The sensitivity of the KeratinoSens™ assay to evaluate plant extracts: A pilot study

Several tests to assess skin sensitization hazard are in peer-review for pre-validation. These tests, as well as the animal tests they aim to replace, were developed (and validated) for the testing of pure substances. However, in the cosmetic field, active ingredients are often mixtures from natural sources. It is therefore important to understand which tests could be used to evaluate their safety. Here we describe a proof-of-concept study to test whether the KeratinoSens^? assay is able to detect sensitizing constituents within botanical mixtures. Four extracts were spiked with different doses of the sensitizers citral, cinnamic aldehyde and isoeugenol. The tested extracts were negative in the test whereas they became positive in most cases when spiked with the sensitizers. Analysis of the results from the samples spiked with different doses allowed the determination of the minimal level of sensitizers being detectable. The contribution to sensitization potential of doses of 2% and above of the spiked sensitizers were reliably detected. There were limitations for an extract with high cytotoxicity, in which case detection of the artificially spiked sensitizers proved difficult. This study gives a proof of principle for testing of mixtures in the KeratinoSens^? assay and indicates how sensitive the assay is to detect minor components with sensitizing potential.     

North Carolina community pharmacists’ attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study

BackgroundSuicide is a major and growing public health problem. Pharmacists are one of the most accessible members of the health care team. Due to their unique place in the health care system, pharmacists may be an ideal resource for monitoring patients at risk of suicide. The objectives of this study were to: (1) investigate community pharmacists’ attitudes toward suicide; (2) identify pharmacist-reported barriers to suicidal ideation assessment; and (3) evaluate facilitators and barriers to pharmacists conducting suicidal ideation assessment.MethodsAn anonymous questionnaire was distributed to North Carolina (NC) community pharmacists. Measures included contact with suicide, perceived role in suicidal ideation assessment, Attitudes Towards Suicide (ATTS), and barriers in suicidal ideation assessment. Multivariable logistic regression was used to analyze the data.ResultsThere were usable and complete data for 225 participants (3.52% response rate). The median ATTS score was 70 (IQR = 7). Community pharmacists were significantly more likely to perform a suicidal ideation assessment at least sometimes when (s)he reported a lower number of barriers (OR = 0.70, 99.5% CI = 0.51–0.98) and when (s)he agreed or strongly agreed that they knew how to help someone who was suicidal (OR = 6.63, 99.5% CI = 1.74, 25.23). The most common barrier to suicidal ideation assessment was lack of education in mental health screening (n = 176).ConclusionsSuicide prevention education programs for pharmacists may need to address reducing barriers, increasing knowledge about suicide, and improving self-efficacy. Targeting these areas may lead more pharmacists conducting these assessments.     

Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review

Background

The impact of collaborative and multidisciplinary health care on the outcomes of care in patients with acute coronary syndromes (ACS) is well-established in the literature. However, there is lack of high quality evidence on the role of pharmacist care in this setting.

A systematic review of the literature on ‘medication wastage’: an exploration of causative factors and effect of interventions

Introduction Reducing any wastage, including that of medications, is a paramount objective in promoting appropriate utilisation of finite resources. The objective was to systematically review the published literature, the possible causative factors associated with medication wastage and the effectiveness of any interventions to reduce wastage. Method A systematic review of studies published in English was identified from the following databases: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Science Citation Index and The Cochrane Library. Data extraction and critical appraisal was undertaken independently by two researchers. Results and discussion Title, abstract and full paper screening reduced the 14,157 studies to 42. A general definition of medication wastage was reported in one paper only. ‘Medication changed’, ‘patient death’, ‘resolution of patient’s condition’ and ‘expired medications’ were most commonly cited reasons for wastage. Only two studies were identified reporting wastage as a research outcome measure following intervention. Conclusion The systematic review has identified a limited literature on medication wastage with a lack of consistency of terms. There is a paucity of robust research focusing on the impact of healthcare interventions on outcomes around medication wastage.     

Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before–after study

Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n?=?152, mean 83 years) were older and took more drugs at admission compared to the control group (n?=?159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p?=?0.006), Correct Directions (p?=?0.016) and Practical Directions (p?=?0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p?=?0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.

     

The impact of pharmacoeconomics on the practitioner and the patient: a conflict of interests?

It is very easy to polarise the debate between clinicians and economists by asserting that clinicians regard the needs of individual patients as paramount, whereas economists are more interested in the priorities of society as a whole. Economists have criticised clinicians for failing to recognise the scarcity of resources relative to wants and also for being unable to appreciate the diversity of individual preferences. Furthermore, economists will assert that the wants of patients are not the same as their needs. A clinician may use degree of illness as a guide to relative need for treatment, whereas an economist would ask for information about response to treatment, explicitly acknowledging that the most severely ill patient may not derive the greatest benefit from treatment. We believe that the key to this problem lies in the differences in the definition of terms by the 2 sides, and in fact that there is some confusion over the primacy of the individual versus society. Both clinicians and economists are liable to assert that healthcare resources should be distributed equitably. However, clinicians have a somewhat imprecise appreciation of the concept of equity, whereas economists have developed a set of explicit definitions of equity, which clearly show the consequences of shifting the balance of resources to achieve equitable distribution. Inevitably, this leads to diversion of resources from one segment of society to another. At present, any transfer of resources is liable to be viewed as a sacrifice of an individual patient's needs in the interests of society as a whole. This paper shows that clinicians already accept that there is a conflict of interests between the wants of individuals and the needs of society. We believe that progress can only be made by increasingly explicit debate about the merits of different treatments. Economists have developed the theoretical framework; it is up to clinicians to turn theory into practice.     

Medication incidents and medication errors in Danish healthcare: A descriptive study based on medication incident reports from the Danish Patient Safety Database, 2014–2018

In Denmark, reporting of safety incidents to the nationwide Danish Patient Safety Database (DPSD) is mandatory. Medication incident reports constitute the largest category of safety reports. We aimed to provide numbers and characteristics of medication incidents and MEs reported to DPSD focusing on medication, their severity and the trends therein. This is a cross-sectional study of medication incident reports for individuals ≥18, submitted to DPSD in 2014–2018. We performed analyses on the (1) medication incident and (2) ME levels. Out of 479 814 incident reports, 61.18% (n = 293 536) were related to individuals ≥70 and 44.6% (n = 213 974) to nursing homes. Most of the events were harmless (70.87%, n = 340 047) and 0.8% (n = 3859) had caused severe harm or death. ME-analysis (n = 444 555) revealed that paracetamol and furosemide were the most frequently reported drugs. The most common drugs for severe and fatal MEs were warfarin, methotrexate, potassium chloride, paracetamol and morphine. When the reporting ratio for all MEs and harmful MEs was considered, other drugs than the most frequently reported ones were found to be associated with harm. We found a large proportion of harmless medication incident reports and reports from community healthcare services and identified high-risk medicines associated with harm.