Comparison of time to treatment initiation of specialty medications between an integrated health system specialty pharmacy and external specialty pharmacies.

BACKGROUND: Specialty medications are commonly dispensed through specialty pharmacies equipped to meet unique monitoring and dispensing requirements. Integrated health system specialty pharmacies (HSSPs) coordinate with health system providers to deliver specialty medications to patients and ameliorate barriers to care. However, payors may restrict specialty medication fills to specialty pharmacies external to the health system, potentially leading to delayed treatment. OBJECTIVE: To compare time to treatment initiation among patients whose specialty medications were transferred to external pharmacies and patients whose medications were filled at an internal HSSP. METHODS: This was a retrospective, propensity-matched cohort study examining time to treatment initiation in patients with a specialty medication referral to the University of Kentucky HealthCare Specialty Pharmacy between July 1, 2021, and July 1, 2022. Patients were classified into cohorts by receipt of dispensing services from the internal HSSP or an external specialty pharmacy. Data collected via chart review included insurance type, reason for prescription transfer, dates of service (including prescription order, transfer, and receipt of medication), and whether a prior authorization or clinical intervention was performed. Subgroup analyses were performed for patients requiring a prior authorization or clinical intervention. The Wilcoxon signed-rank test was used to assess for statistically significant differences in time to treatment initiation between cohorts. RESULTS: A total of 560 patients with external transfers were identified for inclusion into the study, and after exclusion criteria were applied, 408 external transfer patients were propensity matched 1:1 to 408 patients with internal fills (total n = 816). Time to treatment initiation was significantly longer in the external transfer cohort as compared with the internal fill cohort, (18 days vs 12 days; P < 0.0001). The internal fill cohort had a greater mean days from provider order to the medication being ready to fill compared with the external transfer cohort (10 days vs 6 days; P < 0.0001). The internal fill cohort had fewer mean days from the medication being ready to fill to patient receipt of the medication as compared with the external transfer cohort (2 days vs 12 days; P < 0.0001). Similar findings were observed in the subgroup analyses. CONCLUSIONS: Average time to treatment initiation was 6 days shorter for patients whose specialty medications were filled at this HSSP compared with externally transferred patients. Delays in therapy can cause a negative impact on patient care and disease state management, with increased concern for specialty populations. The results of this study highlight the need for continued discussion about policies that limit patient choice to in-network pharmacies.

[Current situation and development trend of digital traditional Chinese medicine pharmacy].

The 21st century is a highly information-driven era, and traditional Chinese medicine(TCM) pharmacy is also moving towards digitization and informatization. New technologies such as artificial intelligence and big data with information technology as the core are being integrated into various aspects of drug research, manufacturing, evaluation, and application, promoting interaction between these stages and improving the quality and efficiency of TCM preparations. This, in turn, provides better healthcare services to the general population. The deep integration of emerging technologies such as artificial intelligence, big data, and cloud computing with the TCM pharmaceutical industry will innovate TCM pharmaceutical technology, accelerate the research and industrialization process of TCM pharmacy, provide cutting-edge technological support to the global scientific community, boost the efficiency of the TCM industry, and promote economic and social development. Drawing from recent developments in TCM pharmacy in China, this paper discussed the current research status and future trends in digital TCM pharmacy, aiming to provide a reference for future research in this field.

Synthetic biology in microalgae towards fucoxanthin production for pharmacy and nutraceuticals.

Synthetic biology has emerged as a powerful tool for engineering biological systems to produce valuable compounds, including pharmaceuticals and nutraceuticals. Microalgae, in particular, offer a promising platform for the production of bioactive compounds due to their high productivity, low land and water requirements, and ability to perform photosynthesis. Fucoxanthin, a carotenoid pigment found predominantly in brown seaweeds and certain microalgae, has gained significant attention in recent years due to its numerous health benefits, such as antioxidation, antitumor effect and precaution osteoporosis. This review provides an overview of the principles and applications of synthetic biology in the microbial engineering of microalgae for enhanced fucoxanthin production. Firstly, the fucoxanthin bioavailability and metabolism in vivo was introduced for the beneficial roles, followed by the biological functions of anti-oxidant activity, anti-inflammatory activity, antiapoptotic role antidiabetic and antilipemic effects. Secondly, the cultivation condition and strategy were summarized for fucoxanthin improvement with low production costs. Thirdly, the genetic engineering of microalgae, including gene overexpression, knockdown and knockout strategies were discussed for further improving the fucoxanthin production. Then, synthetic biology tools of CRISPR-Cas9 genome editing, transcription activator-like effector nucleases as well as modular assembly and chassis engineering were proposed to precise modification of microalgal genomes to improve fucoxanthin production. Finally, challenges and future perspectives were discussed to realize the industrial production and development of functional foods of fucoxanthin from microalgae.

A systematic methodology to assess the identity of plants in historical texts: A case study based on the Byzantine pharmacy text John the Physician's Therapeutics.

ETHNOPHARMACOLOGICAL RELEVANCE: In recent decades, the study of historical texts has attracted research interest, particularly in ethnopharmacology. All studies of the materia medica cited in ancient and medieval texts share a concern, however, as to the reliability of modern identifications of these substances. Previous studies of European or Mediterranean texts relied mostly on authoritative dictionaries or glossaries providing botanical identities for the historical plant names in question. Several identities they suggest, however, are questionable and real possibility of error exists. AIM OF THE STUDY: This study aims to develop and document a novel and interdisciplinary methodology providing more objective assessment of the identity of the plants (and minerals) described in these resources. MATERIALS AND METHODS: We developed an iterative experimental approach, using the 13th century Byzantine recipe text John the Physician's Therapeutics in its Commentary version (JC) as a case study. The methodology has six stages and relies on comparative analyses including statistical evaluation of botanical descriptions and information about medicinal uses drawn from both historical and modern sources. Stages 1-4 create the dataset, stage 5 derives the primary outcomes to be reviewed by experts in stage 6. RESULTS: Using Disocorides' De Materia Medica (DMM) (1st century CE) as the culturally related reference text for the botanical descriptions of the plants cited in JC, allowed us to link the 194 plants used medicinally in JC with 252 plants cited in DMM. Our test sample for subsequent analyses consisted of the 50 JC plant names (corresponding to 61 DMM plants) for which DMM holds rich morphological information, and the 130 candidate species which have been suggested in the literature as potential botanical identities of those 50 JC plant names. Statistical evaluation of the comparative analyses revealed that in the majority of the cases, our method detected the candidate species having a higher likelihood of being the correct attribution from among the pool of suggested candidates. Final assessment and revision provided a list of the challenges associated with applying our methodology more widely and recommendations on how to address these issues. CONCLUSIONS: We offer this multidisciplinary approach to more evidence-based assessment of the identity of plants in historical texts providing a measure of confidence for each suggested identity. Despite the experimental nature of our methodology and its limitations, its application allowed us to draw conclusions about the validity of suggested candidate plants as well as to distinguish between alternative candidates of the same historical plant name. Fully documenting the methodology facilitates its application to historical texts of any kind of cultural or linguistic background.

Nature's Own Pharmacy: Mushroom-Based Chemical Scaffolds and Their Therapeutic Implications.

Mushrooms are new potential sources of valuable medicines, long neglected because of difficulties experienced in their cultivation. There is a large variety of medicinal mushrooms which possess significant therapeutic properties and are used as medications for various diseases because they contain several novel highly bioactive components. Medicinal mushrooms can be identified based on their morphology, size, mass, and the color of the stalk, cap and spore, and attachment to the stalk. Medicinal mushrooms possess a variety of important biological activities and are used as antioxidants, hepatoprotectors, anticancer, antidiabetic, anti-inflammatory, antiaging, antiviral, antiparasitic, and antimicrobial agents, among others. This review provides a basic overview of the chemical scaffolds present in mushrooms and their therapeutic implications in the human body.

Pharmaceutical Assessment of the Impact of the Method of Extraction on the Suitability of Pectin from Plantain (Musa paradisiaca) Peels as a Suspending Agent in Oral Liquid Formulations.

Natural polymers such as pectin have gained increased utilization in pharmaceutical and biotechnology sectors because they are affordable, easily accessible, nontoxic, and chemically modifiable, with the potential to be biodegradable and biocompatible. Musa paradisiaca (plantain) peels make up 30-40% of the overall weight of the fruit. The extraction of pectin from these residues can therefore be viewed as a possible waste of wealth. This study, therefore, focused on evaluating the suspending properties of pectin obtained from Musa paradisiaca (plantain) peels (through acid and alkaline extraction) and presented an alternative suspending agent in the pharmaceutical formulation of suspensions. The unripe peels of Musa paradisiaca were acquired and authenticated at the Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Pectin was extracted from the peels using both acid and alkaline extraction processes, respectively, characterized, and evaluated for its phytochemical properties. Different concentrations of the acid and alkaline pectin extracts were employed as a suspending agent in paracetamol suspensions, using acacia gum as a standard. The pectin yields obtained were 4.88% and 7.61% for the acid and alkaline extraction processes, respectively, while phytochemical screening revealed the presence of glycosides, tannins, saponins, and phenols in both extracts. The alkaline pectin extract recorded higher equivalent weight, degree of esterification, ash content, and crude content than the acid pectin extract, while FTIR identified similar functional groups in both acid and alkaline pectin extracts. The test suspensions reported significant differences (P < 0.05) in flow rates, ease of redispersion, sedimentation volumes, and rates compared with acacia gum. Moreover, when the acid and alkaline pectin extracts were compared, significant differences (P < 0.05) were observed in sedimentation rates and sedimentation volumes, suggesting that the extraction method may affect suspending properties. Ultimately, the alkaline pectin extract had better suspending properties than the acid pectin extract; however, they both can be used as an alternative to acacia gum as a suspending agent.

Hu-Zhang Qing-Mai Formulation anti-oxidative stress alleviates diabetic retinopathy: Network pharmacology analysis and in vitro experiment.

BACKGROUND: In this study, the potential mechanism of the Hu-Zhang Qing-Mai Formulation (HZQMF) on diabetic retinopathy (DR) in inhibiting oxidative stress was explored through network pharmacology analysis and in vitro experiments. METHODS: The Traditional Chinese Medicine Systematic Pharmacology Analysis Platform was used to retrieve the active pharmaceutical ingredients and targets of HZQMF. DR-related genes and oxidative stress-related genes were obtained from PharmGKB, TTD, OMIM, GeneCards, and Drugbank. STRING was used to construct a protein-protein interaction network to screen core targets. Gene ontology and Kyoto encyclopedia of genes and genomes enrichment analyses were performed using R 4.0.3. Network topology analysis was carried out using Cytoscape 3.8.2. Finally, we looked into how well the main API protected human retinal pigment epithelial cells from damage brought on by hydrogen peroxide (H2O2). RESULTS: Quercetin (Que) was identified as the primary API of HZQMF through network pharmacology analysis, while JUN, MAPK1, and STAT3 were identified as the primary hub genes. Kyoto encyclopedia of genes and genomes enrichment analysis showed that the AGE-RAGE signaling pathway may be crucial to the therapeutic process. In vitro experiments confirmed that Que increased cell vitality and inhibited apoptosis. CONCLUSION: Que might significantly reduce H2O2-induced ARPE-19 cell injury by inhibiting apoptosis-related genes of the AGE-RAGE pathway (JUN, MAPK1, STAT3). This study lays the foundation for further research on HZQMF in treating DR.

Professor Georg Dragendorff (1836-1898) as a Toxicologist.

The professor of pharmacy, Johann Georg Noel Dragendorff (1836-1898) is primarily known in the history of pharmacy as a pharmacognosist and forensic chemist, so far he has been less described as a toxicologist. He worked for 30 years (1864-1894) at the University of Dorpat (Tartu) in Estonia, and had been invited from Germany, developing here one of the pharmaceutical research centers in all of Europe. Dr. Dragendorff supervised 90 theses of Master of Pharmacy and 87 theses of Doctor of Medicine in Tartu/Dorpat. Dragendorff's supervised master's theses reveal his particular interest in phytochemistry. Of the 87 doctoral dissertations supervised by Dragendorff, are related to forensic chemistry (26 works), and toxicology with pharmacology (21). This work introduces Dragendorff as a toxicologist, discusses the theses supervised by him and his textbooks. Dragendorff's development as a toxicologist was logical considering his extensive scientific activities and the drugs characteristic of the 19 th century. These, especially alkaloids and mercury preparations, are introduced in more detail in this study.

Primary medication nonadherence rates to specialty disease-modifying antirheumatic drugs for rheumatoid arthritis within a health system specialty pharmacy.

BACKGROUND: Assessing primary medication nonadherence, the rate at which a medication is prescribed for a patient but is not obtained or replaced with an alternative medication within a reasonable time period, can provide a better understanding of the frequency and impact of these barriers to medication access. Previous literature has reported high rates of primary medication nonadherence, ranging from approximately 20% to 55% in patients with rheumatoid arthritis (RA) treated with specialty disease-modifying antirheumatic drugs (DMARDs). The high primary medication nonadherence rate may reflect the difficulties associated with obtaining specialty medications, such as high costs, extended prior authorizations, and pretreatment safety requirements. OBJECTIVE: To evaluate reasons for and rates of primary medication nonadherence to specialty DMARDs in patients with RA referred to an integrated health systems specialty pharmacy. METHODS: We conducted a retrospective cohort study examining eligible patients with a specialty DMARD referral from a health system rheumatology provider to the health system specialty pharmacy. Initially, pharmacy claims were used to identify primary medication nonadherence, defined as the lack of a fill event within 60 days following the medication referral for patients without a specialty DMARD claim in the 180 days prior. Referrals from July 1, 2020, to July 1, 2021, were eligible. Exclusion criteria included duplicate referrals, use for non-RA indications, switches to clinic-administered therapies, and alternate filling methods. Medical record reviews were conducted to confirm referral outcomes. Outcomes included rate of and reasons for primary medication nonadherence. RESULTS: We included 480 eligible patients, 100 of whom had no documented fill event. After medical record review, 27 patients were removed due to having a non-RA diagnosis and 65 patients were removed due to having alternative fill methods, most due to external prescription routing (83.1%). The final primary medication nonadherence rate was 2.1%. Out of the 8 cases of true primary medication nonadherence, 3 patients held specialty DMARD therapy because of other existing disease states, 3 patients were unreachable, and 2 patients were unable to afford medication. CONCLUSIONS: Rates of primary medication nonadherence to specialty DMARDs were low in patients with RA managed by a health system specialty pharmacy. A total of 8 primary medication nonadherence cases were related to safety concerns in non-RA diseases states, patient unreachability, and affordability. However, the limited number of primary medication nonadherence cases limits the generalizability of reasons for primary medication nonadherence found in this study. Key elements of the health systems specialty pharmacy model that likely contribute to low primary medication nonadherence include dedicated financial assistance navigation services, in-clinic pharmacist availability, and open communication between provider offices.

Nomenclature: Herbal Taxonomy in the Global Commerce of Botanicals.

In the world trade of medicinal plants, the naming of plants is fundamental to understanding which species are acceptable for therapeutic use. There are a variety of nomenclatural systems that are used, inclusive of common names, Latinized binomials, Galenic or pharmaceutical names, and pharmacopeial definitions. Latinized binomials are the primary system used for naming wild plants, but these alone do not adequately define medicinal plant parts. Each system has its specific applications, advantages, and disadvantages. The topic of medicinal plant nomenclature is discussed broadly by underscoring when and how varying nomenclatural systems should be used. It is emphasized that pharmacopeial definitions represent the only naming system that integrates plant identity, relevant plant parts, and the specific quality metrics to which a material must comply, thus affording the most appropriate identification method available for medicinal plant materials.

Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network.

Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.

Pharmacy education in traditional and complementary medicines - A systematic review.

BACKGROUND: Traditional and complementary medicines (T&CMs) are not typically covered in medical curricula despite 80% of the world's population using some form of herbal product as part of their healthcare. Concurrent use of T&CMs with conventional therapies is common, and both are primarily accessed in pharmacies. There is an expectation that pharmacists should be knowledgeable about T&CMs. Therefore, this review aimed to investigate what is currently known about pharmacists' T&CMs education and training to inform developments in pharmacy education. METHODS: Eligible studies published between 01/01/2016 and 28/02/2023 were identified across six databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). Data were extracted from included studies and categorized into key themes and sub-themes and reported descriptively. FINDINGS: Fifty-eight studies were identified, conducted across 30 countries, that included information about pharmacists' T&CMs education and training. Within the four main themes extracted, six subthemes were identified including: T&CMs education and training received; inadequate education and training opportunities; knowledge, and confidence towards T&CMs in the pharmacy setting; professional practice behaviour associated with T&CM; university education for pharmacy students; and continuing professional development for practicing pharmacists, including T&CM-drug interactions, interpreting T&CM research, T&CM-specific communication skills, T&CM use in pregnancy and breastfeeding, and efficacy and safety of T&CM in specific conditions. CONCLUSION: Overall pharmacists are receiving limited T&CM education in undergraduate and continuing professional training and report a lack of resources to inform the advice they provide to consumers. The findings of this review can inform developments in T&CMs curriculum and accreditation standards that support the training needs of pharmacists who play a role in fostering the safe and appropriate use of these products.

Incorporation of yoga in pharmacy education.

BACKGROUND: The well-being of pharmacists is critical to support personal and professional health. Identifying and integrating a variety of practices that promote wellness is prudent for schools/colleges of pharmacy so students may form habits before entering the profession as practitioners. Yoga, a practice that combines muscular activity with mindfulness, can be incorporated with minimal resources via numerous mechanisms within and outside of the curriculum. METHODS: The objective was to provide a summary of various strategies incorporating yoga in pharmacy professional curricula as well as detail various approaches to integrating yoga into pharmacy curricula. Literature was evaluated across professional pharmacy programs pertaining to yoga knowledge, beliefs, approaches, and benefits. RESULTS: Ten articles about yoga awareness, knowledge, beliefs, and benefits in professional pharmacy curricula were identified. Improvement in mental health and decreased stress were recognized as benefits. Within schools/colleges of pharmacy, yoga programming has been included in required as well as elective courses, co-curriculum programming, extracurricular activities, and post-graduate training. IMPLICATIONS: Schools of pharmacy can consider incorporation of yoga practice into curricula as a tool to promote well-being and resiliency.

Development of a framework and research impact capture tool for nursing, midwifery, allied health professions, healthcare science, pharmacy and psychology (NMAHPPs).

BACKGROUND: There is an ambitious target to create a UK clinical academic workforce representing 1% of clinicians from nursing, midwifery, the allied health professions, healthcare science, pharmacy and psychology (NMAHPPs). Understanding and recording the impact that clinical academics make across healthcare services is crucial if we are to grow, value and support this highly skilled workforce group. However, it is currently difficult to systematically record, collate and report the impacts associated with NMAHPP research activity. The aims of this project were to i) develop a framework outlining the impacts that were important for key stakeholder groups, and ii) create and pilot a research impact capture tool to record these impacts. METHODS: The framework was developed from the existing literature. It was refined, remodelled and approved by multidisciplinary stakeholder involvement, including patient and public representatives, healthcare managers and research-active clinicians. The framework was converted into a series of questions to create an electronic research impact capture tool, which was also refined through feedback from these stakeholder groups. The impact capture tool was piloted with research-active clinicians across a large NHS Trust and its associated organisations. RESULTS: The impact framework contained eight elements: clinical background, research and service improvement activities, research capacity building, research into practice, patients and service users, research dissemination, economics and research funding, and collaborations. Thirty individuals provided data for the research impact capture tool pilot (55% response rate). Respondents reported a range of positive impacts representing all elements of the framework. Importantly, research-activity appeared to be a key driver for recruitment and retention in the sample population. CONCLUSIONS: The impact capture tool is a feasible method of recording the breadth of impacts associated with NMAHPP research activity. We encourage other organisations to collaboratively use and refine our impact capture tool, with the aim of standardising reporting, and facilitating discussions about research activity within clinical appraisal. Pooling and comparing data will also allow comparison between organisations, and assessment of change over time or after implementation of interventions aimed at supporting and increasing research activity.

Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal.

BACKGROUND: Unregulated antimicrobial use is common in both hospital and community settings of low- and middle-income countries (LMICs). However, discrete data regarding the use/misuse of antimicrobials at pharmacies in LMICs are limited. This study was conducted to understand knowledge, attitude, and practice of pharmacy employees on antimicrobial dispensing in Nepal. METHODS: We conducted a cross-sectional survey using a structured questionnaire on 801 pharmacy employees working in community and hospital pharmacies located in Lalitpur metropolitan city (LMC) of Kathmandu, Nepal between April 2017 and March 2019. RESULTS: A majority (92%) of respondents agreed that demand for non-prescription antimicrobials was common. Asking for prescription before dispensing was ranked as the first preference by majority (69%) of participants. Suspected respiratory tract infection was the most common reason demanding for non-prescription antimicrobials with the highest mean rank of 1.5. Azithromycin was the most commonly prescribed and sold antimicrobial, as reported by 46% and 48% of participants respectively. A majority (87%) of respondents agreed on antimicrobial resistance (AMR) to be a global public health threat; and misuse/overuse of antimicrobials was perceived as the most common cause of AMR with a mean rank of 1.93. CONCLUSION: Our study revealed that unfounded dispensing and use of antimicrobials is prevalent among pharmacies in Kathmandu, Nepal. This over reliance on antimicrobials, notably azithromycin, may escalate burden of AMR. We identified several drivers of inappropriate antimicrobial dispensing practice in pharmacies, which will aid public health authorities in addressing these issues. Further studies considering role of other stakeholders, such as doctors, veterinarians, general public, and policy makers are required to obtain a more holistic perspectives on practices of antimicrobial use so to curb the extant AMR crisis.

Chinese Intelligence Prescription System improves prescription accuracy while decreasing labor and drug costs.

BACKGROUND AND AIM: The traditional method of taking Chinese Medicine involves creating a decoction by cooking medicinal Chinese herbs. However, this method has become less popular, being replaced by the more convenient method of consuming concentrated Chinese herbal extracts, which creates challenges related to the complexity of stacking multiple formulas. METHODS: We developed the Chinese Intelligence Prescription System (CIPS) to simplify the prescription process. In this study, we used data from our institutions pharmacy to calculate the number of reductions, average dispensing time, and resulting cost savings. RESULTS: The mean number of prescriptions was reduced from 8.19 ± 3.65 to 7.37 ± 3.34 ([Formula: see text]). The reduction in the number of prescriptions directly resulted in decreased dispensing time, reducing it from 1.79 ± 0.25 to 1.63 ± 0.66 min ([Formula: see text]). The reduced dispensing time totaled 3.75 h per month per pharmacist, equivalent to an annual labor cost savings of $15,488 NTD per pharmacist. In addition, drug loss was reduced during the prescription process, with a mean savings of $4,517 NTD per year. The combined savings adds up to a not insignificant $20,005 NTD per year per pharmacist. When taking all TCM clinics/hospitals in Taiwan into account, the total annual savings would be $77 million NTD. CONCLUSION: CIPS assists clinicians and pharmacists to formulate precise prescriptions in a clinical setting to simplify the dispensing process while reducing medical resource waste and labor costs.

[Practical pharmacotherapy education "pharmacology role-play": expansion and ingenuity in Medical, Dental, Pharmaceutical and Nursing education.]

Active learning in pharmacology education "pharmacology role-play," in which students pretend to be health professionals and patients and explain diseases and drug treatments. Because pharmacology role-play is based on cases presented in advance and active learning through communication, named Case & Communication based approach (C&C approach). Pharmacology role-play was started in 2010 at the University of Miyazaki, it has been shared by 28 schools in 4 faculties of medicine, pharmacy, dentistry, and nursing (23 medical schools, 1 pharmaceutical school, 2 dental schools, and 2 nursing universities) over the 13 years until 2022. Although it is a common program, it is implemented with diversity while devoting various ingenuity according to the characteristics of the University. Pharmacology role-play is effective in (1) understanding of medical treatment, (2) understanding patient's feelings, (3) improvement of mental attitude and motivation as health professionals (4) positive influence upon study attitude, regardless of universities that conducted the pharmacology role-play. Various efforts include combining with Personal Drugs, developing interprofessional education through joint role-playing by medical students and nursing students, and developing Oriental medicine education through the cases including Kampo medicine. In addition, there are online lectures in response to the Covid-19, and a joint implementation of two universities, all of which are highly effective. The advantage of the multi-institution common program is that a lot of information can be obtained at once, and it is easy to quickly reflect successful ideas. The flexibility and high resilience that can flexibly change the implementation method (face-to-face/remote) according to the situation are also great strengths.

Assessment of a Mindfulness Meditation Elective in an Accelerated Doctor of Pharmacy Program.

Objective. The objective of this study was to determine the effect of a live 14-week mindfulness elective course on the well-being of Doctor of Pharmacy (PharmD) students in an accelerated program.Methods. Pharmacy students enrolled in a mindfulness elective participated in weekly class sessions that included an eight-week mindfulness program geared toward emerging adults. Eight weekly reflections were assigned to students and evaluated using the Text iQ text-analysis tool in Qualtrics. Investigators analyzed the sentiment scores assigned by Text iQ to detect differences in the tone of student reflections over time.Results. Twenty-four students were enrolled in this elective, and 22 students submitted complete reflections for evaluation. Mean sentiment scores and the percentage of responses in sentiment score categories (very positive and positive, mixed and neutral, very negative and negative) for these reflections showed significant differences between weeks.Conclusion. The tone of student reflections was more positive after the students learned and incorporated mindfulness practice into their accelerated PharmD curriculum.

Exploration of current pharmacy practice in cardio-oncology: Experiences & perspectives.

INTRODUCTION: Cardiovascular complications can occur in oncology patients secondary to certain cancer therapies. Pharmacists are involved in the care of oncology patients who are at risk of or experiencing cardiotoxicity related to their cancer therapy. Our study aimed to understand how pharmacists in Canada care to these patients and to explore their experiences, perceptions, and challenges. METHODS: Canadian pharmacists currently involved in the care of patients receiving cancer treatments and at risk of or experiencing cardiotoxicity were invited to participate in a 30-min telephone interview using an interview guide. A combination of inductive and deductive reasoning was applied using two coders who independently reviewed the transcribed interviews and identified key concepts and themes. RESULTS: Eight pharmacists were interviewed. Perceived benefits included sharing specialized knowledge and conducting safety assessments. Perceived challenges were the lack of role recognition and resources and fractured continuity of care. Proposed future directions were to play a more substantial role in direct medication management, creation of specific guidance and tools to support the clinical decision-making process, and to understand how pharmacists at other sites were providing care through the creation of a community of practice. CONCLUSIONS: As patient-focused medication specialists, pharmacists help guide clinical decision-making, assess cardiac risk factors, and offer individualized education to meet the holistic needs of oncology patients at risk of or experiencing cardiotoxicities. The creation of a cardio-oncology community of practice may allow pharmacists with a common interest to connect, share learnings, and collaborate on how to continue to advance the delivery of care.