The impact of increasing workloads and role expansion on female community pharmacists in the United Kingdom

BACKGROUND: Evidence from United Kingdom and the United States indicates that community pharmacists' workloads have increased in recent years for 2 reasons. First, because of social and demographic changes there has been a greater demand for pharmaceutical services. Second, the community pharmacists' role has expanded. This article explores the effect of increased workloads on female community pharmacists. METHODS: Face-to-face interviews (n=30) were conducted with women over the age of 30 years in the North West of England who worked as community pharmacists. The interview schedule was designed to explore factors underpinning female working patterns in community pharmacy. Specifically, interviewees were asked about perceptions of working conditions, positive and negative aspects of community pharmacy working, views of recent changes in pharmacy, and future career plans. RESULTS: Findings suggest that although community pharmacists enjoy aspects of their new roles, their work environment has become increasingly pressurized, resulting in decreased job satisfaction. Additionally, this study found some evidence that increasing workloads resulted in decreased health and well-being. CONCLUSIONS: The role of the community pharmacist has significantly altered in recent years, and this has occurred following a decade of increasing workloads. Consideration of the factors shaping community pharmacy points to high-pressure working environments becoming common place. This is likely to have a negative impact on pharmacists and conceivably the services they provide.     

Citalopram enantiomers in plasma and cerebrospinal fluid of ABCB1 genotyped depressive patients and clinical response: A pilot study

The antidepressant activity of citalopram (R,S-CIT) is mainly due to its (S)-enantiomer (S-CIT). P-glycoprotein (P-gp), encoded by the ABCB1 gene, is a membrane transport protein which regulates the efflux of many drugs. Polymorphisms in the ABCB1 gene may have an impact on the expression and function of P-gp, thereby influencing the response to treatment with antidepressants, which are substrates of this protein. The influence of ABCB1 polymorphism on the disposition of R,S-CIT in plasma and cerebrospinal fluid (CSF) was examined under steady-state conditions in 15 patients with major depression treated with 40 mg/d R,S-CIT for 4 weeks. In contrast to the ABCB1 C3435T polymorphism, only the ABCB1 G2677T polymorphism significantly influences R,S-CIT plasma and CSF concentrations (46 ± 11 ng/ml versus 69 ± 20 ng/ml for TT versus GT/GG in plasma, p = 0.027; 24 ± 5 ng/ml versus 32 ± 9 ng/ml for TT versus GT/GG in CSF, p = 0.05). On the other hand, no significant influence of G2677T polymorphism was found on the plasma and CSF (S)/(R) ratio, suggesting a lack of stereoselectivity in the activity of this transporter. The 2677 GG/GT genotype was associated with a better treatment response (p = 0.001) compared with 2677TT genotype. Furthermore, higher R,S-CIT plasma and CSF concentrations were observed in treatment responders. This study is the first to demonstrate that a P-gp polymorphism significantly influences plasma and CSF concentrations of R,S-CIT in depressive patients, therefore possibly influencing the activity of this antidepressant. These findings should be replicated in future studies with larger groups of patients. Because of the small number of subjects in the present study, future studies with larger groups of patients, also with different ethnicities.     

Reduction in admissions of patients with acute primary angle closure occurring in conjunction with a rise in cataract surgery in Taiwan

Purpose: Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC). Methods: Monthly cataract surgery and APAC admission rates, per 100 000 of the population, were provided by 1997–2004 inpatient and outpatient data obtained from the Taiwanese National Health Insurance Research Database. The 3814 cases of APAC and 503 687 patients who had undergone cataract operations were categorized by age groups (40–49, 50–59, 60–69 and ≥70 years) and by gender. Spearman rank correlation coefficients were used to examine the direction and strength of the relationships. Results: Throughout the study period, the admissions for APAC showed a steady decline from 630 cases in 1997 to 351 cases in 2004, while the number of cataract operations revealed a gradual increase from 26 600 in 1997 to 77 924 in 2004. The Spearman rank correlation coefficients showed significant inverse relationships between monthly APAC admission rates and monthly cataract operation rates for the total group (r = ?0.407, P < 0.001), males (r = ?0.330, P < 0.001), females (r = ?0.444, P < 0.001), 40–49 year olds (r = ?0.335, P < 0.001), 50–59 year olds (r = ?0.497, P < 0.001) and 60–69 year olds (r = ?0.417, P < 0.001). No significant inverse relationship was observed for the ≥70 age group. Conclusion: Significant inverse relationships were noted between the monthly APAC admission rates and the monthly cataract operation rates. We recommend that data should be collected from other regions and ethnic groups to determine the inter‐relationships.     

Do co-spray dried excipients offer better lysozyme stabilisation than single excipients?

The inherent instability of proteins when isolated from their native conditions creates the necessity of suitable stabilisation techniques. Because of the instability of proteins in solution it is often necessary to produce them as solid formulations. A method of producing relatively stable, solid protein pharmaceuticals is to incorporate them with a suitable excipient into an amorphous matrix by dehydration. The use of spray dried multiple excipient/single protein blends was compared to single excipient/protein systems using lysozyme as a model protein to establish the stabilising ability of such systems. Unprocessed controls and spray dried samples were characterised structurally by X-ray powder diffraction and Fourier transform Raman spectroscopy and also thermally by differential scanning calorimetry and thermogravimetric analysis. Retained lysozyme activity was assayed enzymatically. To assess long-term stability, samples were subjected to conditions of elevated temperature and relative humidity (RH) 40 degrees C/75% RH. Structural and thermal analysis of samples revealed that mannitol/trehalose spray dried excipient/lysozyme blends were completely amorphous upon production but partially recrystallised upon storage at elevated temperature and RH. Biological activity assays revealed that samples containing trehalose retained the highest percentage activity. Under the conditions employed mannitol/trehalose systems stabilise lysozyme more effectively than single excipient systems due to their ability to form amorphous products.     

Improved formulation of photosensitizer chlorin e6 polyvinylpyrrolidone for fluorescence diagnostic imaging and photodynamic therapy of human cancer.

An improved formulation of the photosensitizer chlorin e6 (Ce6) in combination with the hydrophilic polymer polyvinylpyrrolidone (PVP) was investigated for its potential clinical applications in fluorescence diagnosis and photodynamic therapy (PDT) of cancer. This study reports the comparative preclinical biodistribution and efficacy of Ce6 delivered with or without PVP versus dimethyl sulfoxide (DMSO). The safety and fluorescence pharmacokinetics of Ce6-PVP in humans was also accessed. Biodistribution results showed that Ce6-PVP had higher tumor to normal tissue ratio compared to the other formulations. The sensitivity and specificity derived from the area under the receiver operating characteristics curves showed that the formulations were able to discriminate tumor from peritumoral muscle in the following order: Ce6-PVP>Ce6>Ce6-DMSO. In vitro PDT results showed that Ce6-PVP was found to induce selective phototoxicity in leukemic cells compared to peripheral mononuclear blood cells. In addition, in vivo light irradiation at 1h after Ce6-PVP was found to induce greater tumor necrosis without causing animal toxicity. In patients, preferential accumulation of Ce6-PVP was observed in angiosarcoma lesions compared to normal skin following intravenous administration. In conclusion, PVP significantly enhanced the Ce6 concentration in tumors compared with Ce6 alone and increased the therapeutic index of PDT without any side effects in animal model. No serious adverse events were observed in human as well.     

腹腔镜在结直肠癌根治术中的应用

目的研究腹腔镜结直肠癌根治术的可行性和手术方法。方法回顾性分析2004年2月-2006年6月腹腔镜结直肠癌根治术52例患者的临床资料。结果52例患者中有48例顺利完成腹腔镜手术，4例中转开放手术，无手术死亡病例，无术后出血、吻合口漏、吻合口狭窄发生，切口感染2例，手术平均时间200min，术中平均失血120ml，术后2—4d胃肠功能恢复，所有标本残端无癌细胞浸润或残留，清扫淋巴结数10—30个，平均（16．2±6．1）个，术后平均住院时间7d，术后电话随访至2006年10月，死亡3例，局部复发2例。结论腹腔镜结直肠癌根治术具有创伤小、康复快、美容等优点，疗效较开腹手术好。     

Follow-up phone calls increase nutrient intake estimated by three-day food diaries in 13-year-old participants of the Raine study

Aim: Our primary objective was to determine the effect of follow‐up phone calls on estimated nutrient intakes obtained by three‐day food diaries from 13‐year‐old adolescents. Methods: Food diaries were recorded using household measures and entered into a dietary analysis software program, before and after follow up by telephone. A sample of 340 participants aged 13 years born into the Western Australian Pregnancy Cohort (Raine) Study, a population‐based longitudinal cohort followed from 16 to 20 weeks' gestation to 13 years of age (current follow up). After face‐to‐face instruction, participants completed three‐day food diaries at home and returned them by post. Follow‐up telephone calls were made to each participant to improve data collection response and to verify missing details in the food diaries. Nutrient intakes before and after telephone follow up were compared using Student's t‐tests in spss . Results were also compared with those of the Child and Adolescent Physical Activity and Nutrition survey. Results: Follow‐up phone calls significantly increased the estimated intake of total kilojoules, water, total carbohydrates, sugars and magnesium (P < 0.05). Conclusion: These results indicate the importance of follow‐up phone calls to obtain missing details in three‐day food diaries completed by adolescents.     

大豆蛋白体外酶解物中血管紧张素转化酶抑制剂活性肽研究

目的:体外模仿部分胃肠道消化酶解过程,考察大豆蛋白酶解消化能否产生血管紧张素转化酶抑制剂(ACEI)活性肽及其活性状况,以揭示大豆蛋白体内消化酶解与ACEI的活性关系。方法:模拟人体胃肠道消化过程,以胃蛋白酶结合胰蛋白酶,相继酶解大豆分离蛋白(SPI),经色谱分离,动态检测不同阶段ACEI肽片段及其活性大小。结果:胃蛋白酶酶解过程前20min内,酶解液ACEI活性达到最高点,随后在胰蛋白酶酶解阶段其抑制活性下降。180min后的酶解产物,其半抑制活性浓度IC50值为0.28±0.06 mg/ml。同时,未经酶解的SPI液在0.73mg/ml时无ACEI活性。SPI酶解液经各种色谱分离后的组分,其IC50值从0.13±0.03到0.93±0.08 mg/ml。低分子量和伴有疏水性基团的肽类最具ACE抑制活性。结论:体外模仿胃肠消化过程使用胃蛋白酶和胰蛋白酶酶解SPI可产生不同ACEI活性的肽片段,说明人体正常摄食消化大豆蛋白可产生血管紧张素转化酶抑制剂活性肽。