-line prophylactic therapy for major surgical procedures, treatment of methicillin-resistant Staphylococcus aureus infections and for those with reported penicillin allergy. Teicoplanin is rarely associated with anaphylaxis and there is limited information on the prevalence of teicoplanin-induced perioperative anaphylaxis. Here, we describe a case of a 12-year-old child with teicoplanin-induced anaphylaxis peri-operatively. Full article

Background: This study aims to evaluate the inter-rater reliability and perceived usability of a newly developed drug-related problem (DRP) classification system for use by pharmacists in the intermediate and long-term care (ILTC) setting in Singapore. Methods: This was a cross-sectional survey study involving the use of a self-administered questionnaire. All 55 pharmacists affiliated to the Pharmaceutical Society of Singapore (PSS) ILTC Pharmacists Workgroup who were above 21 years old and not authors of the classification system were invited to participate. The inter-rater reliability of participants’ classification of 46 mock DRP cases using the new DRP classification system was determined using Fleiss’s kappa (κ). Participants’ perceived usability of the classification system was evaluated using six items with five-point Likert scales (1—“strongly disagree”, 5—“strongly agree”). Results: Thirty-three pharmacists responded to the survey. Overall inter-rater reliability was found to be substantial (κ = 0.614; 95% CI: 0.611–0.617). All usability items received positive ratings (“strongly agree” or “agree”) from at least 69% of participants. Conclusion: The new DRP classification system has substantial external validity and appears to be suitable for use by pharmacists to document and report DRPs in the ILTC setting in Singapore and facilitate evaluation of the impact of pharmaceutical care in the ILTC setting. Full article

Hospital-based adverse drug reaction (ADR) monitoring and reporting programs intend to identify and quantify the risks associated with the use of medicines. To examine the causality, preventability and severity of ADR in a hospital setting; a prospective cohort study on spontaneous ADR reporting was conducted from December 2015 to May 2016. Incidence of ADRs, causality, type, severity and preventability were assessed using necessary assessment scales. The study included 3157 hospitalized individuals, in whom 51 ADRs were detected among 49 patients. The overall incidence of suspected ADRs was found to be 1.6%. According to the causality assessment, most of the ADRs reported were probable (n = 26, 51.0%), and type A (augmented/pharmacological) reactions (n = 39, 76%) were the most common type of ADR found. The majority of ADRs were moderate to severe (n = 35, 68.6%), of which 37.3% were found to be potentially preventable. Predictability was observed in 28 (54.9%) reported ADRs. The prescribed medicines most frequently associated with ADRs were antibiotics, antiepileptics and antihypertensives. This feasibility study was able to highlight the clinical pharmacist’s role in ADR monitoring service and create awareness about the way it could be done to promote safer medication use. Similar ADR reporting programs are necessary to educate and to improve awareness among healthcare professionals in some countries. Full article

The number of transgender and gender-diverse patients seeking medical care in the United States is increasing. For many of these patients, pharmacotherapy is a part of their gender-affirming transition. Effective instructional methods and resources for teaching pharmacy students about this patient population’s social considerations and medical treatments is lacking. Three hours of educational material on caring for transgender patients was added to a third-year course in a four-year Doctorate of Pharmacy program in the United States. The content included cultural, empathy, and medical considerations. Students in the course were given a survey to assess their perception of each instructional method’s effectiveness and self-assess their confidence in providing competent gender-affirming care to transgender people before and after the learning session. The survey response rate was 36% (54/152). Students’ self-assessed confidence to provide competent care to people who are transgender increased significantly. Before the learning session, the median confidence level was 4/10 (Interquartile range (IQR) 3–6), after the class session, the median confidence increased to 7/10 (IQR 6–8, p < 0.01). Students rated the pre-class video, jeopardy game, and patient panel as most helpful to improving their skills. The addition of transgender-related patient care material into the Doctorate of Pharmacy curriculum significantly increased the students’ confidence to provide competent care to people who are transgender. Full article

Introduction: The correct use of a prescribed inhaler device is crucial for achieving successful disease management in asthma. This study investigates non-verbal, demonstrational videos as a method of teaching inhaler naïve individuals how to use a dry powder inhaler (DPI). Methods: Video instructions for four DPIs were examined using a mixed methodology; 31 inhaler-naïve individuals participated in the study. Participants were each shown a demonstrational video of one the four inhalers, after each video the participant demonstrated how they would use the inhaler. After demonstrating the use, participants crossed over to the next inhaler. The demonstrations were videotaped. A common questionnaire was filled at the beginning of the study and four inhaler-specific questionnaires which were filled out by the participant after each inhaler demonstration. Results: The frequency of participant error varied between inhalers. When asked about how they perceived the video instructions, participants often stated they would have liked to receive feedback on their performance. The importance of feedback was further highlighted by the fact that participants tended to overestimate their own inhaler technique. Conclusion: Non-verbal videos may be more efficient for some DPIs than for others as a method for providing inhaler instructions. Lack of feedback on the participants’ inhaler performance emerged as a clear shortcoming of this educational method. Some steps in the inhalation process may be harder for individuals to remember and therefore require extra emphasis in order to achieve correct inhaler technique. Full article

A recent article in the Canadian Journal of Hospital Pharmacy discussed pharmacists’ perception of clinical research. The article illustrated that pharmacists lack the time, resources, and skills to conduct research. In the current paper, two ex-pharmacists, who now work as physicians, commented on the prejudice towards pharmacy researchers. Pharmacy researchers face obstacles such as being mislabeled as “non-clinical” and lacking opportunities to be involved in high-impact publications. The current paper discussed ways to improve pharmacy research, including collaboration with well-established researchers, putting less emphasis on the “clinical” pharmacist title, and changing the pharmacy culture. Full article

Background: The field of Pharmacy education is experiencing a paucity of underrepresented minorities (URMs) faculty worldwide. The aim of this study is to investigate the current professional status of Chinese-origin pharmacy faculty members, who are considered as a good model of URMs at pharmacy academia in western countries, and identify the influencing factors to their academic career progression in academic careers. Methods: An online questionnaire was sent to Chinese-origin academic staffs at pharmacy schools in US, UK, Canada, Australia, and New Zealand. The survey comprised demographic information, educational background, and the influencing factors to academic career progression. Results: The vast majority of Chinese faculty members who worked in US were male. Individuals with junior academic title comprised the largest proportion. Over 75% of Chinese-origin pharmacy academics were involved in scientific disciplines (e.g., pharmaceutics, pharmacology, and medicinal chemistry). Usually, Chinese-origin academic members spent 4 years obtaining their first academic jobs after finishing PhD degree, and need 5–6 years to get academic promotion. The contributing factors of academic promotion were high quality publications and external funding. Conclusion: Our research offers a deep insight into academic career progression for URMs and give some valuable advice for their pharmacy academic paths. Full article

Background: Bacterial resistance is a major public health problem worldwide. One solution to this scourge is to sensitize the general public on rational use of antibiotics. Our goal was to assess people’s knowledge and opinions about antibiotic use and bacterial resistance in an urban setting. Method: We performed a cross-sectional study. A convenience sampling was done. A questionnaire was administered to 400 persons during face-to-face interviews. Results: Most respondents thought that antibiotics are effective against colds/flu (69.8%), cough (72.3%) and sore throat (64.4%). At the same time, 42.8% stated that antibiotic therapy can be stopped as soon as the symptoms disappear. Only 8.8% and 41.8% of people knew that handwashing and vaccination prevented bacterial resistance. Globally, 7% of people had a good knowledge. Socio-demographic variables were not associated with the level of knowledge. The main sources of information were entourage and pharmacy staff. Regarding the opinions, 78.3% of surveyed participants the people thought that that people overuse antibiotics. Additionally, 28% said that they have no role to play against bacterial resistance. Conclusion: People living in an urban setting had a low knowledge about antibiotic use and bacterial resistance. There is a need to implement awareness campaigns. Further studies on population practices toward antibiotic use are necessary. Full article

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

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

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

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

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

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

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

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