Abstract: Objectives: To determine the frequency and types of dispensing errors identified both at the final check stage and outside of a UK hospital pharmacy, to explore the reasons why they occurred, and to make recommendations for their prevention.

Abstract: Since the 1940s, diaethylstilbestrol (DES) has been used by millions of pregnant women to prevent miscarriages and many other disorders in pregnancy. In 1971, it became clear that this apparently innocent treatment proved to be a time bomb for the infants exposed to DES during the first trimester of pregnancy. DES is now associated with an increased risk of breast cancer, clear cell adenocarcinoma (CCAC) of the vagina and cervix, and reproductive anomalies. This article summarises the potential long-term health implications of DES on the mother, DES daughters and DES sons, and the possible side effects on the third generation. Health care professionals have to know the history of DES to prevent future disasters with drugs prescribed.

Abstract: Objective: Pharmacists are health professionals who are ideally positioned to perform a primary health care role. However, the definition of professional value needs to be considered not just as professional education and skills, but also in terms of how consumers perceive it. The main aim of this work was to explore the public’s perceptions and attitudes towards community pharmacy in Portugal.

Abstract: Objectives: To investigate elderly people’s ability to open medicine containers, and how this ability correlates to some common disorders that may cause functional or cognitive impairment.

Abstract: Objective: The extended role of pharmacists has made pharmacy practice more complex and increased the moral responsibility of pharmacy staff. Consequently, ethics has become an important part of their daily work. In health care, ethical dilemmas have been shown to cause distress, usually referred to as “moral distress”. Moral distress among hospital personnel has been well described and discussed in numerous studies. There are very few similar studies in pharmacy settings. This article reports on the results of an investigation concerning whether and in what situations moral distress is present in pharmacy practice.

Abstract: This review brings together information on the treatment of gastroesophageal reflux disease. Published manuscripts were identified from Medline. The articles were then screened for relevance prior to inclusion in the review. Up to 40% of people in Western countries are estimated to regularly experience heartburn, the most characteristic symptom of gastroesophageal reflux disease (GERD). Treatment options available for GERD range from over-the-counter (OTC) antacids to proton pump inhibitors (PPIs) and anti-reflux surgery. Many patients self-medicate with OTC medications such as antacids and low-dose histamine H2-receptor antagonists (H2RA) to relieve episodic or food-related symptoms of GERD, and may not seek medical advice unless symptoms persist or worsen. However, GERD is a chronic disease that frequently affects health-related quality of life and, if not properly managed, the complications of GERD may include erosive oesophagitis (EO), Barrett’s oesophagus and adenocarcinoma. Adequate control of acid secretion is key to the successful treatment of the condition. OTC medications provide effective symptom relief to about one quarter of patients suffering from GERD. H2RAs can also provide effective symptomatic relief, particularly in patients with milder GERD, but become less-effective over time. PPIs are the agents of choice for the suppression of gastric acid production and have become the mainstay of therapy for acid-related diseases. PPIs produce significantly faster and more complete symptomatic relief, significantly faster and more complete healing of erosive GERD compared with H2RAs and are also significantly more effective at preventing relapse of EO. There are a number of existing guidelines for the treatment of GERD. Recommendation for initial therapy consist of general measures, such as lifestyle advice in combination with antacids and/or alginates. When general measures fail, the next step is empirical therapy. Two options exist for the expirical treatment of GERD, so-called “step-up” or “step-down” therapy. There are no clear data to support either treatment strategy as a universal approach to all patients; consequently, physicians must always choose the course best suited to the individual patient.

Abstract: Objective: To explore Nigerian pharmacists’ attitudes towards pharmaceutical care, and determine significant attitudinal differences in different practice settings.

Abstract: Objectives:To implement a pharmacist-led Hypertension Management Clinic in one general medical practice. To evaluate the impact of the clinic on blood pressure (BP) control and prevention of coronary heart disease (CHD). Method:A total of 242 patients attended the pharmacist-led hypertension clinic over a 10-month period. Lifestyle and drug therapy alterations were implemented to achieve British Hypertension Society (BHS) target level BP. A sub-group of 160 patients were used to compare BP control in the clinic setting against that with the general practitioner (GP). Assessment was made of 10-year CHD risk in patients with no artherosclerotic disease. Patients with underlying artherosclerotic disease were prescribed statins, and antiplatelet drugs where indicated. Main outcome measures:Changes in numbers of hypertensive patients meeting the BHS target level BP. Changes in prescribing of antiplatelet agents and statins for primary and secondary prevention of artherosclerosis. Results:In 206 patients with established hypertension, the number achieving target level BPs increased from 74 (36%) pre-clinic to 174 (85%) post-clinic; P < 0.001 chi-squared test. After attending the clinic, for 5 months 74 patients (80%) achieved target level BP in the clinic compared with 27 (40%) with standard GP care; P < 0.001 chi-squared test. Of 188 patients assessed for primary prevention therapy, 126 (67%) required treatment with aspirin and 37 (20%) with a statin. Post-clinic 101 (80%) received aspirin compared with 17 (13%) pre-clinic and 34 (92%) received a statin in comparison with 4 (11%) pre-clinic; both P < 0.001 chi-squared test.A total of 52 (96%) of 54 patients received an antiplatelet agent for secondary prevention of artherosclerosis compared with 40 patients (74%) pre-clinic. Thirty six of 54 patients required a statin for secondary prevention. Thirty five patients (97%) received a statin compared with 23 (64%) pre-clinic; both P < 0.01 chi-squared test. Conclusion:Implementation of a pharmacist-led clinic improved blood pressure control and appropriate prescribing of antiplatelet agents and statins for primary prevention of CHD and secondary prevention of artherosclerosis.

Abstract: Objective: Pharmaceutical care follows a needs-based approach. Cancer patients form a group with particular needs. Information about cancer treatment plays an important role in terms of coping strategies, initiation of self-care behaviour, and quality of life. In order to develop pharmaceutical care strategies for cancer patients, it is important to assess patients’ information needs. This survey aims at providing a suitable instrument to measure patient satisfaction with information on cancer treatment and to reveal the present situation in Germany. Methods: Since there was no suitable German measure available, the Canadian ‘Patient Satisfaction with Cancer Treatment Education (PS-CaTE) questionnaire’ was translated into German and its test quality criteria were examined. Selected socio-demographic variables were added to the original version of the questionnaire to facilitate subgroup analysis. A pre-test was performed to assess the reliability of the adapted instrument.The questionnaire was distributed among patients of cooperating hospitals, oncology practices, and self-aid groups over Germany. Results: The pre-test established a good reliability of the instrument. In the main survey, overall satisfaction, on a 5- point Likert scale, showed a median score of 3.5, where 5 represented the highest degree of satisfaction. A subscale analysis revealed that satisfaction with information provided on adverse events and complementary treatment options was lower compared to the information provided on cancer treatment. A stepwise multiple-regression analysis identified three significant predictors of satisfaction: a) diagnosis of a mammary carcinoma; b) recent diagnosis; and c) treatment by a primary-care oncologist. Patients with a mammary carcinoma and patients treated by a primary-care oncologist were less satisfied, and patients with a recent diagnosis were more satisfied compared to other patients. In comparison to other information sources, pharmacists still seem to play a minor role as a source of information for patients. Conclusions: The version of the questionnaire with a total of 14 items seems to be suitable for measuring patient satisfaction with information. Additional research is needed to further verify the validity of the instrument. The questionnaire may help pharmaceutical-care providers to develop needs-based information strategies. The assessment of patient satisfaction can contribute to the outcome evaluation of pharmaceutical care. The fact that pharmacists are not yet being recognised by most patients as a source of information should support an intensified and more active offer of care by the pharmacist.

Abstract: OBJECTIVE: To determine how well patients could correctly recognize and comprehend the various information items on patient information leaflets, and to explore the reasons underlying poor comprehe ...

Abstract: Objective: Evaluation of a computerized physician order entry in an Internal Medicine Department, with a unit-dose distribution system. Setting: Pharmacy Department, Internal Medicine Department. S. Francisco Xavier Hospital, Lisbon, Portugal. Method: This study was carried out in December 2001 and January 2002. After two years experience of the CPOE system, medication errors were evaluated prospectively, in an internal medical department of a 360-bed academic hospital. Data were collected once a week. Pharmacists reviewed all medical prescriptions as part of their routine work. Medication errors detected were recorded on a data collection form with a design based on the types of errors as defined by the American Society of Hospital Pharmacists (ASHP). Completed forms were reviewed and medication errors were classed according to ASHP guidelines. Results: A total of 2268 orders were monitored (162 patients). In these orders, 73 medication errors (22.4% of the patients) were detected and documented (59 prescribing errors and 14 monitoring errors). The most common prescribing errors were deficiencies related to the right class but wrong drug (28.3%): omeprazole vs. ranitidine/sucralfate in stress ulcer prophylaxis; incorrect dose (30%) and unclear orders (13.3%). Errors related to incorrect frequency of administration (5%); maintenance of IV route (5%); duplicated drug therapy (11.7%); drug interactions (1.7%) and length of therapy (3.3%) were also detected. The 14 monitoring errors detected were failures to review a prescribed regimen for appropriateness and detection of problems. Conclusions: Computerized prescription order entry has demonstrated effectiveness in eliminating medication errors related to transcribing and patient identification. Nevertheless, medication errors related to prescription and monitoring still occur. The use of clinical decision support systems and pharmacist involvement is vital to achieve maximum medication safety and reduce medication error rates.

Abstract: Background: Liquid formulations are usually regarded as the gold standard in paediatric formulation; but sometimes, liquid formulations have stability and taste problems as well as being inconvenient for travelling. Therefore, for the management of long-term illness, some older children, parents and clinicians would prefer to use solid formulations. However, there is a lack of studies to investigate the age at which children are converted from liquid to solid formulations. Objectives: (1) To investigate the age range at which children convert from liquid antiretroviral drug formulations to solid formulations, the formulations are abacavir, didanosine, lamivudine, stavudine, and zidovudine. (2) To calculate how long children stay on each of five UK liquid formulations (retention time) and factors affecting the retention times of the above liquid formulations. Method: This was a retrospective medical records survey at Great Ormond Street Hospital for Children, London, United Kingdom. Patients’ treatment details were entered into SPSS for Windows v. 11.0 and the retention times for the above liquid formulations were calculated i.e., from initiation of the liquid treatment to conversion to solid preparation. The retention times of different preparations were then compared using Cox regression analysis. Results: A total of 92 patients are included in the analysis. The overall average age at conversion was 7.3 years (95% CI 6.3–8.2). Patients on stavudine were more likely to switch to the corresponding solid dose form than the other four medicines (P < 0.001); more than 50% of patients on stavudine switched to solid formulation after nine months of treatment, however, less than 25% of patients on other formulations switched during the same period. Conclusion:Children taking antiretroviral liquid preparations change to solid dose forms at approximately seven years of age. However, for stavudine, children are more likely to take the solid form at an earlier age.

Abstract: Aim: This review summarises the present knowledge of associations between pharmacogenetics and therapeutic efficacy and side effects of antipsychotics to enable pharmacists to judge the applicability for a more tailor made therapy in patients with schizophrenia. Polymorphisms of Cytochrome P450 isoenzymes and neurotransmitter receptors involved in the efficacy and side effects of antipsychotics are highlighted in this review. Method: A search was performed in Medline and EMBASE for the period 1995–August 2002. Also relevant references from the selected papers were incorporated. Results: Poor metabolism with respect to CYP2D6 seems to be related with more pronounced extrapyramidal symptoms and more specifically with a higher incidence of tardive dyskinesia. The C/C-genotype for CYP1A2 results in smokers in a reduction of enzyme activity, but an effect on the incidence of tardive dyskinesia is controversial. For dopamine D2 receptors the effect of the –141C Ins/ Del polymorphism on efficacy is not clear yet, although the Taq I polymorphism is associated with greater improvement of positive, but not negative symptoms in acute psychosis. The Gly9-allele of the dopamine D3 receptor is associated with the response to clozapine, but in studies in which the choice of antipsychotics is not restricted, the role of this polymorphism is unclear. The reverse is applicable to the dopamine D4.2/4.7 polymorphism. For the 5-HT2A receptor the His452Tyr polymorphism is associated with response to clozapine, the 102 T/C polymorphism leads to equivocal results. The polymorphism studied for 5-HT5A, 5-HT6, α1A- and α2A-receptors give no clear associations with the response to clozapine. The polymorphism studied of the dopamine D2 and D4 receptor are not related to extrapyramidal adverse effects and side effects, respectively. The 9Gly-variant of the dopamine D3 receptor, the 102C-variant, but not the His452Tyr polymorphism of the 5-HT2A-receptor and the 23Ser-variant (for females only) of the 5-HT2C receptor seem to increase the susceptibility to tardive dyskinesia. Weight gain induced by antipsychotics seems to be associated with the –759C-allele of the 5-HT2C receptor. Conclusion: The results show the first careful steps toward application of pharmacogenetics in a more individualised, tailor-made, pharmacotherapy. A precondition seems to be a multifactorial approach, as can be expected for multifactorial processes.

Abstract: Aim: Glioblastoma multiforme (GBM) is an incurable disease that can only be managed in a palliative way. The GBM accounts for approximately half of all newly diagnosed primary brain tumors with an incidence of 2–3 cases per 100,000 people each year. Surgery and radiation are the standard options for palliation, and whether there is a place for chemotherapy is still discussed. Boron neutron capture therapy (BNCT) is a promising and possibly curative method of treating GBM. The purpose of this article is to provide an updated review on the current management and future possibilities of treating GBM with BNCT. Method: Use was made of computerized searches and of checking cross-references of articles and book chapters. Results: The principle of BNCT uses the high ability of 10B to capture thermal neutrons and to disintegrate immediately into a He nucleus (α-particle) and a Li nucleus. To reach a sufficient concentration of 10B in the malignant cells compared to the surrounding healthy tissue, 10B-carriers must be highly tumor-selective. At present, the 10B carriers boronophenylalanine (BPA) and sodium borocaptate (BSH) are used in clinical trials to perform BNCT. Conclusion: The BNCT is a promising and possibly curative method of treating GBM, but at present this procedure is far from perfect. Because of the lack of selectivity of the boron carriers, it appears so far that radiation toxicity limits the radiation dose, so that tumor damage is modest. Current investigations and developments are aimed at targeting the boron carriers to the tumor, in order to limit the damage to the healthy, surrounding tissue.

Abstract: Objective: The objective of this study was to explore patients’ understanding and management of their illnesses and prescribed medicines. Method: Patients receiving three or more repeat prescription drugs were interviewed in their homes after their repeat prescriptions had drug-related problem (DRP) identified by a community pharmacist in a GP surgery. Results: In total, 58 patients were interviewed. Patients distinguished strongly between ‘forgetting’ and ‘taking less’ of their medicines, and some actively reduced the dose themselves. More than 25% of the patients involved their spouse in the administration of their medicines. Patients had more worries about their illness (48%) than their medicines (31%). Any changes made to their present medication, or introduction of new medicines, were thought to ‘upset the balance’. Conclusion: More information is needed on patients’ perspectives, both on side effects, compliance and how to deal with long-term medication. Health care professionals should seek to understand and respect patients’ choices to assure optimal care.

Abstract: In this article the authors provide insight into the basis for price setting of medicines, the increasing pharmaceutical budgets in the past decades, and the measures governments and insures have taken to curb rising pharmaceutical costs Four reasons are out lined for the fact that medicines are by some considered expensivey: 1) there are fundamental differences between medicines and other consumer products; 2) medicines are technology requiring an inordinate amount of research and development; 3) medicines are developed, manufactured, and distributed according to strict regulatory requirements; 4) medicines are most often selected by a physician for a specific patient and reimbursed in whole or in party by a third-party insurer or the state Pharmaceuticals mean share of GDP has been 12% in OECD countries in recent decades Pharmaceuticals accounted for 154% of total health expenditure, with public spending about half of this amount Since 1970, the average share of GDP for pharmaceuticals in most countries has increased 15% more per year than GDP growth Four types of strategies to curb rising Pharmaceuticals costs are described and a taxonomy of strategies provided These are:1)price and profit controls; 2) reimbursement system charges; 3) other fiscal measures; 4) quality measures Pharmaceuticals policy has suffered from the pervasive misunderstanding that drugs are like any other commodity; resulting in policy makers viewing pharmaceuticals expenditures without thinking about drugs in their proper content of health care The authors conclude by advocating a balanced approach to policymaking in a environment of rising pharmaceuticals costs

Abstract: Objective: To evaluate the incidence of cross anticonvulsant hypersensitivity syndrome (AHS) between phenytoin (PHT) and carbamazepine (CBZ) in hospitalized patients.

Abstract: Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry. The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation; patients and professionals have different rationalities with regard to their views on medicine. Because the lay public and medicine users are not one entity, one of the many challenges facing policy makers today is to identify, incorporate and prioritise the many diverse needs. The authors recommend research which includes studies that look at: lay attitudes towards pharmaceutical policy; lay experiences of drug therapy and how it affects their daily lives; the problem of identifying lay representatives; the relationship between industry and the consumers; the effect of the media on medicine users and on pharmaceutical policy itself. The authors acknowledge that although lay involvement in policy is still in its infancy, some patient organisations have been successful and there are developments towards increased lay involvement in pharmaceutical policymaking.

Abstract: Objective: To quantify the amount of potential prescription errors for anticancer drugs in order to improve the quality of care.

Abstract: In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sector. Pharmaceutical policy encompasses three major policy inputs: public health policy, health care policy and industrial policy. In order to analyse and understand pharmaceutical policy, it is important to know how policymakers view pharmacy and pharmacists. The authors look at the issues that arise when policy regulates pharmacy as a business, and what this means for the profession. The perspective of pharmacy as a health care profession, as well as what it means when we view pharmaceutical policy in the context of the health sector labour market, is discussed. The authors also discuss how factors external to the profession are affecting its purpose and realm of practice, including the current trend in managerialism, and how the division of labour with other health professionals such as physicians and pharmacy assistants is affecting the pharmacy profession’s position in the labour market. Next the authors look at ways in which the pharmacy profession has affected policy. Pharmacists have been instrumental in developing new and expanding roles for the profession, sometimes inspired by external events, but often as a result of their own prerogative. The pharmacy profession is encouraged to take a leading role in forming and contributing to policy, in this way making visible its contribution to society in general and public health in particular. If not, the profession will forever be reacting to policy and will remain at the mercy of policymakers and other strong actors in society.

Abstract: The evaluation of healthcare practice and service delivery is fraught with difficulties Service development and / or delivery occurs within socially dynamic settings which are in a continual state of change Service development also often involves large elements of improvisation The action research approach is useful for health service research, as it supports collaboration between researchers and practitioners, and not only allows but makes explicit that the action researcher has both roles within the setting being studied This paper discusses action research methodology and offers insight into principles that favor its use for service delivery development This includes consideration of the interactive variables within studies of health care systems and the importance of evaluating relationships between stakeholders to understand how these factors or variables, which cannot be controlled for, are responsible for successful development of the service Action research facilitates change and helps bridge the heory--practice gap With the current dynamic changes within both the pharmacy profession and national health services, researchers may find the action research technique of value when considering new roles and innovative ways of engaging in collaborative, multi-disciplinary working to improve delivery of patient care

Abstract: To assess the pharmaceutical sector to know whether people have access to essential medicines. The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory). The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies. Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines. The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary. The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.

Abstract: Objective: The study explores characteristics of community pharmacies with respect to implementing pharmaceutical care activities. The article addresses the provision of pharmaceutical care at reality level, perceived level and policy level. Method: A cross-sectional questionnaire was sent to all Danish community pharmacies to investigate the provision of pharmaceutical care (n=288). The respondents were pharmacists. Pharmaceutical care activities were operationalised by detecting and identifying medicine-related problems, setting goals to solve medicine-related problems, and documenting efforts to solve them. A non-respondent analysis was also performed. Main outcome measure: The identification of medicine-related problems (from self-report) was used as a proxy measure of pharmaceutical care activities and compared to pharmacies’ self-reported provision of pharmaceutical care. Results: The survey response rate was 75.7. The characteristics of pharmacies that detected medicine-related problems differed from those of pharmacies with only a perceived provision of pharmaceutical care. Pharmacies that actually detected medicine-related problems focused on external cooperation regarding their pharmacy activities. Conclusion: The profiles of the perceived providers of pharmaceutical care and the respondents that detected medicine- related problems were distinct, thus indicating two separate groups of pharmacies. Pharmaceutical care has only been implemented in Denmark to a limited extent. This may be explained in part by the top-down implementation strategy conceived by the proprietor organisation.

Abstract: Promoting therapy adherence requires understanding various psychosocial parameters, including patients’ need for information. Drug information adapted to patients’ needs may empower them and increase their confidence in drug therapy. Objectives: To explore psychiatric in-patients’ information preferences and to test the reliability of a Dutch version of the Intrinsic Desire for Information (IDI) scale in psychiatric institutions in Flanders. Standardised interviews were conducted with psychiatric patients in 11 hospitals. The interview consisted of the IDI-scale and five open questions. Patient demographics collected were sex, age, number of medicines taken, diagnosis, number of admissions during the past year, marital status, education level and occupation. 279 patient interviews were completed. A factor analysis on the original 12-item scale yielded 3 factors. An abbreviated scale was derived from the first factor (F1). This 6-item scale measured ‘extent of information desired:’ (EID) and consisted of six items (Cronbach’s α = 0,73). A second factor (F2) measured ‘information provider preference’ (IPP) (α = 0,56) and a third factor (F3) measured ‘inhibited information desire’ (IID) (α = 0,69). EID was associated with number of medicines taken, duration of hospitalisation and marital status. The internal reliability of the EID-factor appears to be reproducible in the specific setting of psychiatric hospitals. It may be useful to help healthcare professionals develop pharmaceutical care towards psychiatric patients. Validation of the scale remains to be completed. Information need in psychiatric in-patients measured by the EID-score was comparable to the need measured in general hospitals during earlier research in England. Targeted information services seem to be desirable to enhance therapy adherence and quality of life in psychiatric patients.

Abstract: Introduction: Over the past few years, the use of total parenteral nutrition (TPN) has been established for pre-term and sick term neonates. At ‘IASO’ Hospital, a series of protocols implemented through the use of a computer programme has been developed to assist in the time consuming task of prescribing and preparing TPN in neonates. The algorithms used for neonates of a different gestational age are based on the protocols created through screening of literature and personal experience. This is important because it heralds a uniformity of the prescription of TPN at IASO and other hospitals where these protocols have been implemented. Objective: The objective is to determine the extent of error occurrence of the manual method as opposed to the new computerized procedure of TPN formulation, and to assess the immediate benefits stemming from the computer programme’s use, in terms of personnel time reduction. Furthermore, the usefulness of the automated compounder in the computer driven process of TPN solution formulation was also assessed. Setting: Gynaecology Hospital ‘IASO’. Method: For a period of 6 months, sick and prematurely born babies were included in the study. Calculations regarding the composition of TPN solutions were conducted both by computer and manually. Main outcome measure: The time needed to complete the procedure and the results’ accuracy were measured and compared. Results: Implementation of the protocols into practice via this computer programme has been found to reduce the time spent by the physician and the pharmacist on TPN solution preparation, but the most important contribution is the virtual elimination (no errors in computerized calculation) of errors in the complex task of prescribing and formulating TPN solutions. For example, the average time taken to prepare the individual TPN solutions was 5.2 min while the computerized procedure took 15.4 min. Conclusion: Use of this system can optimize pharmacists’ and physicians’ work and help prevent prescription and preparation errors.

Abstract: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management. A mixed urban/ rural region in the west of Scotland. Semi-structured qualitative research interviews. A total of 50 people with CHF (NYHA Class II and III) due to left ventricular systolic dysfunction (33 males; mean age 67 years, 17 females; mean age 68 years) and 30 nominated caregivers recruited from the outpatient departments of two hospitals in the West of Scotland. Sampling was purposive to include patients from a range of CHF severity, ages and sexes. Managing medications was a responsibility shared by both the patients with CHF and caregivers. Treatment regimens were reported to be difficult to comply with. Health professionals were seen to provide little support for medication management. Pharmacists were viewed as being a good and accessible source of practical assistance who were also knowledgeable about the individual’s heart health history. Participants reported valuing advice from pharmacists about the side effects of medications and for their assistance in reducing the complex logistics of medication management and in having medications delivered. Patients with CHF and caregivers voiced a willingness to try to manage their medication regimen accurately but had a limited capacity to do so. Pharmacists were viewed as providing valuable support to patients with CHF and their caregivers, in terms of medication management. The extended role of pharmacists in medication management of CHF should be encouraged.

Abstract: Objective: To apply human error theory to explain non-adherence and examine how well it fits. Method: Patients who were taking chronic medication were telephoned and asked whether they had been adhering to their medicine, and if not the reasons were explored and analysed according to a human error theory. Results: Of 105 patients, 87 were contacted by telephone and they took part in the study. Forty-two recalled being non-adherent, 17 of them in the last 7days; 11 of the 42 were intentionally non-adherent. The errors could be described by human error theory, and it explained unintentional non-adherence well, however, the application of ‘rules’ was difficult when considering mistakes. The consideration of error producing conditions and latent failures also revealed useful contributing factors. Conclusion. Human error theory offers a new and valuable way of understanding non-adherence, and could inform interventions. However, the theory needs further development to explain intentional non-adherence.

Abstract: Objective: To characterize the pattern of surgical antimicrobial prophylaxis in the Czech Republic. Method: Cross sectional survey with a self-administered postal questionnaire. Data collected included use of antimicrobial prophylaxis, surgical site infection rate, pathogens causing surgical site infection and demographics of the institution. Descriptive and multivariate analyses were performed. Setting: Hospital, surgical departments in the Czech Republic. Main outcome measure: Prevalence of surgical antimicrobial use, factors associated with use, the profile of antimicrobial use, timing, route, dosage regimen and duration of initiated prophylaxis. Result: The response rate was 55.5%. Surgical antimicrobial prophylaxis was used in 97.5% of departments, and 85% departments justified prophylaxis based on guideline. The timing of the first dosage was within 2 h of operation in 95.0% of departments and 36.7% of all departments administered more than 2 doses of SAP in operations that lasted less than 4 h of all respondents. The three most common prophylactic antimicrobial agent used were cefazolin, co-amoxiclav and cefuroxime amongst the 26 single antimicrobial agents and 16 antimicrobial combinations. Penicillins and enzyme inhibitor was the most frequent class used. Surgical antimicrobial prophylaxis was administered intravenously in 82.5% of all cases. The regimen used varied markedly in dose and duration prescribed. The surgical site infection rate occurred. 1–5% in 71.7% of departments. Most departments identified the causative pathogen at all times. Staphylococcus aureus was the most frequent pathogen of surgical site infection and was detected in 90.8% of all departments. There was significant association between Pseudomonas aeruginosa with cefuroxime use and Bacteriodes fragilis with co amoxiclav use. Conclusion: This survey has identified several areas for improvement in surgical antimicrobial prophylaxis in the Czech Republic. Particular areas of concern include route of administration, duration and timing of first dosage of SAP, and the inappropriate use of broad-spectrum antimicrobials.

Abstract: To assess the perceived usefulness of the United States Pharmacopeia (USP) Medication Counselling Behavior Guidelines among Finnish community pharmacists. The Guidelines were systematically disseminated to pharmacists through a 4-year project (TIPPA 2000–2003). A postal questionnaire was sent to a random sample (n = 734) of Finnish community pharmacists (response rate 51%). More than one quarter (27%) of the respondents was aware of the Guidelines. The Guidelines were made known to the respondents mostly via a book on patient counselling skills (41% of those knowing the Guidelines), continuing education (37%), and in-house training (28%). Over 60% of those who knew about the Guidelines regarded them as a good or very good instrument for learning the principles of patient counselling. The Guidelines were considered less useful as an instrument for the self-evaluation of performance in different settings. The results of this study indicate that even though the USP Guidelines have been promoted strongly through basic and continuing education during the TIPPA Project, more than half of the respondents were not aware of the Guidelines. The Guidelines were considered more useful in learning the principles of patient counselling than learning self-evaluation of performance.