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S.NO Title & Authors Name page
1
Interns Experiential Training Perspectives with Pharmacist Prescribing Protocol Development
Elhaum Khobahy, Nkechiamaka Nwosu, Reza Abbasgholizadeh, Mousa Abkhezr, Valerie U. Oji
 Abstract                  View                 Download                 XML
Pharmacist intern impressions on prescribing roles and protocol development in the course of their advanced experiential training experiences are described. The objectives of this qualitative study were to: 1) Identify core protocol requirements, 2) Compare/Contrast protocols from U.S. states with extensive pharmacist prescribing protocol history and 3) Design a pharmacist prescribing protocol based on integrated or collaborative care theory. Feedback on prescribing protocol development and pharmacist prescribing roles was gathered from a focus group of pharmacist interns’ activities that included 1) review of the local State Pharmacy law requirements (TX); and 2) comparison of these requirements with six other states or territories (CA, MD, DC, KS, VA, WA) where services are provided by the experiential training site and/or that state has a long history of experience with collaborative drug therapy management; 3) review of local state and out-of-state sample protocols; and 4) key general discussion questions. Prescribing protocols were obtained via Freedom of Information Act (FOIA), known samples, and data on hand. A concise, comprehensive prescribing protocol was developed for application of collaborative chronic care. Core protocol requirements identified were State Pharmacy and Medical Board approval and guidelines; pharmacist and physician licensure; specified prescribing-related and medication-management activities to be delivered by the pharmacists; how medication-management decisions would be made, documented and evaluated. Differences across U.S. states included the issuance of Pharmacist DEA numbers, pharmacist educational requirements, treatment algorithms, state/local guidelines and protocols. Interns\' shared experiences led to a perceived underutilization of pharmacists in meeting existing patient health service access needs and addressing medication-related problems. They also identified potential implementation challenges such as time and staffing limitations, provider status recognition, third-party reimbursement, overcoming multidisciplinary stereotypes of pharmacists’ roles, unfamiliarity with pharmacist prescribing as compared to other providers, educational needs for reinforcement on patient diagnoses, laboratory value orders/interpretations, medical record and claims documentation, and interprofessional communication. A positive interest in prescribing roles and protocol development was identified in contributing to patient health service needs. Implementation can be facilitated with an understanding of core protocol requirements, state laws, treatment guidelines and algorithms, potential service implementation challenges, and educational strategies for clinicians, administrators and policy-makers. Educational preparedness should consider the incorporation of these experiences, especially across multidisciplinary settings, to improve collaborative care.
1-10
2
ASSESSING PRESCRIBING PATTERNS OF ESSENTIAL MEDICINES IN THREE RURAL DISTRICT HOSPITALS IN RWANDA
Remy Pacifique Ntirenganya , Valens Mugiraneza, Bethany L. Hedt-Gauthier, Marie Paul Nisingizwe, Anicet Nyawakira, John Nyiligira Felix Rwabukwisi Cyamatare, Isaie Nsabimana, Regis Habimana, Frederic Muhoza, Cheryl L. Amoroso
 Abstract                  View                 Download                 XML
Inappropriate prescribing is a global health problem and main challenges include over prescription of antibiotics, over-use of injections, over-spending by failing to prescribe generic medicines and prescription of multiple medicines. This cross-sectional study included patient encounters at outpatient departments of three rural hospitals in Rwanda to assess prescribing patterns of essential medicines using the WHO core prescribing indicators. Patient encounters were randomly sampled. Chi-square and Kruskal-Wallis statistical tests were used to compare results. Our findings show that the average number of medicines prescribed per patient (1.8) was within WHO targets, the percentage of encounters with an antibiotic prescribed (37.2%) was above targets, while the percentage of encounters with an injection prescribed (7.2%) and percentage of medicines prescribed in generic names (75.0%) or from the National Essential Medicines List (70.5%) were below WHO targets. Clinicians, researchers, academics and policymakers should use these findings to plan for interventions like problem-based learning or Drug and Therapeutics Committees that promote good prescribing practices.
655-660
3
PREPARING FOR U.S. PHARMACY PRACTICE: REGISTRATION PROCESS FOR FOREIGN PHARMACY GRADUATES
Mousa Abkhezr, Valerie U. Oji
 Abstract                  View                 Download                 XML
Practicing abroad in the global health arena is a desired objective by many foreign pharmacy graduates. By definition, a pharmacist whose undergraduate pharmacy degree was conferred by a recognized school of pharmacy outside of the 50 United States and the District of Columbia, and Puerto Rico is considered a foreign pharmacy graduate. These pharmacists in order to be licensed in the USA have to pass four tests including: 1-foreign pharmacy graduate equivalency examination (FPGEE), 2- test of English as a foreign language (TOEFL), 3- North American pharmacist license examination (NAPLEX), and 4-multistate pharmacy jurisprudence examination (MPJE). There is a last requirement to complete 1500 hours internship; this may be required before or after passing NAPLEX and MPJE, depending on the specific state of intended practice. This internship has to be under the supervision of a licensed pharmacist known as preceptor. Studying and practicing abroad may be challenging, but there are opportunities and resources to navigate through the process. 
322-326
4
ENTERAL FEEDING AND FLUOROQUINOLONES
Rania Tarek Malatani
 Abstract                  View                 Download                 XML
“When the gut works, use it” is a common expression used to encourage the use of the enteral route for nutrition over the parenteral route in hospitalized patients. The same access device is often used to deliver both the enteral formula and medications without regard to the administration site (gastric versus small bowel). Changes in drug response as well as complications of drug administration may result from delivering enteral nutrition and medication together through the same tube. Currently, there is no standard of practice regarding the administration of specific medications when patients are receiving tube feeding, and if the feeding should be held for a period of time before and after drug administration. This report provides a general review regarding interactions between enteral feeding and the fluoroquinolones antibiotic class.
74-77
5
WHEN AND FOR HOW LONG SHOULD DEXMEDETOMIDINE BE USED IN THE INTENSIVE CARE UNIT
Engi Nakhla, Ehab Daoud, Shyam Gelot
 Abstract                  View                 Download                 XML
Dexmedetomidine is a novel sedative that was approved for use in the US at the end of the last century. Currently, the FDA labeling for its use are: sedation in non-intubated patients prior to and during surgical and other procedures, and in intubated and mechanically ventilated patients during treatment in an intensive care setting and to be administered by continuous infusion not to exceed 24 hours. Multiple investigations for other indications and prolonged durations have caused controversies for its use. Given the risks of this medication, strict adherence to guidelines for its use is recommended. The aim of this review is to discuss the approved and the not yet approved indications to use this medication.
13-15
6
A STUDY ON UTILIZATION PATTERN OF HIGHER GENERATION ANTIBIOTICS AMONG PATIENTS VISITING COMMUNITY PHARMACIES IN CHIDAMBARAM, TAMIL NADU AT SOUTH INDIA
*Akram Ahmad, S. Parimalakrishnan, Guru Prasad Mohanta, Isha Patel and PK Manna
 Abstract                  View                 Download                 XML
Infectious diseases are a prominent cause of death in developing countries. The antibiotic resistance caused by emergence of antibiotic resistant microorganisms, is a health problem leading to poor treatment outcomes and increased cost, increased mortality, morbidity and adverse drug reactions. The government of India proposed to introduce the New Drug Policy in 2011which calls for the making of a new schedule, Schedule HX, under the Drugs and Cosmetics Act. A cross-sectional and observational study was conducted in a private community pharmacy situated in Chidambaram, a city in rural South India to determine the appropriateness of the higher generation antibiotics (cephalosporin, flouroquinolone and coamoxiclav groups) in the out-patient department. The prescriptions were collected from the patients after they purchased the medicine from the pharmacy. All prescriptions containing higher generation antibiotics were assessed for the inappropriateness using a modified Medication Appropriateness Index. 300prescriptions containing higher generation antibiotics were analyzed. Out of the 77.66% of the prescriptions containing, 69.95% of prescriptions contained higher generation antibiotics. When assessed for the appropriateness of the prescription, 51%of the prescriptions containing higher generation antibiotics were prescribed inappropriately. <br />
466-471
7
EXPANDING THE ROLE OF COMMUNITY PHARMACY: AN EVALUATION OF GENERIC DRUG DISCOUNT PROGRAMS, PHARMACY BASED IMMUNIZATION SERVICES AND CONVENIENT CARE CLINICS
*Jeffrey C. Keimer and Shaker A. Mousa
 Abstract                  View                 Download                 XML
We evaluated the clinical and economic impact of generic drug discount programs (GDDPs), pharmacy based immunization services and convenient care clinics (CCCs) based upon existing literature, reviewing original research and case study reports using library databases, primarily MEDLINE and EBSCOHost.&nbsp; Keywords used included &ldquo;generic discount list,&rdquo; &ldquo;four dollar generic,&rdquo; &ldquo;pharmacy immunization,&rdquo; &ldquo;flu shot,&rdquo; &ldquo;pharmacist immunizer,&rdquo; &ldquo;convenient care clinic,&rdquo; &ldquo;retail health clinic,&rdquo; and &ldquo;minute clinic.&rdquo;&nbsp; We then added other terms such as &ldquo;clinical impact,&rdquo; &ldquo;cost-effectiveness,&rdquo; &ldquo;outcomes,&rdquo; and &ldquo;perceptions.&rdquo; While all 3 programs have the potential to clinically benefit patients and provide some level of cost-effectiveness, there are also concerns that need to be addressed. Some concerns include: a) GDDPs have the potential to cause fragmentation of care owing to patients going to other pharmacies in search of lower prices and prescription claims data not being captured by patients&rsquo; pharmacy benefit managers, b) GDDPs may be less cost effective in pharmacies with less purchasing power compared to larger chains, c) pharmacy based immunization services still face legal and social barriers that prevent pharmacists from being recognized as legitimate vaccine administrators, d) some insurance carriers still don&rsquo;t pay for pharmacist-administered vaccinations, e) CCCs may not currently be located in areas that could best benefit from their services, f) CCCs may disrupt a patient&rsquo;s continuity of care with their primary care physicians, and g) CCCs may hinder the efforts of pharmacists to expand their own professional roles by lessening the need for them to do so. Expanding the roles of community pharmacies has the potential to improve patient care by increasing patients&#39; access to healthcare services. While strong evidence exists to support pharmacist-delivered immunizations, less is known regarding GDDPs and CCCs.&nbsp; More studies are required to assess the clinical and economic questions raised regarding these types of programs.
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