bluuebunny/crossref_metadata_2025 huggingface dataset:
The ABC of New Zealand's Ten Year Vision for Pharmacists: awareness, barriers and consultation
Authors: Scahill Shane , Harrison Jeff , Sheridan Janie
Published: October 2010

Objectives

This study aimed to determine New Zealand pharmacists' awareness of, recall of consultation about, and potential barriers to the implementation of the Focus on the Future: Ten Year Vision for Pharmacists in New Zealand: 2004–2014 document.

Method

A national postal survey was carried out in New Zealand of practising pharmacists registered with the Pharmacy Council of New Zealand (n = 1892). The survey was conducted between September and December 2006.

Key findings

The response rate was 51.8% (n = 980 usable surveys). Approximately three-quarters (73.4%) reported being aware of the 10-year vision document and 40.9% recall being consulted. Fewer than one-third (29.8%) had read the document prior to completing the survey. Thirty-two variables describing potential barriers to implementing the 10-year vision were reduced, through factor analysis, to seven factors with significant eigenvalues (>1.0). The factors describe the underlying themes of barriers identified in the survey, including pharmacist humanistic, integrated systems of care and teamwork, funder stakeholder relationships and remuneration, lack of appreciation of knowledge and skills, lack of research support, current expertise and continuing professional development, and lack of voice. The majority of barrier variables within the seven factors were rated as extremely or quite important.

Conclusions

There was a high level of awareness and moderate level of recall of consultation on the document among respondents. Although 40% recall being consulted on the document, fewer than one-third reported having read the document prior to completing our survey. Pharmacists highlighted a significant number of potential barriers to the implementation of the 10-year vision. If the pharmacy profession in New Zealand is to move forward towards the state described in the 10-year vision document then these potential barriers need to be better understood and addressed.
Language issues in the community pharmacy: A perspective from Wales
Authors: Hughes M Louise , John Dai N , Jones Arwyn T , Jones Elen H , Wilkins M Lowri
Published: October 2010

Objectives

This study aimed to obtain the views of Welsh speakers to explore the role of the Welsh language in community pharmacies in bilingual communities in Wales.

Methods

Two communities with a high proportion of Welsh speakers were purposively identified for the research: one in North Wales and one in West Wales. Stage 1: semi-structured interviews with a purposive sample of Welsh speakers to identify key themes. Data collection continued until no new themes emerged. Interviews were tape-recorded, transcribed verbatim, coded manually and analysed thematically. Stage 2: self-complete questionnaire developed based on the interview results. The anonymous, bilingual questionnaire and covering letter, with a postage-paid envelope, were delivered to 500 homes (250 in each community) for completion by the person in the household who visited a pharmacy most often. There was no follow-up mailing due to anonymity. Data were analysed using SPSS version 12.

Key findings

Results from both interviews (n = 36) and questionnaires (response rate was 52%, 82% of whom were Welsh speakers) found that the majority of Welsh speakers in the study were able to understand English but preferred to use Welsh in the pharmacy. They would find it easier to explain symptoms and would ask more about their medication if they could speak Welsh with the pharmacist. In addition, the study participants would generally feel more at ease with a Welsh-speaking pharmacist and would feel they were getting a better service if they could use their first language.

Conclusions

This study of Welsh speakers indicates that language choice is important for bilingual people who may prefer to use their native, minority language for consultation with health professionals. Further, it is clear that a concordant partnership between patient and pharmacist is less likely where one party is using a language with which they are not confident or comfortable. Pharmacists need to be aware of the linguistic needs and preferences of bilingual clients.
What factors affect medication-storage practice among patients on methadone maintenance treatment?
Authors: Williams Nigel , Robertson James , McGorm Kelly , Roberts Kay , Elton Rob
Published: October 2010

Objectives

Medication storage in patients' homes is an important safety issue. Safe storage of methadone oral solution is of particular concern. Previous studies have suggested that only about half of patients store methadone appropriately. The aims of this study were to describe medication-storage practice in a sample of patients receiving methadone maintenance treatment (MMT), and to identify factors associated with safe storage.

Methods

The setting was a primary health care centre in Edinburgh, Scotland. One hundred and four consecutive patients on MMT completed a self-administered questionnaire covering medication-storage practice, together with clinical and demographic variables. Storage of medication was classified as ‘acceptable’ if medication was out of sight and out of reach of children, and ‘optimal’ if it was also kept in a secure container.

Key findings

Percentages (95% confidence intervals) for acceptable and optimal storage were as follows: methadone 80% (71–86%) and 33% (24-12%); other prescribed medication 69% (59–78%) and 27% (19–37%); purchased medication 64% (50–76%) and 28% (17–42%). Safe storage of methadone was more common in patients taking higher doses of methadone (P = 0.004 for acceptable storage, and P = 0.012 for optimal storage), and in those with children in the house (P = 0.007 and 0.061). Safe storage of prescribed and purchased medication was strongly associated with safe storage of methadone (P < 0.01 in both cases).

Conclusions

Medication-storage practice was better than in previous surveys of patients on MMT. This may reflect the high profile given to safety issues for children of drug-using parents in Scotland, as well as local initiatives. Some aspects of prescribing and dispensing practice could be improved further.
Legal issues in prescription writing: A study of two health institutions in Nigeria
Authors: Erhun Wilson O , Adekoya Olalekan A , Erhun Mercy O , Bamgbade Olukemi O
Published: October 2010

Objectives

This study examined the degree of deviation (from both World Health Organization (WHO) specifications and the particular institution's specifications) on the part of prescribers in adequately filling prescription forms and the legal implications of such deviations for the prescriber and the institution.

Methods

The study was carried out at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) and Obafemi Awolowo University Health Centre, Ife-Ife, Nigeria. The Teaching Hospital is a 1000-bed tertiary health care facility that serves as a training centre for health professionals. The Health Centre is a 25-bed health care facility. A random sample of prescriptions received from the Pharmacy Department of the OAUTHC and the Obafemi Awolowo University Health Centre were analysed.

Key findings

For the Teaching Hospital, the prescriber's name and signature were on 80 and 96% of the prescriptions, respectively, whereas all prescriptions from the Health Centre contained this information. For the Teaching Hospital, 100, 1.8, 93.8 and 98.4% of prescriptions contained the patient's name, address and age, and the date, respectively, whereas 99.6, 86.4 and 99.9% of prescriptions from the Health Centre contained patient code number, age and the date respectively. The precentages of completely filled prescriptions for the Teaching Hospital and the Health Centre were 1.3 and 85.9% respectively. Prescription patterns for the major drug classes in both institutions were compared and related to the level of deviation from the ideal prescription-writing specifications of the WHO.

Conclusions

The legal implications of non-compliance with WHO standards in prescription writing are discussed, with appropriate recommendations.
Differences in attitudes towards medication between population groups in the Durban Metropolitan Area of South Africa
Authors: Suleman Fatima , Ally Shabnam , Bayat Samirah , Essack Razia , Moodley Renalda , Mtembu Thobekile , Ramalingham Emily
Published: October 2010

Objectives

Personal factors, especially attitude, have been implicated in the utilization of health care services, and in access to medical treatment. There is little information on the attitudes of the general public in South Africa towards medications and whether attitudes differ across population groups or among the different users of the health care system. This study aimed to determine the general attitude of a local population to medications, self-care orientation and health professional contact, and whether differences existed between age groups, gender and race groups.

Methods

We carried out a randomized, cross-sectional quantitative study via telephonic questionnaire survey (adapted from a previous study) of a sample of 1132 telephone numbers. The setting was the Durban Metropolitan Area, KwaZulu-Natal, South Africa. Key findings A total of 500 (44.2%) people responded. The majority had a positive attitude towards medication. An increase in age resulted in increased medication use. Females were more likely than males to use medication and seek professional health care (P = 0.0406). Most of the respondents (86.0%) were self-care-orientated and displayed moderate medication knowledge (46.2%). Some 295 (59.0%) of the 500 respondents had visited a pharmacy within the last 6 months.

Conclusions

Health care professionals can adopt an informed approach to address the needs of the population with regard to medication, by targeting groups more likely to use medication (females and the older age group). In addition, gaps in medication knowledge were identified which could be used for health-promotion interventions by health care workers.
Accuracy of drug-allergy recording in a District General Hospital
Authors: Gay Kathryn J , Hill Christopher , Bell Thomas
Published: October 2010

Objectives

The aim was to audit the accuracy of drug-allergy documentation in a District General Hospital.

Methods

A drug card and case-note review was used. The subjects of the study were 117 medical and surgical current inpatients in a District General Hospital. Outcome measures were information collected, including whether the drug hypersensitivity box was filled in on the drug card, what was written in the box and whether this was signed and dated. The information on drug allergies was then checked with the patients. The medical notes were audited for a completed ALERT sheet and its accuracy.

Key findings

Sixty-nine patients in this study were on surgical wards, and 48 were on medical wards. Some 97.4% had the drug-allergy box on the drug card filled in to some extent, and only three (2.6%) had nothing documented. Including those boxes that were blank, 32 (27.4%) were signed and 22 (18.8%) were dated. Twelve patients (10.3%) stated that the allergy information recorded about them was incorrect. The ALERT forms in the medical notes were only filled in on 58.1% of occasions (i.e. they had a patient addressograph label), and of those that were completed, 36.5% did not match the information on the drug card.

Conclusions

Although doctors ask about drug allergies, documentation is not done well for a number of reasons, including the design of the drug card. Currently there is a blank allergy box with no guidance about what should be written there. The new drug card to be introduced in the next few months will distinguish between true drug allergies and side effects. It will also prompt the nature of the allergy to be documented, from whom this information was obtained, and the signature of the person filling in the information. Failure to accurately document drug allergies leads to the potential for doctors to prescribe medication that could be harmful for the patient.
Patients' preferences for an increased pharmacist role in the management of drug therapy
Authors: Tinelli Michela , Ryan Mandy , Bond Christine
Published: October 2010

Objectives

This study investigated patients' preferences for an innovative combined prescribing-and-dispensing role for pharmacists in the management of drug therapies, compared to the more traditional dispensing-only role.

Methods

The project was a cross-sectional study. A structured self-completed Discrete Choice Experiment questionnaire was administered to a sample of patients aged over 18 years waiting to see their doctor at the surgery. Respondents compared the proposed combined innovative service with both their ‘current’ service and a ‘dispensing-only pharmacist’ service. Analyses were initially conducted for all respondents and then repeated excluding those with constant preferences (i.e. those who always chose the same option). The setting was two general practices in Aberdeen, Scotland.

Key findings

We approached 244 people and 204 returned an evaluable questionnaire. Everything else being equal, respondents preferred their ‘current’ service to either the proposed combined prescribing-and-dispensing role or a dispensing-only service. However, those without constant preferences, who were mostly younger, preferred the combined service, where a pharmacist both prescribed and dispensed.

Conclusions

Patients value input from their pharmacists, but are resistant to change and prefer their current situation. However, younger people are more willing to trade between alternatives, and preferred the innovative combined prescribing-and-dispensing service. Changes in the pharmaceutical service could be supported by the public. The Discrete Choice Experiment approach is considered a useful tool for evaluating preferences for alternative pharmacy services.
The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia
Authors: Siow Jing Yong , Lai Pauline Siew Mei , Chua Siew Siang , Chan Siew Pheng
Published: October 2010

Objectives

In recent years, the usage of activated vitamin D (α-calcidol and calcitriol) in the University Malaya Medical Centre (UMMC) has escalated and this has put unnecessary burden on the hospital's limited health care budget. The main aim of this study was to determine the effects of a clinical pharmacist's intervention in reducing the inappropriate use of activated vitamin D.

Methods

Data were collected retrospectively. Pre-intervention data were obtained from records of the previous year's use of activated vitamin D. An intervention screening form was developed based on a new guideline which was produced by the UMMC Osteoporosis Committee. Use of activated vitamin D from August 2006 to July 2007 was reviewed by a clinical pharmacist using the screening form.

Key findings

Of the 557 requests screened, 44.5% were identified as unnecessary prescriptions. The main indications recommended for prescribing activated vitamin D were long-term glucocorticoid treatment (38.8%) and abone mineral density T-score of less than −2.5 for patients aged 60 years and above (22.4%). As a result of the intervention, the number of patients on activated vitamin D decreased from 4095 to 2338, which led to a significant reduction in expenditure from RM798 400.60 (US$221 777.90) to RM397 783.80 ($110 495.50) (P = 0.002). The main reasons for the approval of activated vitamin D use were impaired renal function (46.6%) and long-term glucocorticoid use (38.5%).

Conclusions

Pharmacist intervention on the use of activated vitamin D was effective and resulted in a cost saving of up to RM400 616.80 ($111 282.40) annually. Prescribers in the UMMC are now aware of the guidelines and justifications for the use of activated vitamin D. Therefore, the implementation of the guidelines to reduce the inappropriate use of medications is a multidisciplinary effort between pharmacists and prescribers.
Medicine-related questions handled by community pharmacists: an exploratory study
Authors: Rutter Paul M , Warren Sharon , Rutter Jill
Published: October 2010

Objectives

The objectives of this study were to determine what type of medicine-related questions community pharmacists were asked and to ascertain whether responses given were appropriate.

Methods

All community pharmacists from three Primary Care Trusts were invited to participate in a week-long exploratory study. Piloted data-collection forms were self-completed. Data were analysed descriptively using Microsoft Excel and statistical tests conducted with Minitab.

Key findings

Sixty-six medicines-related questions were answered by participating pharmacists. The type of questions asked were varied and asked by patients, the general public and health care professionals. Most answers (over 80%) were assessed as being appropriate; only four questions raised concern with assessors that possible patient harm may have resulted. Almost half (42%) of the questions were answered without consultation to any reference source.

Conclusions

Despite the small-scale nature of the study the findings show that community pharmacists provide a good-quality service that is easily accessible to all people. However, the failure to use reference sources may impact on pharmacists' ability to answer medicine-related questions fully.
What probable factors underlie inadequacy of medication history information recorded in patients' case notes by physicians in a Nigerian teaching hospital?
Authors: Yusuff Kazeem B , Tayo Fola , Aina Bola A
Published: October 2010

Objective

To identify probable factors underlying inadequacy of medication history information recorded in patients' case notes by physicians in an ambulatory tertiary care setting in Nigeria.

Method

A cross-sectional survey was conducted, with a pre-tested 25-item questionnaire, of 93 physicians at the nine medical units in the Department of Medicine at University College Hospital, Ibadan, Nigeria.

Key findings

The overall response rate was 79.6% (74/93), and the usable rate was 75% (70/93). A majority of physicians opined that a detailed medication history is an essential component of optimal and patient-specific care; and they were able to identify correctly the key components of a detailed medication history. However, about 60% of physicians opined that the adequacy of medication history documented by them is affected by heavy workload due to the large number of patients to which they attend. The majority (75%) of physicians also considered detailed documentation of patient medical history to be more important than medication history.

Conclusions

Physicians' heavy workload, due to the large number of patients, and their belief that medical history is more important than medication history, appear to be the probable factors underlining the inadequacy of physician-acquired medication history in a developing sub-Saharan tertiary care setting.
Pharmacy support staff involvement in, and attitudes towards, pharmacy-based services for drug misusers
Authors: Scott Jenny , Mackridge Adam J
Published: October 2010

Objective

This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training.

Methods

The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants.

Key findings

Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services.

Conclusions

Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange.
Using learning outcomes for undergraduate pharmacy education to assess final-year students' perceptions of their preparedness for pharmacy practice
Authors: Willis Sarah C , Hassell Karen , Seston Elizabeth M , Hann Mark
Published: October 2010

Objective

Using learning outcomes for undergraduate pharmacy education in Great Britain, this study explored the extent to which final-year students perceived their education had prepared them for various aspects of practice. Fifteen learning outcomes were evaluated, encompassing competencies necessary for both the performance of pharmacists' tasks and for a professional approach to those tasks.

Methods

Final-year students studying at 14 British pharmacy schools completed a questionnaire evaluating perceptions of the extent to which their course had met learning outcomes defined by the profession's regulatory body ‘for and of pharmacy graduates’. Learning outcomes were divided into two groups: those related to preparedness for competence in the performance of pharmacist-role tasks (Group 1 learning outcomes) and those related to how tasks are approached (Group 2 learning outcomes). Univariate analysis explored associations between contextual/demographic variables and learning outcomes; multivariate analysis was used to determine whether the pharmacy school attended independently predicted learning outcomes once ethnicity and gender had been controlled for.

Key findings

A response rate of 67.8% was achieved. Respondents were more likely to have felt prepared for broad areas than for specific competencies (Group 1 learning outcomes). Marginally fewer felt prepared for a professional approach to tasks (Group 2 learning outcomes). Females and respondents from minority ethnic groups were significantly more likely to have felt prepared for many outcomes; significant variation between pharmacy school attended and outcomes were also found. After controlling for student characteristics, multivariate analysis demonstrated that the pharmacy school attended predicted variation in 11 out of 15 learning outcomes.

Conclusions

In the main, students perceived that the learning outcomes of curricula had been met. However, differences between school attended and students' perceptions suggest that either some schools are providing insufficient opportunities for their students to develop skills or that students at some schools have unrealistic expectations of the skills they will need.
The influence of pharmacy education on students' moral development at a school of pharmacy in the USA
Authors: Latif David A
Published: October 2010

Objectives

The aim was to assess the relationship between moral development and pharmacy education at a small, private pharmacy school located in the south-eastern region of the USA. Corollary objectives were to assess the impact, if any, of gender, age and grade point average on moral development.

Methods

Seventy-one pharmacy students' moral reasoning was assessed during a 2-week orientation before the beginning of first-year classes in August 2006, and again after finishing didactic requirements for the Doctor of Pharmacy degree (PharmD) at the University of Charleston School of Pharmacy in April 2009.

Key findings

A paired t-test revealed that significant growth in moral reasoning occurred during their didactic pharmacy education. The class mean N2% score in August 2006 was 38.68 compared with 42.32 in April 2009 (P < 0.01). Based on independent t-tests and Pearson correlations, there were no significant differences in the sample between age and N2% score, and between grade point average and N2% score.

Conclusions

The findings reveal that the students at University of Charleston School of Pharmacy experienced significant moral growth during the three didactic years of the pharmacy curriculum. As concluded in previous studies within the health professions, females scored significantly higher than males on moral reasoning in both the first and second assessment.
Using computer-tailored smoking-cessation advice in community pharmacy: A feasibility study
Authors: Hodges Lisa , Gilbert Hazel , Sutton Stephen
Published: October 2010

Objective

Community pharmacists are in an optimal position to provide smoking-cessation services. Computer-based interventions that generate behavioural feedback materials designed to encourage and help smokers to quit can complement existing services and ensure that smoking-cessation advice is reliably delivered. This study aimed to assess the feasibility of offering a system of computer-generated individually tailored behavioural feedback for smoking cessation in community pharmacy.

Method

The setting was community pharmacies in North London. Pharmacists, already offering cessation advice routinely in the pharmacy, were trained to use a computer-based system generating a feedback report containing highly tailored behavioural advice about quitting. Pharmacists' advice was structured around the report, which was printed for the participant. Pharmacists were interviewed after recruitment ended, and participants were sent a follow-up questionnaire 4 weeks after baseline.

Key findings

Pharmacists felt they had benefited from taking part in the study and were more confident in their management of, and advice to, smokers. All agreed that the computer program was an acceptable and valuable tool to aid smoking-cessation advice in pharmacies. Eleven smokers were recruited; five completed the follow-up, four of whom reported 4-week prolonged abstinence. Reaction to the feedback report from participants was positive.

Conclusions

The feedback from both pharmacists and participants demonstrates that use of this computer system to structure and standardise delivery of smoking-cessation advice in community pharmacy is feasible and acceptable. The study suggests that the use of this system could increase pharmacists' confidence and the quality of the advice they give, leading to improved outcomes. However, a randomised controlled trial to fully evaluate the effectiveness of the system is needed.
Recruitment strategies for palliative cancer care patients and carers
Authors: Hussainy Safeera Y , Marriott Jennifer L
Published: October 2010

Objective

Randomised controlled trials (RCTs) in palliative care often experience recruitment problems. This paper reports on the impact of using different strategies to recruit patients and carers into an RCT involving patient/carer interaction with community pharmacists.

Methods

The RCT was conducted with palliative care patients and carers from a palliative care service in an outer area of Melbourne, Victoria, Australia. Patients/carers were recruited to assess their medication knowledge after interaction with pharmacists who either had extra education in palliative care, or had no additional education. An initial recruitment strategy utilised palliative care nurses recruiting patients and carers in their homes. This strategy was twice modified during the trial to increase recruitment; patient/carer and pharmacist inclusion criteria were first revised and then the researcher recruited patients and carers directly in their homes.

Key findings

The statistically determined sample size for the study was not achieved. A high attrition rate (79%) occurred despite using three different recruitment strategies. Causes of attrition included patient death and the time period over which the trial was run. Gate-keeping was also a major barrier to recruitment.

Conclusions

This study supports previous findings of recruitment difficulties to palliative care trials. Strategies for improving recruitment are suggested which may be helpful for researchers.
Time and motion study for pharmacists' activities in a geriatric hospital
Authors: Wirth Francesca , Azzopardi Lilian M , Gauci Marise , Adami Maurice Zarb , Serracino-Inglott Anthony
Published: October 2010

Objectives

This study aimed to identify and quantify activities undertaken by pharmacists in a geriatric hospital.

Methods

A data collection form was developed, validated and tested for applicability and practicality. Pharmacist activities were organised into three categories: Clinical, Administration and Others. Clinical activities incorporated patient discharge, patient admission, checking the ward controlled drugs record book, emergency trolley and patient medication trolley, prescription monitoring, ward round, discussion with health care professionals, and other professional activities; Administration activities included checking the ward medication stock and medication order; Others included break and inactive time. Observers conducted 6000 min of direct observation using a time and motion technique and observed the work activities of three pharmacists on three wards. Data were analysed using Microsoft Excel 2007 and SPSS version 16.0. Descriptive statistics were carried out.

Key findings

The time dedicated to Clinical activities was 3636 min (60.60%), Administration activities 1646 min (27.43%) and Others 718 min (11.97%). When considering total time in minutes for Clinical and Administration activities, ward round (1348 min), medication order (1255 min), patient discharge (723 min) and prescription monitoring (562 min) occupied most of the pharmacists' time. Ward round activities were subdivided into: patient profiling (545 min), actual ward round (668 min) and conference (135 min).

Conclusions

The time and motion study indicated that the pharmacists' time is mainly allocated to clinical activities. However, there is still a large proportion of time taken up by administrative activities, which can be conducted by non-pharmacist personnel, allowing more time to be directed to patient care.
Implementation of a method for glucose measurements in community pharmacies
Authors: Kjome Reidun L S , Nerhus Kari , Sandberg Sverre
Published: October 2010

Objectives

We aimed to implement a method for glucose measurements that could be used as a comparison method for asessing patients' self-monitoring of blood glucose. Further, we investigated whether pharmacies could achieve an analytical quality comparable to glucose measurements performed in general practice.

Methods

Sixteen Norwegian pharmacy employees were trained in glucose measurement, quality control and blood sampling. The comparison method, HemoCue Glucose 201+, was validated in four steps: (1) estimation of the variation between the HemoCue instruments to be used at the 16 pharmacies, (2) comparison between HemoCue results and a laboratory glucose method, (3) monitoring quality by internal quality controls and (4) an external quality-assessment scheme. The pharmacies' results of the external quality assessment were compared to those of 359 general practices.

Key findings

The coefficient of variation for HemoCue instruments was 6.1% at the low level and 1.7% at the normal and high levels. Bias was negligible at the normal level. The coefficients of variation for internal quality controls were 4.5, 1.5 and 1.2% for the low, normal and high levels, respectively. All pharmacies achieved good precision and acceptable or good trueness in the external quality assessment. The pharmacies exhibited significantly lower variation between sites (2.2 and 1.2%) than general practices (3.8 and 2.9%) on both external quality-assessment samples.

Conclusions

Given correct training and the establishment of a system of quality assurance, pharmacies are capable of obtaining glucose measurements that can be used as comparison measurements for controlling patients' meters. The pharmacies had external quality-assessment results comparable to general practice.
Enhancing an Introductory Pharmacy Practice Experience at free medical clinics
Authors: Morello Candis M , Singh Renu F , Chen Karen J , Best Brookie M
Published: October 2010

Objectives

The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population.

Methods

Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2.

Key findings

Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience.

Conclusions

Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.
Pharmacy under the spotlight: New Zealand pharmacists' perceptions of current and future roles and the need for accreditation
Authors: Scahill Shane , Harrison Jeff , Sheridan Janie
Published: October 2010

Objectives

The aim was to determine New Zealand pharmacists' views on the range of services outlined in the Ten Year Vision for Pharmacists document and the need for accreditation to provide these services.

Methods

A national postal survey of practising pharmacists registered with the Pharmacy Council of New Zealand (n= 1892) was carried out, with two follow-ups.

Key findings

The response rate was 51.8% (n= 980 usable surveys). Findings indicated that the majority of pharmacists believe they should continue to undertake traditional clinical and technical roles (median 98.5%, range 92.7–99.3%). Less than one-third of respondents felt these activities required pharmacists to be accredited. A lower proportion, but still the majority, of respondents thought that pharmacy should undertake selected enhanced or collaborative roles (median 74.85%, range 64–92.5%). However, there was a greater emphasis on accreditation for these roles, with more than two-thirds of respondents suggesting a need for accreditation.

Conclusions

There is a high level of support for the retention of current clinical and technical roles. A lack of need for additional accreditation suggests that pharmacists believe their training is adequate. There is a positive, but more tempered view regarding enhanced or collaborative services. There is recognition of a greater need for accreditation for enhanced and collaborative services. This suggests a cautious optimism about new services and a perceived need for pharmacists to learn more about these programmes.
Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understanding
Authors: Ngo Suong N T , Stupans Ieva , Leong Wei Sin , Osman Marwa
Published: October 2010

Objectives

The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen.

Methods

In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen.

Key findings

Sixty per cent of patients (n= 110/183), predominantly females, were currently on other medications and 64.5% of patients (n= 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n= 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n= 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product.

Conclusions

Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications.
Selective Synthesis of Secondary Amines via N-Alkylation of Primary Amines and Ammonia with Alcohols by Supported Copper Hydroxide Catalysts
Authors: He Jinling , Yamaguchi Kazuya , Mizuno Noritaka
Published: October 2010

The N-alkylation of primary amines and ammonia (in situ generated from urea or aqueous ammonia) with alcohols to secondary amines was efficiently promoted by supported copper hydroxide catalysts, Cu(OH)x/Al2O3 and Cu(OH)x/TiO2. The observed catalysis was truly heterogeneous, and the catalysts could be reused without an appreciable loss of catalytic performance.
Highly Active Supported Nickel Catalysts for Pre-reforming of Liquefied Petroleum Gas
Authors: Shen Kui , Wang Xueguang , Wang Xinxing , Zou Xiujing , Lu Xionggang , Ding Weizhong
Published: October 2010

Mg–Al mixed oxide supported Ni catalysts were significantly more active than other catalysts so far reported for the pre-reforming of liquefied petroleum gas, in which LPG was completely pre-reformed to methane, carbon oxides, and hydrogen under high space velocity with low steam/carbon ratio of 2.0.
A simple method to estimate the episode and programme sensitivity of breast cancer screening programmes
Authors:   The Impact Working Group, Zorzi Manuel , Guzzinati Stefano , Puliti Donella , Paci Eugenio
Published: October 2010

Background

The estimation of breast cancer screening sensitivity is a major aim in the quality assessment of screening programmes. The proportional incidence method for the estimation of the sensitivity of breast cancer screening programmes is rarely used to estimate the underlying incidence rates.

Methods

We present a method to estimate episode and programme sensitivity of screening programmes, based solely on cancers detected within screening cycles (excluding breast cancer cases at prevalent screening round) and on the number of incident cases in the total target population (steady state). The assumptions, strengths and limitations of the method are discussed. An example of calculation of episode and programme sensitivities is given, on the basis of the data from the IMPACT study, a large observational study of breast cancer screening programmes in Italy.

Results

The programme sensitivity from the fifth year of screening onwards ranged between 41% and 48% of the total number of cases in the target population. At steady state episode sensitivity was 0.70, with a trend across age groups, with lowest values in women aged 50-54 years (0.52) and highest in those 65-69 (0.77).

Conclusions

The method is a very serviceable tool for estimating sensitivity in service screening programmes, and the results are comparable with those of other methods of estimation.
Improving colorectal cancer screening outcomes: Proceedings of the second meeting of the International Colorectal Cancer Screening Network, a global quality initiative
Authors: Atkin Wendy S , Benson Victoria S , Green Jane , Monk Clare R , Nadel Marion R , Patnick Julietta , Smith Robert A , Participants Patricia Villain
Published: October 2010

The International Colorectal Cancer Screening Network (ICRCSN) is a global consortium of initiatives delivering organized colorectal cancer (CRC) screening to their populations. The aim of the Network is to promote improvements in quality assurance (QA) and programme evaluation to maximize the benefit and to minimize the risk associated with CRC screening. ICRCSN currently includes 41 member initiatives from 27 countries. The ICRCSN held its second international meeting in Oxford in September 2008 with representatives from 24 countries. This report summarizes the presentations and discussions, the feedback from participants on their current and future needs and the potential role of the ICRCSN in supporting those needs.
Mortality reductions produced by sustained prostate cancer screening have been underestimated
Authors: Hartley James A
Published: October 2010

Background

The recently published European Randomized Study of Screening for Prostate Cancer (ERSPC) reported prostate specific antigen (PSA)-based screening to have reduced the prostate cancer death rate by only 20%. However, this is an underestimate caused by (i) including in the 20% the years before the impact of the first screen becomes manifest, and (ii) not having full information for the follow-up years where the effects of the screening are most apparent. This paper provides a re-analysis of the results using time-specific measures, which avoid the first of these sources of error.

Methods

Mortality rate ratios for follow-up years 1-12 were derived from the yearly numbers of prostate cancer deaths and numbers of men being followed in each arm of the ERSPC. To reduce statistical noise, they were based on moving three-year intervals, and a smooth rate ratio curve was fitted to the yearly data, in order to measure the steady state reduction in mortality and to identify the time at which it reached this level.

Results

The re-analysis suggests that the sustained reduction in prostate cancer mortality may be more than 50%.

Conclusion

Re-analysis of the ERSPC data suggests that if screening is carried out for several years, and if follow-up is pursued until the reduction becomes manifest, the reduction in mortality will be 50-60%. An analysis that includes the 2007-2008 follow-up data is required to quantify more precisely the impact of this intervention.
Breast and cervical cancer screening programme implementation in 16 countries
Authors: Dowling Emily C , Klabunde Carrie , Patnick Julietta , Ballard-Barbash Rachel ,   For The International Cancer Screening Network (Icsn)
Published: October 2010

Objective

There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population-based breast cancer screening programmes.

Methods

In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes.

Results

In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70+ cervical; 40-75+ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (<4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes.

Conclusion

Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.
Examination of the pregnancy-associated plasma protein-A assay on the Beckman Coulter Access® platform: suitability for use in first trimester Down's syndrome screening
Authors: Lambert-Messerlian Geralyn , Palomaki Glenn E , Canick Jacob A
Published: October 2010

Objective

To explore the clinical validity of the new Access® pregnancy-associated plasma protein-A (PAPP-A) assay for Down's syndrome screening.

Setting

Academic hospital.

Method

Residual serum samples ( n = 416) received for routine first trimester Down's syndrome screening (10-13 weeks) were retrieved from freezer storage and tested using two PAPP-A immunoassay methods. The new Access® assay was specifically compared, on a subset of these samples ( n = 194), with an assay proven to give acceptable Down's syndrome screening performance, the PerkinElmer (PE) AutoDELFIA method. Access® PAPP-A levels were examined in relation to gestational age and maternal weight, and were compared with the PE method by regression and Bland-Altman analyses.

Results

Access® PAPP-A assay results were highly correlated with the PE AutoDELFIA method ( r = 0.97). PAPP-A levels obtained using the Access® assay increased with advancing gestational age and were inversely related to maternal weight, as expected. The distribution of multiples of the median (MoM) values fit a log Gaussian distribution and the standard deviation of the log MoM (0.2331) matched published estimates. PAPP-A MoM levels in Down's syndrome pregnancies ( n = 6, median 0.30) showed the expected reduction.

Conclusion

Using an appropriate gestational age-specific median equation, the Access® PAPP-A assay is expected to perform acceptably in first trimester Down's syndrome screening.