Community pharmacy as a performance: a participant observer's account of a day in the life of a locum

Objective — To understand, from a dramaturgical viewpoint, the performance of “community pharmacy.” Method — Participant observation supported by focus groups and semistructured interviews; the study adopted a grounded theory approach. Setting — Fieldwork was conducted within 21 community pharmacies in East Anglia, England. Key findings — Pharmacists identify with their setting and stage props. On the stage of community pharmacy, the pharmacist crucially converts the drug into medicine, during a complex and well‐rehearsed performance. There are sometimes distractions, which make the performance sub‐optimal. Other insights included what counts as error, how to manage stress, and the fact that the trust on which professional practice rests is at stake when expressive performance fails. Conclusion — It is possible to conduct ethnography of community pharmacy and this is among the first such studies of British community pharmacy. Were the pharmacist to leave the stage and its props (the drugs), only to advise patients on medicines, the performance of community pharmacy, as we know it, might disappear.     

Amelioration of sulfur mustard skin injury following a topical treatment with a mixture of a steroid and a NSAID

The ability to ameliorate sulfur mustard (HD)-induced oedema by treatment with anti-inflammatory drugs was reported previously after screening four steroids and four non-steroidal anti-inflammatory drugs (NSAIDs) using the mouse ear vesicant model. Following the screening study, one steroid and one NSAID (Adexone and Voltaren) were selected as the most effective, and a mixture of the two was chosen for the present more extensive research. The effect of the combined treatment on clinical, biochemical and histopathological parameters following HD insult was studied. Mice ears were exposed to 0.2 micro l of HD for 10 min to produce a moderate skin injury. Oedema development peaked ca. 48 h following exposure, as determined by weighing ear biopsies. Histological observations at that time exhibited damage to the epidermis and dermis. An increase in prostaglandin E (PGE) was measured in skin homogenates, starting 8 h following exposure and lasting at least up to 48 h post-exposure. A topical treatment using the above anti-inflammatory mixture significantly reduced inflammatory parameters when applied up to 4 h following exposure. These parameters included extent of oedema, levels of PGE, area of clinical damage and extent of cytotoxic injury (vesications and damaged epithelial cells). Thus, a combination of a steroid and NSAID was found to be effective in reducing the intensity of HD skin injury and possibly shortening the time to full recovery. The treatment, however, did not prevent completely the ensuing cytotoxic processes in the epithelial layer.     

Study of a microencapsulation process of a virucide agent by a solvent evaporation technique

Abstract

A highly water-soluble virucide agent was microencapsulated by a water/oil/water emulsification-solvent evaporation method. An aqueous drug solution was emulsified into a solution of polymer in methylene chloride, followed by emulsification of the primary emulsion in an external aqueous phase. Microcapsules were formed after solvent evaporation, the solidification of the microcapsule walls was followed by an optical method. The influence of stirring speed was analysed to find the optimal hydrodynamic conditions with respect to the process yield, corresponding to the weight of obtained microcapsules per litre of water/oil/water emulsion, the initial virucide agent content and the drug release kinetics. The optimal conditions were obtained for the complete suspension speed. The improvement of the microencapsulation process was attempted by increasing the concentration of the primary emulsion and by the reuse of the external aqueous phase after removal of the microcapsules.     

Occurrence of a new cephalosporoate in a culture broth of a Cephalosporium acremonium mutant.

A new metabolite was isolated from the culture filtrate of a deacetylcephalosporin C-producing mutant, derived from Cephalosporium acremonium ATCC 14553, by means of adsorption on activated carbon, column chromatography on DEAE-Sephadex A-25 and gel filtration through a Sephadex G-10 column. The compound was identified as D-5-amino-5-carboxyvaleramido-(5-formyl-4-carboxy-2H, 3H, 6H-tetrahydro-1, 3-thiazinyl) glycine by spectral analyses, elucidation of hydrolysis products of the compound, and comparison of characteristics of the compound with those of a synthetic authentic compound.     

Role of a pharmacist in a seizure clinic

The involvement of a clinical pharmacist in a Department of Veterans Affairs seizure clinic is described. A pharmacist who had served a residency in ambulatory care began working in a seizure clinic in 1988 after obtaining the cooperation of a neurologist interested in a multidisciplinary approach to patient care. A clinical protocol was developed to guide the pharmacist's participation. The seizure clinic is staffed by the clinical pharmacist, a pharmacy resident, and a neurologist and is currently treating 162 adult male veterans. Of the 162 patients, 159 are receiving anti-convulsant therapy. The role of the pharmacist is to assist the neurologist in providing patient-care services. The pharmacist interviews each patient, performs a neurological assessment and mental status evaluation, and orders laboratory tests. Information is recorded by the pharmacist on a history form and a subjective and objective assessment and planning form. The pharmacist presents the findings to the neurologist, and the patient is then interviewed jointly by the pharmacist and the neurologist. Between appointments, the pharmacist follows up on abnormal laboratory test values and informs patients of any necessary dosage adjustments. More time is available for patient care, there has been an increase in the detection of adverse drug reactions and disease states, and record keeping has improved. A pharmacist assumed a primary-care role in a seizure clinic by interviewing and assessing patients, ordering laboratory tests, and participating in the selection and adjustment of anticonvulsant therapy.     

Podophyllum toxicity: a report of a fatal case and a review of the literature

A 59-yr-old male ingested 10 g of podophyllum in a fatal suicide attempt. Previously unreported nuclear and cytoplasmic changes were observed in circulating leukocytes. Symptoms did not occur until 10 h after ingestion with loss of reflexes, coma, and a marked lactic acidosis. Despite hemoperfusion, the patient expired 39 h after ingestion. The literature on podophyllum toxicity is reviewed.     

Use of a microcomputer in a pediatric hospital

The implementation and uses of a microcomputer in a 186-bed pediatric hospital are described. A Kaypro-10 portable microcomputer and an Epson Fx-80 printer were purchased in anticipation of increased workload generated by addition of beds to the hospital's neonatal intensive-care unit. Programs in C-BASIC language were developed for performing mathematical calculations, labeling of unit dose injections and oral liquids, and generating automatic-stop-order renewal notices. A master menu was designed to allow access to all programs. Work sheets to aid in the calculation of solution volumes required to deliver desired dosages of emergency drugs and for preparation of parenteral nutrient solutions are generated by the microcomputer, along with labels for these solutions. Other computer programs allow charging of floor stock items for i.v. admixtures, tracking of emergency-drug boxes, and generation of controlled-substances and anaphylaxis-dosing labels. A total of 510 hours was required to develop the microcomputer programs at a salary cost of $2600. Hospital pharmacies experiencing an expansion of patient services may be able to reduce the impact of the increased workload on manpower requirements by computerizing existing systems. Pharmacies with specialized needs can consider microcomputer implementation and inhouse software development as one alternative.