Responsibility and confidence: Identifying barriers to advanced pharmacy practice.

BACKGROUND: Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings. METHODS: Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented. RESULTS: Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission. DISCUSSION: We identified 6 potential barriers to the development of pharmacists' self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously. CONCLUSION: Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.

Glucosamine and chondroitin use in canines for osteoarthritis: A review.

Osteoarthritis is a slowly progressive and debilitating disease that affects canines of all breeds. Pain and decreased mobility resulting from osteoarthritis often have a negative impact on the affected canine's quality of life, level of comfort, daily functioning, activity, behaviour, and client-pet companionship. Despite limited and conflicting evidence, the natural products glucosamine hydrochloride (HCl) and chondroitin sulfate are commonly recommended by veterinarians for treating osteoarthritis in dogs. There is a paucity of well-designed clinical veterinary studies investigating the true treatment effect of glucosamine and chondroitin. The purposes of this review article are to provide a brief background on glucosamine and chondroitin use in canine osteoarthritis and to critically review the available literature on the role of these products for improving clinical outcomes. Based on critical review, recommendations for practice are suggested and a future study design is proposed.

Canadian educational approaches for the advancement of pharmacy practice.

Canadian faculties (schools) of pharmacy are actively engaged in the advancement and restructuring of their programs in response to the shift in pharmacy to pharmacists having/assuming an advanced practitioner role. Unfortunately, there is a paucity of evidence outlining optimal strategies for accomplishing this task. This review explores several educational changes proposed in the literature to aid in the advancement of pharmacy education such as program admission requirements, critical-thinking assessment and teaching methods, improvement of course content delivery, value of interprofessional education, advancement of practical experiential education, and mentorship strategies. Collectively, implementation of these improvements to pharmacy education will be crucial in determining the direction the profession will take.

A physical assessment skills module on vital signs.

OBJECTIVES: To implement and evaluate a physical assessment module for pharmacy students. DESIGN: A physical assessment module focusing on vital signs was incorporated into the curriculum for third-year pharmacy students. This module consisted of an online component, a practical skills workshop, and a clinical practice site. ASSESSMENT: The mean score on the in-class quiz, which evaluated students' knowledge of physical assessment after completion of the online module, was 94%. During the practical skills laboratory, 48% of student-measured systolic blood pressure (BP) readings and 60% of student-measured diastolic BP readings were within 5 mmHg of the machine reading. In the assessment of blood pressure technique, areas of difficulty included detection of Korotkoff sounds; steady deflation of cuff; and hand-eye coordination. CONCLUSION: Students more frequently underestimated systolic BP than the diastolic BP when compared to the automated machine readings. Findings from this study will be used to improve existing modules and evaluation methods on the physical assessment of vital signs.