mySinusitisCoach: patient empowerment in chronic rhinosinusitis using mobile technology.

Mobile health technology is emerging to take a prominent position in the management of chronic diseases. These technologies aim at enhancing patient empowerment via education and self-management. To date, of all the different apps available for patients with sinus disease, none were developed by medical experts dealing with chronic rhinosinusitis (CRS). The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) has undertaken a multi-stakeholder approach for designing, developing and implementing a tool to support CRS patients in monitoring their symptoms and to provide patients with a digital support platform containing reliable medical information about their disease and treatment options. mySinusitisCoach has been developed by medical experts dealing with CRS in close collaboration with patients, primary care physicians and community pharmacists, meeting the needs of both patients and health care providers. From a research perspective, the generation of real life data will help to validate clinical studies, patient stratification and improve understanding of the socio-economic impact of CRS, thereby paving the way for better treatment strategies.

[Improving the quality of compounded medicines through self-assessment: proof of concept]. / Améliorer la qualité des préparations magistrates par l'autocontrôle: proof of concept.

A systematic quality control of compounded medicines, and an associated guidance of community pharmacists, was identified as a complementary opportunity to improve and guarantee the quality of compounded medicines. Before implementing this on a national scale, a pilot project was organized. Fifty pharmacies prepared the same formula and had it checked regarding labelling, preparation reports and analytical parameters. This proof of concept demonstrated that the organisation of quality control of compounded medicines by the professional body itself is feasible. Such audits fit well in de quality assurance systems in place in community pharmacy, where any corrective measures are properly documented and implemented. This form of self-regulation has a preventive character for detecting defects and contributes to improving the quality of the preparations and thus to the patient safety.

[Development of a protocol for counseling patients starting with oral hypoglycemic agents]. / Développement d'un protocole pour l'accompagnement de la première délivrance des antidiabétiques oraux.

INTRODUCTION: Counseling of patients filling a first prescription is an essentiaL aspect of pharmaceutical care. The use of a protocol summarizing all relevant counseling aspects can be a useful tool to standardize pharmaceutical care and to promote impLementation. AIM: (1) To develop a protocol for counseling of patients starting with oral hypoglycaemic agents (OHA), and (2) to investigate current provision of counseling for these patients in Belgian community pharmacies. METHOD: Based on literature, a consensus meeting with community pharmacists and consultation with physicians, we developed a protocol for counseling patients starting OHA. Additionally, an observational study of current provision of counseling for patients starting OHA was performed in 90 community pharmacies. RESULTS: All pharmacists reported to provide the most important item of our protocol, i.e. dose and timing of OHA intake. All other protocol items were provided by a smaller proportion of pharmacists: indication (by 64.4% of pharmacists), mechanism of action (30.0%), what to do if a dose is missed (3.3%), side effects (34.4%), hypoglycaemia (24.4%) and Lifestyle advice (68.9%). About 45% of pharmacists reported to give written drug information to patients starting OHA. Reduction of the administrative workload was most frequently mentioned as measure to spend more time on patient counseling. The majority of pharmacists considered our protocol as feasible and appLicabLe in daily pharmacy practice. CONCLUSION: This study found that current counseLing practices for patients starting OHA can be improved. Our protocol could be a useful and feasible tool to facilitate implementation of first prescription counseling.

[Drug related problems pharmacists encounter when a patient is discharged from hospital]. / Problématique des médicaments à prendre par les patients sortant de l'hôpital: etude réalisée auprès de pharmaciens d'officine flamands.

AIMS: To explore drug related problems a community pharmacist encounters when a patient is discharged from hospital. The study also investigates which information from the hospital reaches the community pharmacy. METHODS: A validated survey was presented, by community pharmacists, to patients or their family after hospital discharge, between the 1st of December 2007 and the 29th of February 2008. The survey contained questions on 4 items: patient characteristics--discharge medication--information received from the hospital--drug related problems and pharmacists interventions. Analyses were done with SPSS 16.0. MAIN RESULTS: 82 community pharmacists participated. 261 patients were included. Only 25% of the patients collected their medication from the pharmacy themselves. On discharge, patients on average received two additional drugs, compared to the pre-hospital situation. 69% received a medication chart, but less than half of them brought this chart along when visiting the pharmacy. Only 9% got computer-generated prescriptions from the hospital and < 3% received a letter of referral addressed to their pharmacist. In 33% of the cases the pharmacists noticed one or more problems concerning the medication prescribed after hospital discharge. The chance to detect a problem increased significantly when the chart was brought to the pharmacy (p=0.033). In case of observed problems, the community pharmacist succeeded to reach the treating specialist by phone in less than one third of those cases. CONCLUSION: The results foster the discussion on the need for a better seamless care and the role clinical and community pharmacists could play in this care model.

[Automatic blood pressure monitors in Belgian community pharmacy]. / Tensiomètres automatiques dans les officines Belges.

Patients' demands for automatic blood pressure monitors have increased steadily over the last few years. The offer in the Belgian community pharmacies has risen accordingly. For approximately 40 automatic devices op the Belgian market, an overview is given stating their most important aspects, with emphasis on clinical validation.

Ginkgo biloba medicines and food supplements on the Belgian market: a comparative study.

Medicines and food supplements based on the dry extract of the leaves of Ginkgo biloba L. were evaluated by determination of the content of total flavonoids, rutin and terpene lactones by means of liquid chromatography. All examined medicines complied with the fixed requirements whereas all food supplements deviated from 1 or more of the criteria. It could also be demonstrated that some products contained extracts to which rutin was added.

Piracetam preparations on the Belgian market: a comparative study.

Piracetam preparations formulated as capsules, tablets and granules were evaluated with different tests including in vitro dissolution and assay with previously validated methods according to the guideline of the European network of official medicines control laboratories (OMCLs). All examined products complied with the requirements as described here and in the European Pharmacopoeia except for the dissolution test where 3 products did not meet the USP acceptance criteria applied on the established specification.

In-house packing and testing of capillaries for capillary electrochromatography using simple equipment.

The feasibility of producing packed capillaries for capillary electrochromatography (CEC) is evaluated. Emphasis is put on the fact that only material was used that is already available in any LC/CE orientated laboratory. An experimental set-up is developed for filling the capillaries by use of an ordinary LC pump, and frits are sintered with a glowing resistance wire, fed by a d.c. power supply. Electrochromatography was carried out in an in-house built capillary electrophoresis apparatus, without pressurizing the vials. Under these conditions, the capillaries performed well, producing up to 190,000 plates per meter. Bubble formation did not appear, on condition that the mobile phase was thoroughly helium degassed. Even at ambient temperature, electrophoresis obeyed Ohm's law up to a voltage of 30 kV, proving that Joule heating was not a major concern.

Interlaboratory study comparing the microbiological potency of spiramycins I, II and III.

An interlaboratory study has been performed to determine the relative potencies of spiramycins (SPMs) I, II and III by diffusion or/and turbidimetric assays with Bacillus subtilis or Staphylococcus aureus as the test organisms. Six laboratories from three countries participated. Experimental procedures were according to the European Pharmacopoeia, 3rd ed. The activity of SPM I is markedly higher than that of SPM II and III. By diffusion, the activities of SPM II and III relative to SPM I were found to be 57 and 72%, respectively. The interlaboratory relative standard deviations (RSD) varied from 3.6 to 16.3%. By turbidimetry, the activities of SPM II and III relative to SPM I were found to be 45 and 52%, respectively. The interlaboratory RSD values varied from 2.6 to 7.7%. The results of the study were analyzed according to the ISO 5725-2 guidelines to determine the repeatability, the between-laboratory and the reproducibility variances of both methods.

Phosphodiesterase susceptibility of modified oligonucleotides studied in an integrated capillary electrophoresis system.

A capillary electrophoresis system that integrated an enzymatic reaction and capillary polymer sieving electrophoresis was used to check the enzymatic stability of oligonucleotides. Phosphodiesterase I was employed to assess the susceptibility to 3'-exonucleolytic breakdown of some unmodified and modified oligonucleotides. Before degradation, the purity of the synthetic oligodeoxynucleotides was checked by capillary electrophoresis with a replaceable hydroxyethyl cellulose polymer solution. Enzymatic breakdown was achieved inside the capillary by merging substrate and enzyme zones based on their difference in electrophoretic mobility. After reaction, oligonucleotide fragments were swept to the detector, where they were individually detected and the remaining substrate was quantified. The results from the in-capillary degradation were compared to an off-line incubation and separation.

Ranitidine preparations on the Belgian market: a comparative study.

Ranitidine preparations formulated as tablets and granules were evaluated with different tests including in vitro dissolution and assay. Previously the analytical methods of these tests were validated according to the guidelines of the European network of Official Medicines Control Laboratories (OMCLs). All examined products complied to the requirements as described in the European, the British and the US Pharmacopoeia and consequently they can be considered as pharmaceutically equivalent.

Determination of the kinetic parameters of adenosine deaminase by electrophoretically mediated microanalysis.

The possibility of determining the Michaelis constant of the irreversible deamination of adenosine to inosine by adenosine deaminase, using capillary electrophoresis, was investigated. This paper describes the use of electrophoretically mediated microanalysis (EMMA) as the technique for carrying out the assay. Initial reaction velocities of the enzymatic reaction were estimated from the peak area of inosine, and the Michaelis constant was calculated according to the Lineweaver-Burk equation. The result (Km = 5.3 x 10(-5) M +/- 8 x 10(-6) M) was consistent with previously reported values. Using the present method, a total amount of as few as 1.2 fmole of enzyme and 9.2 ng of substrate were injected in the capillary for the construction of a Michaelis Menten curve (seven concentrations of substrate, each concentration analyzed in triplicate), which is far smaller than the quantities required in conventional methods.

Capillary electrophoresis of RNA oligonucleotides: catalytic activity of a hammerhead ribozyme.

Ribozymes are sequences of catalytic RNA that are being evaluated as possible antisense therapeutics. This paper describes how capillary electrophoresis (CE) could be used to measure the catalytic rate of a synthetic hammerhead ribozyme in cleaving its substrate. This substrate was a synthetic full-RNA 17-mer, whereas the ribozyme was made up of a mixture of 37 2'-OH and 2'-OCH3 RNA nucleotides. After experimental conditions to exclude ribonuclease contamination were successfully met, different CE modes were tried out to separate the ribozyme from its substrate. Only the combination of chemical and thermal denaturation was adequate to disrupt strong secondary structures and to inhibit comigration of the two molecules. Cleavage kinetics were measured by continuous injection from the reaction vial into a polymer-filled capillary, and by determination of the area of the shrinking substrate peak. Compared to the well-established slab gel electrophoresis, CE is at least one order of magnitude faster, may be completely automated, allows easier and more precise quantitation of results, and, due to the small scale and self-contained nature of the apparatus, reduces health risks from dangerous chemicals. Unfortunately, UV detection in a 100-microm internal diameter capillary lacked the sensitivity to perform assays in the nanomolar range, which was necessary for a full Michaelis-Menten analysis.