Validating a clinical workload measurement instrument for documenting pharmaceutical care

The purpose of this study was to develop and validate a workload documentation instrument to manually record clinically oriented pharmaceutical care activities. Previous research documents clinical workload by pharmacists; however, the tools employed have not been tested for validity. Reported information is difficult to interpret since individuals are unlikely to categorize activities in a consistent manner. PharmaTrend was used as a template for defining activity and problem categories that corresponded to various clinical activities performed by our clinical, faculty, and staff pharmacists. Because the institution was not completely computerized, the actual documentation tool was portable and manual. Testing of the original instrument was accomplished using a survey consisting of written scenarios. Two phases of testing were required to achieve an overall 80 percent accuracy rate. At least 60 percent of available pharmacists participated in both phases and completed 90 percent or more of the surveys. The investigators concluded that an instrument to record clinically oriented pharmaceutical care activities had been developed, tested, and validated.     

Patient satisfaction with arthritis medication

Patient derived information to support the long term use of non-steroidal anti-inflammatory drugs (NSAIDs) is lacking. In contrast, data detailing the adverse effects of individual NSAIDs is accumulating. We determined the importance of NSAIDs as therapy to 153 patients with osteoarthritis (age range 36 to 92), comparing results in elderly and younger patients. Around half of the patients reported moderate relief of symptoms, with a further quarter reporting good, or even excellent, relief. One half of patients aged 75 years or less, but only one fifth of patients aged over 75 years, recalled having been informed of the adverse effects of NSAIDs. A total of 59 per cent of patients reported having used simple analgesics, such as paracetamol, as first line therapy. As some patients are helped by them, we suggest that efforts should be directed towards increasing the first line use of simple analgesics in patients with osteoarthritis and towards increasing patient awareness of potential NSAID-related adverse effects.     

Patient and physician satisfaction with rofecoxib in osteoarthritis: results of a post-marketing surveillance study in primary care in Germany

A post-marketing surveillance study was conducted in Germany to assess the efficacy and tolerability of rofecoxib in the treatment of osteoarthritis (OA). Patients were eligible for inclusion in this study if they were being treated for the first time or being switched from other medications. More than three-quarters of the 80,371 patients enrolled in the study reported improved pain relief and function during treatment with rofecoxib (12.5 or 25 mg/day), including a reduction in pain experienced when walking on a flat surface or climbing or descending stairs. A majority of patients also considered that the duration of analgesia provided by rofecoxib was longer than with previous medications (predominantly non-steroidal anti-inflammatory drugs). Some 85% of patients reported an improvement in quality of life during rofecoxib therapy and a similar proportion considered once-daily rofecoxib to be a simpler regimen than their previous medications. Tolerability of rofecoxib was consistent with previous experience in controlled trials, with adverse events recorded in less than 1.5% of patients (n = 1090). No new or unexpected types of adverse events were recorded. A total of 81 serious adverse events were reported, corresponding to an event rate of approximately one per 1000 patient-years of treatment. Most of these serious events were not considered attributable to rofecoxib use. Physicians considered that rofecoxib provided better and more prolonged analgesia than previous medications and improved quality of life for more than 80% of patients, and regarded once-daily rofecoxib as a simpler treatment regimen than previous therapies in more than 90% of patients. Patient and physician satisfaction with rofecoxib was high in this survey. Most respondents regarded the drug as effective, easy to use, and a well-tolerated medication for the treatment of OA.     

Complex pharmaceutical care intervention in pulmonary care: part B. Patient opinion and process survey.

OBJECTIVE: The IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigates and describes the results of complex pharmaceutical care interventions provided to selected pulmonary patients to improve their drug use. This paper describes the patients' opinions about the care provided and the results of the intervention. METHOD: Questionnaires investigating patients' opinions about provided pharmaceutical care were sent to 185 patients participating in the IPMP study after the intervention by their pharmacists had been finished. One year after the start of the intervention, patients were invited to a final consultation by their pharmacists to evaluate their drug use and their symptoms (n = 138). At this point in time pharmacists investigated the knowledge of the patients about the medication and their inhaler technique again. MAIN OUTCOME MEASURE: The influence of the intervention on patients' symptoms. Change in drug-related problems, knowledge and skills concerning pulmonary medication after intervention. Satisfaction of the patients with the provided pharmaceutical care. RESULTS: In total 141 out of 185 patients completed the questionnaire. Patients were satisfied with the intervention by their pharmacists and considered it important. The majority (67%) reported that they had learned more about their medication or the inhaler technique, resulting in significantly improved coping behaviour with their pulmonary medication compared with patients who valued the intervention as a nice conversation with their pharmacist only. Patients with improved ability to cope reported statistically significantly fewer symptoms compared with patients reporting no change in behaviour (chi-square test, P < 0.05). In the final consultation of 138 patients, pharmacists observed increased knowledge and skills and decreased drug-related problems. The patients concerned were pleased with the change in treatment and were more satisfied with their current medication as compared with their earlier reports. CONCLUSION: Patients can be influenced effectively by the tailored intervention of pharmacists resulting in improved ability to cope with pulmonary medication and in fewer reported adverse effects and symptoms. Patients attributed these results to the intervention of the pharmacists.     

品管圈结合RATER指数在提高PIVAS药学服务满意度中的应用

目的:探讨品管圈和RATER指数在提高静脉药物调配中心(PIVAS)满意度中的应用效果.方法:收集品管圈活动前后医生、护士、患者对PIVAS的满意度并进行统计分析,运用品管圈结合RATER指数的方法进行改进.结果:开展品管圈活动后医生群体的满意度由71.43％提升到82.40％,护士群体的满意度由67.86％提升到82...     

Patients satisfaction with free healthcare pharmaceutical services in Sierra Leone: a national cross-sectional study

International Journal of Clinical Pharmacy - Background Patient satisfaction is a critical construct of quality of pharmaceutical care in that it reflects whether a given service is meeting...     

Chitosan: some pharmaceutical and biological aspects--an update

Chitosan, a natural polysaccharide, is being widely used as a pharmaceutical excipient. It is obtained by the partial deacetylation of chitin, the second most abundant natural polymer. Chitosan comprises a series of polymers varying in their degree of deacetylation, molecular weight, viscosity, pKa etc. The presence of a number of amino groups permit chitosan to chemically react with anionic systems, thereby resulting in alteration of physicochemical characteristics of such combinations. Chitosan has found wide applicability in conventional pharmaceutical devices as a potential formulation excipient, some of which include binding, disintegrating and tablet coating properties. The polymer has also been investigated as a potential adjuvant for swellable controlled drug delivery systems. Use of chitosan in novel drug delivery as mucoadhesive, gene and peptide drug administration via the oral route as well as its absorption enhancing effects have been explored by a number of researchers. Chitosan exhibits myriad biological actions, namely hypocholesterolemic, antimicrobial and wound healing properties. Low toxicity coupled with wide applicability makes it a promising candidate not only for the purpose of drug delivery for a host of drug moieties (antiinflammatories, peptides etc.) but also as a biologically active agent. It is the endeavour of the present review to provide an insight into the biological and pharmaceutical profile of chitosan. Various investigations carried out recently are reported, although references to research performed on chitosan prior to the recent reviews have also been included, where appropriate.     

Nimesulide: some pharmaceutical and pharmacological aspects--an update

Nimesulide, a non-steroidal anti-inflammatory drug (NSAID), is administered orally or rectally twice daily for a variety of inflammation and pain states. This is a unique NSAID, not only because of its chemical structure but also because of its specific affinity to inhibit cyclooxygenase-2 (COX-2), thus exerting milder effects on the gastrointestinal mucosa. Current data on selective COX-2 inhibitors suggest that they may have an efficacy similar to that of standard NSAIDs. Initial general clinical experience with selective COX-2 inhibitors appears to show that they are particularly promising in individuals at risk because of renal diseases, hypertension or congestive heart failure. Various experimental models and clinical studies have demonstrated the anti-inflammatory efficacy of nimesulide. Nimesulide is superior, or at least comparable in efficacy, to other NSAIDs, but is better tolerated and has less potential for adverse reactions. Thus, selective COX-2 inhibitors should have anti-inflammatory effects devoid of side effects on the kidney and stomach. They may also demonstrate new important therapeutic benefits as anticancer agents as well as help prevention of premature labour and even retard the progression of Alzheimer's disease. No clinically significant drug interactions have been reported for nimesulide. Not much has been reported about the pharmaceutical aspects of nimesulide. Its poor aqueous solubility poses bioavailability problems in-vivo. This could be overcome by the formation of inclusion complexes with beta-cyclodextrin, as has been reported by various researchers. However, absence of any in-vivo data regarding the relative absorption of nimesulide from beta-cyclodextrin complex compared with that from conventional formulations of the drug makes the use of such fast-releasing complexes rather questionable. Only a limited number of assay procedures (HPLC, spectrophotometric, spectrofluorimetric) for the determination of nimesulide and its metabolite in plasma/urine samples or in dosage forms have been reported in the literature. The purpose of this review is to provide a concise overview of the pharmacological and pharmaceutical profile of nimesulide. Various investigations carried out recently are reported, although older references to research performed on nimesulide have also been included, where appropriate.     

Automated determination of flutamide by a validated flow-injection method: application to dissolution studies of pharmaceutical tablets

The first flow-injection (FI) method for the determination of flutamide – a potent antiandrogen used for the treatment of prostate cancer – is reported. The method is based on the direct measurement of the absorbance of the analyte at 310 nm under flow conditions. Parameters affecting the determination such as detection wavelength, sample injection volume and flow rate were studied and optimized. The assay was validated (linearity, limits of detection and quantitation, accuracy, repeatability, reproducibility and selectivity) for the dissolution studies of flutamide-containing tablets during stability testing. The results were in good agreement with high performance liquid chromatography (HPLC) used as a reference method.