Association rule mining for the ordered placement of traditional Chinese medicine containers: An experimental study.

In traditional Chinese medicine (TCM) clinics, the pharmacists responsible for dispensing the herbal medicine usually find the desired ingredients based on positions of the shelves (racks; frames; stands). Generally, these containers are arranged in an alphabetical order depending on the herbal medicine they contain. However, certain related ingredients tend to be used together in many prescriptions, even though the containers may be stored far away from each other. This can cause problems, especially when there are many patients and/or the limited number of pharmacists. If the dispensing time takes longer, it is likely to impact the satisfaction of the patients' experience. Moreover, the stamina of the pharmacists will be consumed quickly.In this study, we investigate on an association rule mining technology to improve efficiency in TCM dispensing based on the frequent pattern growth algorithm and try to identify which 2 or 3 herbal medicines will match together frequently in prescriptions. Furthermore, 3 experimental studies are conducted based on a dataset collected from a traditional Chinese medicine hospital. The dataset includes information for an entire year (2014), including 4 seasons and doctors. Afterward, a questionnaire on the usefulness of the extracted rules was administered to the pharmacists in the case hospital. The responses showed the mining results to be very valuable as a reference for the placement and ordering of the frames in the TCM pharmacies and drug stores.

Evaluation of Knowledge and Practice of Pharmacy Professionals regarding the Risk of Medication Use during Pregnancy in Dessie Town, Northeast Ethiopia: A Cross-Sectional Study.

BACKGROUND: The developing organism is unique in its responsiveness to drugs and predictability of therapeutic effectiveness based on the adult which can lead to grave consequences in the neonate and child. Moreover, uncertainty about the risks of drug use in pregnancy could result in restrictive attitudes towards prescribing and dispensing medicines and their use. Pharmacists have huge duties to improve medication use, especially among pregnant women. The objective of this study is, hence, to assess the knowledge and practice of pharmacy professionals (PPs) towards the risk of medication use during pregnancy. METHODOLOGY: A questionnaire-based cross-sectional study was carried out over practicing community and hospital pharmacy professionals in Dessie town. They were asked about the safety of common drugs during pregnancy. It involves both prescription-only medications (POM) and over-the-counter (OTC) medications. Secondly, they were asked about their practice towards the risk of medication use during pregnancy. Both descriptive and analytical statistics were utilized. For descriptive analysis, results were expressed as numbers, percentages, and mean (± SD and 95% CI). RESULT: Seventy-six pharmacy professionals in Dessie, Northeast Ethiopia, took part in the study. Most of the respondents (64.5%) believed that amoxicillin is safe in all trimesters. 26 (34.2%) of participants knew that isotretinoin is unsafe for use by pregnant women. About dietary supplements, 32.9% of PPs reported that Vitamin A supplements are safe in all trimesters. There was a significant difference observed for study college and years of experience of the PPs in their score of knowledge test (p=0.020 and p=0.024, respectively). Additionally, there was a difference seen for gender (p=0.030), study college (p=0.036), and working institution (p=0.013) in their advice to pregnant women. CONCLUSION AND RECOMMENDATION: Overall, PPs exhibited very low knowledge about drug safety during pregnancy. The absence of obligatory continuing pharmacy education for pharmacists is expected to have negatively affected the level of medication knowledge and consequently the pharmaceutical care services delivered in community and hospital pharmacies. As medication knowledge of PPs is poor, a multitude of strategies (educational, economic, managerial, and regulatory) should be designed by the government, universities, and pharmaceutical associations to improve the pharmacy professionals' role in the healthcare system by providing them with continuous and up-to-date medication knowledge.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

OBJECTIVE: The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. METHODS: International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. KEY FINDINGS: Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. CONCLUSION: There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data.

OBJECTIVE: To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS: This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS: The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION: Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data / Infraestrutura das farmácias da atenção básica no Sistema Único de Saúde: Análise dos dados da PNAUM-Serviços

ABSTRACT OBJECTIVE To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

RESUMO OBJETIVO Caracterizar a infraestrutura das farmácias da atenção básica do Sistema Único de Saúde, visando condição para a humanização dos serviços ofertados. METODOS Trata-se de estudo transversal, de abordagem quantitativa, a partir de dados obtidos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015. As informações de 1.175 farmácias/unidades de dispensação foram oriundas de observação direta e mensuração das instalações das unidades de dispensação realizadas por pesquisadores treinados e uso de formulário padronizado. As variáveis analisadas referem-se à estrutura física das farmácias ou unidades de dispensação de medicamentos das unidades de saúde amostradas. RESULTADOS A área da farmácia foi superior a 14 m2 em 40,3% das unidades pesquisadas, com destaque para as regiões Centro-Oeste (56,9%) e Sudeste (56,2%) e Nordeste com apenas 26,3%. A sala de espera possuía cadeiras para os usuários (80,2%), em 31,8% a área de dispensação era inferior à 5m2 e em 46,2% foi superior a 10m2. Foram encontradas grades no guichê de atendimento, separando o atendente do usuário em 23,8% das unidades; havia acesso à internet em 44,1%. Na maioria das unidades, a área destinada ao armazenamento de medicamentos não possuía refrigerador ou geladeira para o seu armazenamento exclusivo e 13,7% apresentavam área para consulta farmacêutica. CONCLUSÕES É necessária a estruturação da ambiência dos serviços de farmácia visando a humanização do atendimento e a melhoria das condições de trabalho aos profissionais. Isso propicia melhor qualificação do serviço de farmácia para além da entrega do medicamento. Os dados apresentados pela região Nordeste indicam condições menos favoráveis ao desenvolvimento de serviços de dispensação adequados. Com base no panorama apontado, sugere-se a ampliação dos incentivos para a estruturação física dos serviços farmacêuticos, levando em consideração as especificidades regionais.

Biosimilars: from technical to pharmacoeconomic considerations. 30th Rencontres Nationales de Pharmacologie et Recherche clinique pour l'Innovation et l'Evaluation des Technologies de Santé. Tables rondes.

A biosimilar is a biological medicinal product claimed to be similar to a reference biological medicinal product. Its development plan includes studies comparing it with the reference product in order to confirm its similarity in terms of quality, preclinical safety, clinical efficacy, and clinical safety, including immunogenicity. Biosimilars differ from generics both in their molecular complexity and in the specific requirements that apply to them. Since patents on many biological medicinal products will expire within the next 5 years in major therapeutic areas such as oncology, rheumatology and gastroenterology and as those products are so costly to the French national health insurance system, the availability of biosimilars would have a considerable economic impact. The round table has issued a number of recommendations intended to ensure that the upcoming arrival of biosimilars on the market is a success, in which prescribing physicians would have a central role in informing and reassuring patients, an efficient monitoring of the patients treated with biologicals would be set up and time to market for biosimilars would be speeded up.

Characterizing healthcare quality in the community pharmacy setting: insights from a focus group study.

BACKGROUND: There is currently no common frame of reference defining community pharmacy quality. It can therefore be difficult to know whether the provision of care meets minimum standards and how to improve quality of care. OBJECTIVE: The aim of this research was to develop a conceptual framework characterizing healthcare quality in the community pharmacy setting. METHODS: Ten focus group discussions with 47 participants were conducted across the northwest of England, United Kingdom. All participants had experiences of health care provided by community pharmacies and included patients and their carers, pharmacists and pharmacy staff, and National Health Service staff who commissioned pharmacy services. Constant comparative analysis was used to analyze the verbatim transcripts. RESULTS: Community pharmacy quality can be conceptualized as dynamic with 3 interdependent dimensions. Each dimension was associated with structures, processes, and outcomes. The first dimension (accessibility) emphasized that in addition to patients requiring access to the available services, medicines, and health care advice, it was equally important for pharmacy personnel to have access to adequate structures to provide quality health care. The second dimension (effectiveness) highlighted a shift away from simply supplying medicines to supplying medicines appropriately, from passively providing services and information to individualizing advice to achieve intended outcomes, and from having structures available to using them purposefully to achieve outcomes. The third dimension (positive perceptions of the experience) enabled patients and carers to better care for themselves and for others, and it influenced future access. At the same time, when pharmacy personnel believed themselves to be valued and that they had done a good job, they felt motivated to continue to provide high-quality care. CONCLUSIONS: All 3 dimensions should be considered when the term quality is used in the context of community pharmacy. This research can be used as a springboard for similar studies in other sectors or jurisdictions wishing to characterize quality for their health care services. In particular, this research provides a common frame of reference for those interested in the provision and assessment of quality health care from community pharmacies.

Effect of high and low temperatures on the drugstore beetle (Coleoptera: Anobiidae).

The drugstore beetle, Stegobium paniceum (L.) (Coleoptera: Anobiidae), is a pest of stored medicinal and aromatic plants. Generally, mortality of each stage increased with an increase of temperature and exposure time. Heat tolerance for different stages from highest to lowest was young larvae, old larvae, eggs, adult, and pupae. The mortality after 7 h at 42 degrees C for young larvae, old larvae, eggs, adults, and pupae, respectively, was 16 +/- 5, 31 +/- 6, 48 +/- 3, 63 +/- 8, and 86 +/- 2% (mean +/- SEM). Similar trends for stage specific mortality were seen with the lethal time for 90% mortality (LT90) at 42 degrees C; 773, 144, 12, and 11 h for old larvae, eggs, adults, and pupa respectively. Mortality was too low with young larvae to estimate LT90. The LT90 for young larvae at 42, 45, 50, 55, and 60 degrees C was 25, 20, 3.9, 0.18, and 0.08 h, respectively. The cold tolerance of different stages at 0 degree C from highest to lowest was adults, old larvae, young larvae, pupae, and eggs. The LT90 at 0 degrees C was 298, 153, 151, 89, and 53 h, respectively. The LT90 for adults at 5, -5, -10, and -15 degrees C was 792, 58, 2, and 0.8 h, respectively. The supercooling point of adults was -15.2 +/- 2 degrees C; young larvae, -9.0 +/- 0.8 degrees C; old larvae, -6.5 +/- 0.5 degrees C; and pupae, -4.0 +/- 1.4 degrees C. Heat treatments that control young larvae should control all other stages of S. paniceum. Cold treatments that control adults should control all other stages of S. paniceum. Dried plants stored at 5 degrees C for 45 d or 42 degrees C for 30 h and then kept below 18 degrees C throughout the rest of the year, should remain pest-free without any chemical control.

[Update on the Mali Pharmacy Code: legislative section]. / Essai de mise au point d'un code de la pharmacie au Mali: partie legislative.

Due to colonization (1895-1960) Mali has been submitted, on the legislative and regulation plan to a corpus of numerous and scattered texts relative to pharmacy. It is essentially the Law AN XI of 21 Germinal or the 11 April 1803 Law; the content of Book V of the Public Health Code relative to pharmacy practice, of which some disposals have been extended to Overseas Territories, Togo and Cameroon in 1953; the 1955 Ministerial Order about the dispatching of the Retail Pharmacy in AOF; the 1960 Law creating the Board of Pharmacists in the Federation of Mali etc. After independence, the new Malian State while renewing the pharmacy legislation issued by the old tutor State which was not opposed to the new fundamental Law, has also set up, according to the political orientations of the moment, some new texts. In the framework of this work, we have collected all the legislative and regulation texts that have been allowed in Mali in the pharmacy area and in that of Studies in Pharmacy. We have examined those texts and proceeded to codify the legislative part. The present Code consists of 189 articles divided in 5 titles layed out in chapters and sections.

Home delivery of dietary products in inherited metabolic disorders reduces prescription and dispensing errors.

UNLABELLED: In the UK, for patients with inherited metabolic disorders (IMD) the traditional system for acquiring essential dietary products [patient prompted prescriptions generated by a medical general practitioner (GP) and dispensed by a chemist] is problematic. OBJECTIVE: To investigate the efficacy of a home delivery service (HDS) for essential dietary products (EDP) (i.e. protein substitutes, milk replacements, energy and vitamin and mineral supplements) for subjects with IMD, particularly examining any prescription and dispensing errors, metabolic control and consumer satisfaction. METHODS: A prospective, controlled, home delivery trial for EDP was conducted in patients with IMD for 12 months. Sixty-two patients with IMD [50 with phenylketonuria (PKU); 12 with other IMD: aged 6 months-30 years] were recruited. Thirty subjects used a monthly HDS (Homeward: Nutricia) to receive EDP, 32 remained on the traditional system. Each month, the HDS checked home stock levels of EDP, obtained their prescriptions directly from GP's, and then delivered them to the subjects' homes. An independent researcher completed monthly telephone interviews with patients/parents about any EDP prescription errors or delay in receipt. RESULTS: Incorrect protein substitute was dispensed once by the HDS compared with nine subjects who had 12 errors in the control group (P = 0.01); incorrect flavours of protein substitute were dispensed to the home delivery group once compared with eight subjects getting 11 errors via the chemist (P = 0.03). The HDS delayed delivery of protein substitute for one subject on three occasions compared with 39 occasions in 16 subjects via the chemist (P = 0.001). In patients with PKU, plasma phenylalanine control deteriorated in the control group (P < 0.05) but not in the HDS group. CONCLUSIONS: The long-term use of a HDS for EDP in IMD is safer, effective and more reliable than conventional systems.

Safer injections following a new national medicine policy in the public sector, Burkina Faso 1995-2000.

BACKGROUND: The common failure of health systems to ensure adequate and sufficient supplies of injection devices may have a negative impact on injection safety. We conducted an assessment in April 2001 to determine to which extent an increase in safe injection practices between 1995 and 2000 was related to the increased access to injection devices because of a new essential medicine policy in Burkina Faso. METHODS: We reviewed outcomes of the new medicine policy implemented in 1995. In April 2001, a retrospective programme review assessed the situation between 1995 and 2000. We visited 52 health care facilities where injections had been observed during a 2000 injection safety assessment and their adjacent operational public pharmaceutical depots. Data collection included structured observations of available injection devices and an estimation of the proportion of prescriptions including at least one injection. We interviewed wholesaler managers at national and regional levels on supply of injection devices to public health facilities. RESULTS: Fifty of 52 (96%) health care facilities were equipped with a pharmaceutical depot selling syringes and needles, 37 (74%) of which had been established between 1995 and 2000. Of 50 pharmaceutical depots, 96% had single-use 5 ml syringes available. At all facilities, patients were buying syringes and needles out of the depot for their injections prescribed at the dispensary. While injection devices were available in greater quantities, the proportion of prescriptions including at least one injection remained stable between 1995 (26.5%) and 2000 (23.8%). CONCLUSION: The implementation of pharmaceutical depots next to public health care facilities increased geographical access to essential medicines and basic supplies, among which syringes and needles, contributing substantially to safer injection practices in the absence of increased use of therapeutic injections.

["Do you have a remedy for macular degeneration?" A field study about the advice given on dietary supplementation in 60 German pharmacies]. / "Haben Sie ein Mittel gegen Makuladegeneration?" Eine Feldstudie in 60 deutschen Apotheken über die Beratung zu Nahrungsergänzungsmitteln.

PURPOSE: Since completion of the AREDS study, evidence has accumulated to suggest that some form of dietary supplementation may be of value in special individuals who are at risk of progressive age-related macular degeneration (ARMD). We wanted to find out which of the many supplements available are recommended in practice and which instructions, promises, and purchasing arguments are used by German pharmacies. METHODS: A blinded consultation following a standardized protocol was carried out in 60 pharmacies. RESULTS: In 36 pharmacies specific products for dietary supplementation were recommended, but the dosage never complied with the AREDS study, and in 24 pharmacies, the necessity for a medical examination or consultation with an ophthalmologist was not mentioned. Possible interactions with other drugs or side effects were generally excluded. CONCLUSIONS: Potential risks of supplement intake were underestimated. Medical knowledge of the most frequent cause of blindness in the Western world was insufficient. A clear policy of recommendations according to evidence-based criteria is needed.

Evaluación de la implantación de una guía de incorporación de nuevos medicamentos en un hospital / Evaluation of a guide for the introduction of new drugs in a hospital

Objetivo: La incorporación de nuevos fármacos en los hospitales tiene una gran repercusión en el uso racional de medicamentos del Sistema Nacional de Salud, aunque existe un apreciable grado de variabilidad entre diferentes centros, lo que genera problemas de equidad y accesibilidad. Para dar respuesta a estos problemas, en Andalucía se elaboró la Guía de Incorporación de Nuevos Fármacos (GINF) que propone un procedimiento estructurado de toma de decisiones, fundamentado en la evaluación de la evidencia disponible. Material y métodos: Se evalúan todas las solicitudes recibidas en la Comisión de Farmacia y Terapéutica del Hospital Virgen del Rocío de Sevilla, con la metodología propuesta en la guía GINF, desde enero de 2002 a julio de 2003. Se realiza un estudio descriptivo sobre las características de los fármacos, los solicitantes, la actividad de la Comisión, indicadores de calidad de las solicitudes, el proceso seguido y las decisiones. Resultados: Se evaluó el total de las 32 solicitudes recibidas, correspondientes a 26 fármacos. Se aprobaron 19 (73 por ciento), aunque, de éstos, 14 lo fueron de forma restringida o con un protocolo específico de utilización, 4 como equivalentes terapéuticos y sólo 1 sin ninguna restricción. El 72 por ciento de los solicitantes aportó los ensayos clínicos pertinentes, mientras que las estimaciones sobre el número de pacientes/año y otros datos para la evaluación económica fueron mucho más escasas. Conclusiones: Es posible mejorar el proceso de introducción de fármacos en los hospitales mediante una guía que facilite a los profesionales y las comisiones de Farmacia criterios explícitos y transparentes (AU)

Medical pluralism in action? A case study of community pharmacies in Johannesburg, South Africa.

OBJECTIVES: The main aim of this study was to examine whether, and to what extent, community pharmacies have become sites for the practice of complementary and alternative medicine (CAM) as an example of "medical pluralism." METHODS: Qualitative as well as quantitative methods such as a telephone survey of all pharmacies in Johannesburg, observations, and in-depth interviews with pharmacists and CAM healers were used. RESULTS: The evidence presented in this paper, although based on a study of community pharmacies in Johannesburg only, can be interpreted as an indication of a general trend in urban areas in South Africa, that of involvement with CAM in the form of dispensing and sales of CAM products, provision of advice, and, in a few cases, employment of CAM practitioners to consult on their premises. Thus the two systems of CAM and allopathic medicine are being practiced within the same premises. However, the manner in which they operate, as portrayed in this study, is that of two separate systems existing in relative harmony side-by-side. CONCLUSION: Because of the constraints of the study, it is difficult to ascertain to what extent this is a first step toward the development of a more meaningful integration between the systems. It is much easier to demonstrate that this growth is driven by the pharmacists' response to the growing demand from the public and their readiness to seize the opportunity to expand their responsibilities and increase their profits. This is supported by the willingness of CAM healers to participate in the endeavor.