A Drug Content, Stability Analysis, and Qualitative Assessment of Pharmacists' Opinions of Two Exemplar Extemporaneous Formulations.

Despite a decline in the number of active pharmaceutical ingredients prepared extemporaneously using proprietary products, there remains a need for such products in the community (for example, liquid medicines for paediatrics which may be otherwise commercially unavailable). A lack of experience and quality assurance systems may have diminished pharmacist's confidence in the extemporaneous preparation process; therefore, pharmacists were asked to prepare two proprietary products, omeprazole and amlodipine. The resulting products were characterised in terms of variability in drug quantity, stability, particle size and antimicrobial properties. Furthermore, a self-administered questionnaire was used to assess 10 pharmacists' opinions on the perceived complexity of the extemporaneous compounding process and their overall confidence in the final extemporaneously compounded products. Drug content studies revealed that 88.5% and 98.0% of the desired drug content was obtained for omeprazole and amlodipine, respectively. Antimicrobial properties were maintained for both drugs, however variability in particle size, particularly for amlodipine, was evident between formulations. While pharmacists who partook in the study had some or high confidence in the final products, they reported difficulty formulating the suspensions. Findings from this study provide insight into pharmacists' views on two extemporaneously prepared products and highlight the variability obtained in preparations prepared by different pharmacists.

Successful application of large microneedle patches by human volunteers.

We describe, for the first time, the design, production and evaluation of large microneedle patches. Such systems, based on 16 individual microneedle arrays (needle height 600µm), were prepared from aqueous blends of 15% w/w Gantrez® S97 and 7.5% w/w poly(ethyleneglycol) 10,000Da. Ester-based crosslinking was confirmed by FTIR and mechanical strength was good. Insertion depths in a validated skin model were approximately 500µm. Ten human volunteers successfully self-inserted the microneedles of these larger patches in their skin, following appropriate instruction, as confirmed by transepidermal water loss measurements. The mean insertion depth ranged between 300 and 450µm over the area of the large patches. That this was not significantly different to a single unit MN patch self-applied by the same volunteers is encouraging. Microneedle patch sizes much larger than the 1-2cm2 will be required if this technology is to be successfully translated to clinic for delivery of drug substances. The work described here suggests that use of such larger patches by patients can be successful, potentially opening up the possibility for a significant expansion of the size of the market for transdermal drug delivery.

Tracing the prescription journey: a qualitative evaluation of an interprofessional simulation-based learning activity.

BACKGROUND: In many countries across the world, the majority of prescribing occurs within the community setting. Close collaboration between general practitioners (GPs) and pharmacists is required to ensure effective therapeutic treatment of patients, whilst minimising prescribing and dispensing errors. Despite the need to work collaboratively, medical and pharmacy training is often unilateral. Interprofessional education (IPE) and simulation-based education (SBE) are teaching approaches widely used by healthcare professionals to foster collaborative practice. At Queen's University Belfast (QUB), an innovative IPE activity was developed for medical and pharmacy undergraduate students that aimed to develop a greater understanding of their roles and duties in community prescribing and dispensing. This study set out to evaluate the impact of such a SBE activity on students' attitudes towards collaborative practice in prescribing and dispensing medication in the community. METHODS: Interprofessional groups of year 3 pharmacy (n = 10) and year 4 medical (n = 9) students took part in a SBE activity. This focused on the IPE team clinically assessing, diagnosing, writing prescriptions, dispensing medication(s) and counselling a simulated patient (in a simulated practice and pharmacy setting). Using a questioning guide, four focus groups of medical and pharmacy students were used to evaluate their attitudes towards the simulated IPE activity. Interviews were audio-recorded, transcribed and analysed iteratively using thematic analysis. RESULTS: Four main themes emerged from the analysis: (1) IPE simulation activity: creating a broader learning experience; (2) patient-centred practice: a shared understanding; (3) professional skills: explored and shared; and (4) professional roles: a journey of discovery, respect and stereotypes. CONCLUSIONS: Students broadened their knowledge of each other's expertise in skills and clinical roles whilst working together. Furthermore, students valued the opportunity to strengthen cooperation with their future colleagues with the shared goal of improving patient-centred care.

The Use of a Pressure-Indicating Sensor Film to Provide Feedback upon Hydrogel-Forming Microneedle Array Self-Application In Vivo.

PURPOSE: To evaluate the combination of a pressure-indicating sensor film with hydrogel-forming microneedle arrays, as a method of feedback to confirm MN insertion in vivo. METHODS: Pilot in vitro insertion studies were conducted using a Texture Analyser to insert MN arrays, coupled with a pressure-indicating sensor film, at varying forces into excised neonatal porcine skin. In vivo studies involved twenty human volunteers, who self-applied two hydrogel-forming MN arrays, one with a pressure-indicating sensor film incorporated and one without. Optical coherence tomography was employed to measure the resulting penetration depth and colorimetric analysis to investigate the associated colour change of the pressure-indicating sensor film. RESULTS: Microneedle insertion was achieved in vitro at three different forces, demonstrating the colour change of the pressure-indicating sensor film upon application of increasing pressure. When self-applied in vivo, there was no significant difference in the microneedle penetration depth resulting from each type of array, with a mean depth of 237 µm recorded. When the pressure-indicating sensor film was present, a colour change occurred upon each application, providing evidence of insertion. CONCLUSIONS: For the first time, this study shows how the incorporation of a simple, low-cost pressure-indicating sensor film can indicate microneedle insertion in vitro and in vivo, providing visual feedback to assure the user of correct application. Such a strategy may enhance usability of a microneedle device and, hence, assist in the future translation of the technology to widespread clinical use.

Using debate to teach pharmacy students about ethical issues.

OBJECTIVE: To create, implement, and evaluate debate as a method of teaching pharmacy undergraduate students about ethical issues. DESIGN: Debate workshops with 5 hours of contact with student peers and facilitators and 5 hours of self-study were developed for second-year pharmacy students. Student development of various skills and understanding of the topic were assessed by staff members and student peers. ASSESSMENT: One hundred fifty students completed the workshops. The mean score for debating was 25.9 out of 30, with scores ranging from 23.2 to 28.7. Seventy percent of students agreed that the debates were a useful teaching method in the degree program. CONCLUSION: A series of workshops using debates effectively delivered course content on ethical issues and resulted in pharmacy students developing skills such as teamwork, peer assessment, communication, and critical evaluation. These findings suggest that pharmacy students respond favorably to a program using debates as a teaching tool.

Hydrogel-forming microneedle arrays can be effectively inserted in skin by self-application: a pilot study centred on pharmacist intervention and a patient information leaflet.

PURPOSE: To investigate, for the first time, the influence of pharmacist intervention and the use of a patient information leaflet on self-application of hydrogel-forming microneedle arrays by human volunteers without the aid of an applicator device. METHODS: A patient information leaflet was drafted and pharmacist counselling strategy devised. Twenty human volunteers applied 11 × 11 arrays of 400 µm hydrogel-forming microneedle arrays to their own skin following the instructions provided. Skin barrier function disruption was assessed using transepidermal water loss measurements and optical coherence tomography and results compared to those obtained when more experienced researchers applied the microneedles to the volunteers or themselves. RESULTS: Volunteer self-application of the 400 µm microneedle design resulted in an approximately 30% increase in skin transepidermal water loss, which was not significantly different from that seen with self-application by the more experienced researchers or application to the volunteers. Use of optical coherence tomography showed that self-application of microneedles of the same density (400 µm, 600 µm and 900 µm) led to percentage penetration depths of approximately 75%, 70% and 60%, respectively, though the diameter of the micropores created remained quite constant at approximately 200 µm. Transepidermal water loss progressively increased with increasing height of the applied microneedles and this data, like that for penetration depth, was consistent, regardless of applicant. CONCLUSION: We have shown that hydrogel-forming microneedle arrays can be successfully and reproducibly applied by human volunteers given appropriate instruction. If these outcomes were able to be extrapolated to the general patient population, then use of bespoke MN applicator devices may not be necessary, thus possibly enhancing patient compliance.

Development and validation of procedures for assessment of competency of non-pharmacists in extemporaneous dispensing.

OBJECTIVES: To develop and validate procedures that may be suitable for assessment of competency of two groups of non-pharmacist staff (pharmacy students and trainee support staff) in extemporaneous dispensing. This is important given the prospect of remote supervision of community pharmacies in the UK. METHODS: Analytical methods were validated according to International Conference on Harmonisation specifications and procedures were optimized to allow efficient drug extraction. This permitted straightforward determination of drug content in extemporaneously prepared lidocaine hydrochloride mouthwashes and norfloxacin creams and suspensions prepared by 10 participants recruited to represent the two groups of non-pharmacist staff. KEY FINDINGS: All 10 participants had completed the extemporaneous dispensing of all three products within 90 min. Extraction and analysis took approximately 15 min for each lidocaine hydrochloride mouthwash and 30 min for each diluted norfloxacin cream and norfloxacin suspension. The mean drug concentrations in lidocaine hydrochloride mouthwashes and diluted norfloxacin creams were within what are generally accepted as being pharmaceutically acceptable limits for drug content (100 +/- 5%) for both groups of participants. There was no significant difference in the mean drug concentration of norfloxacin suspensions prepared by the participant groups. However, it was notable that only one participant prepared a suspension containing a norfloxacin concentration that was within pharmaceutically acceptable limits (101.51%). CONCLUSIONS: A laboratory possessing suitable equipment and appropriately trained staff could cope readily with the large number of products prepared, for example, by a cohort of pre-registration students. Consequently, the validated procedures developed here could usefully be incorporated into the pre-registration examination for pharmacy students and a final qualifying examination for dispensers and pharmacy technicians. We believe that this is essential if the public and the profession are to have confidence in extemporaneous dispensing carried out in the absence of a pharmacist.