Doctorates in medicine and pharmacy

Pharmacists had to wait until the Delong Act in 1979 to obtain a diploma of professional practice giving them the title of doctor. Since 1898, some of them could be called "Doctor of Pharmacy", but this title was neither a university degree nor a diploma of professional practice. A state doctorate of pharmacy was created in 1939 and replaced in 1977 by the doctorate of pharmaceutical sciences which was suppressed in 1984, like all other doctorates as university degrees. With the present reform, the doctorate of medicine, which was both a university degree and a diploma of professional practice, has only kept this latter qualification as "state diploma of doctor of medicine", like the pharmacists new diploma of professional practice. Physicians and pharmacists can now only obtain the highest university grade with the "doctorate" created in 1984. The conditions of obtention are indicated.     

Insecticides against headlice in Glasgow

A postal questionnaire for describing current practices of insecticide usage for the prevention and treatment of pediculosis was sent to 53 pharmacists in Glasgow. 91% returned completed questionnaires. Between 19,000 to 36,000 bottles of insecticide against headlice were bought by the public in Glasgow in 1991. Most of these were sold in small volumes (less than 100 ml) and sales were highest during the autumn. Although pharmacists sold a range of different classes of insecticide, the most popular were those that contained malathion, the treatment for pediculosis recommended by the Health Board. Choice of treatment was probably influenced by advice given to the public by pharmacists and general practitioners. Clients preferred shampoo formulations. There was evidence that treatments were used prophylactically against headlice. However, there was little indication of large scale resistance to insecticides in the louse population. The results indicate that headlice remain a persistent problem in Glasgow, despite the public adhering to the advice of health professionals.     

Saskatchewan dial-access drug information service

In September 1974 the colleges of pharmacy and medicine of the University of Saskatchewan began offering a drug information service to the pharmacists and physicians of Saskatchewan without charge. With the help of a radio-page system, calls are taken immediately by experienced pharmacists and pharmacologists. The cost of long-distance phone calls is borne by grants from the Saskatchewan medical and pharmaceutical associations. During the 1st year of operation 415 requests for information were received. Of 93 persons who called up to Feb. 28, 1975, 76% responded to an evaluation questionnaire; virtually all described the service as very valuable. The information received resulted in the alteration of drug therapy in one third of calls requesting information to assist in current treatment of a patient.     

Marchantinquinone, isolated from Reboulia hemisphaerica, as inhibitor of lipid peroxidation and as free radical scavenger

Recent years have witnessed a renewed interest in plants as pharmaceuticals in the Western world. This interest is channeled into the discovery of new biologically-active molecules by the pharmaceutical industry and into the adoption of crude extracts of plants for self-medication by the general public. In both of these areas some attention is being paid to the investigation and use of ethnopharmacology, the traditional use of plants for medicinal purposes by particular cultural groups. Ethnopharmacologic leads have resulted in the introduction of new single molecule drugs but have a greater role to play if crude extracts are accepted for clinical use in the West. The problems confronting such usage are discussed. Considerable benefits for developing countries are possible when the local medicinal plants are subjected to scientific methods of validation of traditional use and quality control. This approach has met with success in some parts of the world but is not always appreciated by national governments and international agencies. Related areas of concern such as conservation of ecology and culture must be integrated with any such program. Plants used in traditional medicine therefore have an important role to play in the maintenance of health in all parts of the world and in the introduction of new treatments.     

Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes study

OBJECTIVE: To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD). DESIGN: Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used. SETTING: Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center. INTERVENTIONS: Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents. MAIN OUTCOME MEASURES: Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL. RESULTS: Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients. CONCLUSION: Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.     

Self-medication of dyspepsia: how appropriate is it?

BACKGROUND: The scope of self-medication is increasing in many countries, and drugs for dyspepsia are a popular group for deregulative activities. This study investigated what kind of upper gastrointestinal symptoms people self-medicate and how appropriate this self-medication is. METHODS: An anonymous questionnaire was give to 50 consecutive customers buying antacids, alginates, or sucralfates in 10 pharmacies in the capital area in Finland in 1995. In half of the pharmacies the questionnaire was returned by mail, and in the other half the questionnaire was filled out at the pharmacy. The response rate was 53% (n = 292). RESULTS: The commonest reasons for self-medication were heartburn (88%), gastrointestinal pain (31%), and acid regurgitation (32%). Seventy-five per cent of respondents had used dyspepsia drugs for more than a year. The commonest way to self-medicate was to interchange regular and occasional use. Knowledge about the proper use of dyspepsia drugs was poor, and 6% of respondents had symptoms contraindicating self-medication but had not visited a physician during the past year. Patients more than 60 years old were especially at risk of potential inappropriate use. CONCLUSIONS: Over-the-counter (OTC) drugs for dyspepsia are likely to be used improperly. A physician's advice on the use of OTC dyspepsia drugs, in addition to detailed printed information about drug action and proper administration, would be important means to guarantee appropriate use of these drugs.     

Sources of regulatory information for pharmacists

Sources of regulatory information of use to pharmacists are summarized. Regulatory information is provided by government, legal, pharmaceutical industry, nongovernment, and investigational drug sources. Databases and trade and professional organizations also provide such information. Information on legislative statutes and regulations can be found in the Federal Register, Code of Federal Regulations, and List of CFR Sections Affected. Many other government reports are also available. Various law reports are published by state and federal courts; legal textbooks, journals, and newsletters also provide pharmacy law information. Pharmaceutical industry sources supply information on U.S. drug approvals, pharmaceutical companies, and FDA enforcement actions, whereas nongovernment regulatory sources provide comprehensive regulatory and drug information. Investigational drug sources enable pharmacists to keep abreast of new drug development. Databases provide a wide variety of information, and trade newsletters supply information of interest to the organization. Knowledge of appropriate references will allow pharmacists to keep abreast of regulations that may affect them and new developments in their area of expertise.     

Food lobbies, the food pyramid, and U.S. nutrition policy

The U.S. Department of Agriculture's 1991 withdrawal of its Eating Right Pyramid food guide in response to pressure from meat and dairy producers was only the latest in a long series of industry attempts to influence federal dietary recommendations. Such attempts began when diet-related health problems in the United States shifted in prevalence from nutrient deficiencies to chronic diseases, and dietary advice shifted from "eat more" to "eat less." The Pyramid controversy focuses attention on the conflict between federal protection of the rights of food lobbyists to act in their own self-interest, and federal responsibility to promote the nutritional health of the public. Since 1977, for example, under pressure from meat producers, federal dietary advice has evolved from "decrease consumption of meat" to "have two or three (daily) servings." Thus, this recent incident also highlights the inherent conflict of interest in the Department of Agriculture's dual mandates to promote U.S. agricultural products and to advise the public about healthy food choices.     

Drug selection in hospitals. A model of reference in self-management of resources

The practice of medicine today must balance the optimal use of new pharmaceutical agents with the need for cost containment. Hospital policy regarding therapeutics and its historical perspective are discussed. Various aspects of the operations of Pharmacy and Therapeutics Committees are presented. The potential benefits of a formulary system are therapeutic, economic and educational and it could lead to a uniformity of drug usage throughout a district. The role of Clinical Pharmacology to provide advice to both Institution and physicians in how therapeutic practice may be optimized is also stressed.     

Accuracy of technicians versus pharmacists in checking syringes prepared for a dialysis program

The accuracy of pharmacy technicians versus pharmacists in checking drug doses prepared in syringes for a dialysis program was studied. Three pharmacy technicians from the pharmacy of a regional kidney disease program in Minnesota participated in the study after completing a training program and after common preparation errors had been identified by pharmacists. From November 1995 to April 1996, the technicians used labels printed from a database of pharmacist-verified orders to prepare and label i.v. syringes. Four medications were used-epoetin alfa, calcitriol, heparin prepared from beef lung, and heparin prepared from porcine intestinal mucosa. Each syringe was checked by one of nine pharmacists for accuracy of dose and medication, and all errors were recorded. The technicians checked syringes prepared by other technicians and also recorded errors. Accuracy rates (percentages of syringes correctly evaluated) for pharmacists and technicians were compared. A total of 10,608 syringes were checked. Accuracy rates for pharmacists and pharmacy technicians were 99.86% and 99.83%, respectively. Accuracy rates in checking syringes did not differ significantly between pharmacists and technicians in this study setting.     

Contribution of clinical pharmacists to patient care

Literature reports of the contributions of clinical pharmacists to patient care are reviewed. The topics covered are: clinical pharmacist functions in the drug use process, specific clinical activities of clinical pharmacists, and specialty areas of clinical pharmacy practice. It is concluded that more research needs to be done on the effectiveness and legal basis of clinical pharmacy services, and that adequate methods of payment for clinical pharmacy services must be developed.     

Third world medicine in first world cities: capital accumulation, uneven development and public health

This paper addresses issues of public health and access to care for the urban poor in the context of current U.S. urban, economic and industrial policy. The pathologies that threaten "inner city" neighborhoods are the result of decades of political neglect, economic exploitation and resource withdrawal, which themselves stem directly from public and corporate sector strategies to facilitate capital accumulation and consolidation. The resulting conditions of uneven development between wealthy and impoverished local sectors mirror similar relationships between First and Third World countries. These same patterns are reflected and reproduced in the health care "industry" itself, where growing corporate dominance has developed alongside a concomitant reduction in support for public sector and community-based care. These trends create and exacerbate conditions that place poor and minority populations at risk. Community development and political empowerment, as well as the overall corporate hegemony that increasingly characterizes the political economy of the U.S.A., are essential public health considerations that must be included in any meaningful health policy or health care reform proposals.     

The perceived influence of clinical pharmacy services on physician prescribing behavior: a matched-pair comparison of pharmacists and physicians

In contrast with cross-sectional designs used in previous studies, this exploratory study compared survey data from 127 matched pairs of clinical pharmacists and physicians working together. Physicians' perceptions of the importance of clinical pharmacy activities for patient care and the competence of pharmacists performing the activities were examined for their influence on prescribing behavior in an institutional setting. Data from a national survey showed that physicians rated pharmacists higher regarding recommendations based on drug use evaluations (p = 0.004) and competency to provide all clinical pharmacy services. Scores for pharmacokinetics ratings were similar between pharmacists and physicians (p = 0.168). Pharmacists rated the importance of recommendations based on cost-effectiveness higher than physicians (p = 0.012). Overall, physicians' perceptions of activity importance for patient care and pharmacist competency appear to dictate pharmacists' influence on physician prescribing behavior (R = 0.723).