Joint interprofessional education of pharmacy and dietetics undergraduates - a scoping review.

INTRODUCTION: Interprofessional education (IPE) is an integrative approach that enables collaboration of students of two or more different health professions in aim to acquire skills and competencies related not only to their field of study but also to ensure the standard of care based on collaborative practice. IPE has not yet been explored in relation to collaboration between dietetics-nutrition and pharmacy students, while there is evidence that in many cases nutrition is complementary to pharmacotherapy in the treatment process. AIM: The aim of this scoping review was to gather, describe and discuss all relevant literature regarding joint interprofessional training of pharmacy and dietetics-nutrition undergraduates. METHODS: We performed a literature search for studies where IPE between dietetics-nutrition and pharmacy students was described. 2204 articles on this topic were identified. After eligibility assessment, 8 articles were included in the review. RESULTS: Eight studies were included in the review. Two of these described IPE activities between dietetics and pharmacy students only. The included studies varied in setting, methodology and outcome measures and covered a wide range of topics relevant to clinical practice, such as management of inflammatory bowel diseases, care of the older adults or counselling skills. The most common teaching method was the use of case studies. Some of the included studies did not identify specific learning objectives. The most common way of gathering feedback from participants was through questionnaires and interviews. CONCLUSIONS: IPE of pharmacy and dietetics-nutrition students is feasible and may be beneficial in many aspects related to learning. However, there is no well-established model or standard that would facilitate the implementation of such activities in individual educational institutions.

The influence of OSPE and PBL on competency-based pharmacy student self-assessment.

BACKGROUND: In addition to vocational education and experience, the pharmaceutical profession's proper pursuit requires acquiring and continuously improving professional competencies. In recent years, the need has been increasingly highlighted for developing a medical education system based on helping students develop their competencies. It is necessary to adapt the tools and methods for assessing competencies during formal education. It will enable students to know the directions of further personal or professional development. OBJECTIVE: The study aimed to compare pharmacy students' self-assessment outcomes before and after the Objective Structured Practical Examination (OSPE), which finished the Pharmaceutical Care course (PCc). The study's purpose was also to compare the outcomes of the self-assessment of competencies between the students of two academic years for whom classes on the PCc were provided by different methods. METHODS: The study was conducted over two academic years (2018/2019 and 2019/2020) among 5th-year students enrolled at the Faculty of Pharmacy of the Jagiellonian University Medical College (JUMC) at the end of the Pharmaceutical Care course. Different teaching methods were used in the delivery of the course in these academic years. The students self-assessed their competencies using a questionnaire consisting of a list of personal and patient care competencies. The students completed the questionnaire before and after the OSPE, which followed the completion of the PCc. RESULTS: Students' professional competencies as self-assessed after the exam were higher than those assessed before the exam. Differences were observed in both personal and patient care competencies. Students taking the course in the 2019/2020 academic year set their pre-OSPE competencies higher than students taking the PCc in 2018/2019. CONCLUSION: The self-assessment scores increased for most competencies included in the study following the OSPE. This may suggest that taking part in the exam, involvement in patient's case simulations, and self-assessment of performance at individual stages of the exam contributed to increased subjective assessment of professional competencies.

Greater fuel efficiency is potentially preferable to reducing NOx emissions for aviation's climate impacts.

Aviation emissions of nitrogen oxides (NOx) alter the composition of the atmosphere, perturbing the greenhouse gases ozone and methane, resulting in positive and negative radiative forcing effects, respectively. In 1981, the International Civil Aviation Organization adopted a first certification standard for the regulation of aircraft engine NOx emissions with subsequent increases in stringency in 1992, 1998, 2004 and 2010 to offset the growth of the environmental impact of air transport, the main motivation being to improve local air quality with the assumed co-benefit of reducing NOx emissions at altitude and therefore their climate impacts. Increased stringency is an ongoing topic of discussion and more stringent standards are usually associated with their beneficial environmental impact. Here we show that this is not necessarily the right direction with respect to reducing the climate impacts of aviation (as opposed to local air quality impacts) because of the tradeoff effects between reducing NOx emissions and increased fuel usage, along with a revised understanding of the radiative forcing effects of methane. Moreover, the predicted lower surface air pollution levels in the future will be beneficial for reducing the climate impact of aviation NOx emissions. Thus, further efforts leading to greater fuel efficiency, and therefore lower CO2 emissions, may be preferable to reducing NOx emissions in terms of aviation's climate impacts.

The Potential Role of the Pharmacist in Supporting Patients with Depression - A Literature-Based Point of View.

OBJECTIVE: The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression. METHODS: A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies. RESULTS: This paper includes two main sections: 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples. CONCLUSION: The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.

Effect of Education for Hypertensive Patients with Correctly Performed Self-Blood Pressure Monitoring (SBPM).

INTRODUCTION: The study objective was to assess the impact of pharmacist-led education on the patient's knowledge and skills on SBPM (self-blood pressure monitoring). METHODS: Patient knowledge was assessed using tests and patients' skills were based on a checklist (20 parameters) completed by the researcher based on the SBPM video records. Patients taking pressure measurements were filmed for 20 days and after 6 months. After the first 10 days, patients were educated about the correct SBPM procedure. Knowledge tests were repeated three times (before/after/6 months after education). RESULTS: All patients' knowledge and skills in the field of SBPM were improved after education. After the education, patients scored an average of 9 out of 10 points in the knowledge test (increasing an average of five points after education), six months later-an average increase of 7.36 points. Patient skills after training were rated at 17.4 out of 20 points on average (increase by an average of 5.14 points after education), six months later, there was an average of 16.23 points. CONCLUSIONS: The study showed an increase in patients' knowledge and skills in the field of SBPM after training.

As the twig is bent, so is the tree inclined: a survey of student attitudes toward interprofessional collaboration supported with the curricula analysis.

Pharmaceutical care was legally introduced as an interprofessional service in Poland in 2009. However, a collaboration between physicians and pharmacists remains incidental. Proper education at the undergraduate level is necessary to shape the attitudes of students toward establishing interprofessional relations. The aim of the study was to assess the perception of physician-pharmacist collaboration among final-year medical and pharmacy students through questionnaires with both closed-ended and open-ended questions. The study also includes an analysis of medicine and pharmacy curricula in terms of promoting interprofessional collaboration between the two fields. The statistical analysis of data obtained from 502 respondents revealed significant differences between the perceived areas for such collaboration. Moreover, the division of roles and responsibilities during the pharmacotherapy process between both professions seems to be unclear. Importantly, only 10.14% of the respondents evaluated these professional relations as 'good' or 'very good'. Also, 66.87% of the students emphasized the importance of educational interventions to improve interprofessional collaboration between pharmacists and physicians. Although 70% of medical and 87% of pharmacy students wish to establish such collaboration in the future, only 15% and 35%, respectively feel adequately prepared for the task. Understanding similarities and differences in this field appears to be the key to designing effective educational solutions for promoting interprofessional attitudes among healthcare undergraduates.

Trading off Aircraft Fuel Burn and NO x Emissions for Optimal Climate Policy.

Aviation emits pollutants that affect the climate, including CO2 and NO x, NO x indirectly so, through the formation of tropospheric ozone and reduction of ambient methane. To improve the fuel performance of engines, combustor temperatures and pressures often increase, increasing NO x emissions. Conversely, combustor modifications to reduce NO x may increase CO2. Hence, a technology trade-off exists, which also translates to a trade-off between short-lived climate forcers and a long-lived greenhouse gas, CO2. Moreover, the NO x-O3-CH4 system responds in a nonlinear manner, according to both aviation emissions and background NO x. A simple climate model was modified to incorporate nonlinearities parametrized from a complex chemistry model. Case studies showed that for a scenario of a 20% reduction in NO x emissions the consequential CO2 penalty of 2% actually increased the total radiative forcing (RF). For a 2% fuel penalty, NO x emissions needed to be reduced by >43% to realize an overall benefit. Conversely, to ensure that the fuel penalty for a 20% NO x emission reduction did not increase overall forcing, a 0.5% increase in CO2 was found to be the "break even" point. The time scales of the climate effects of NO x and CO2 are quite different, necessitating careful analysis of proposed emissions trade-offs.

Are We Ready to Implement Competence-Based Teaching in Pharmacy Education in Poland?

Pharmacists in Poland are responsible for the dispensing and quality control of pharmaceuticals. The education process in pharmacy is regulated and monitored at the national level. Pharmacy education at Jagiellonian University is organized in a traditional way based on input and content teaching. The aim of the study was to determinate whether the Jagiellonian University curriculum in the Pharmacy program meets the criteria of the European Competence Framework. The mapping of the intended curriculum was done by four academic teachers. The qualitative and quantitative analysis of the distribution of the European Competence Framework among a group of courses and study years was done. We observed that most of the personal competencies are offered to students in their senior years, while the patient care competencies are distributed equally during the cycle of the study, and only some of them are overrepresented at the senior years. We need a legislation change at the national level as well as organizational and mental change at the university level to move from learning outcome-based pharmacy education to competence-based.

PROSPECTS FOR DEVELOPMENT OF PHARMACY IN POLAND UNTIL THE YEAR 2030. THE DOCUMENT OF THE NATIONAL SECTION OF PHARMACEUTICAL CARE OF THE POLISH PHARMACEUTICAL SOCIETY.

Modern society expects pharmacists to be more involved in monitoring and supervising pharmacotherapy. International documents clearly define pharmacists as guardians of the safety and effectiveness of pharmacotherapy, not coincidentally putting safety matters first. With regard to this issue, the National Section of Pharmaceutical Care of the Polish Pharmaceutical Society hereby presents its own proposal for the development of modern pharmaceutical practice in Poland. The purpose of the proposed actions is to increase the involvement of pharmacists from generally accessible pharmacies in ensuring the safety and effectiveness of pharmacotherapy applied outside of hospitals and improving health indicators within society over the next ten to twenty years.

The impact of pharmaceutical care on patients with hypertension and their pharmacists.

OBJECTIVE: The purpose of the study was to assess the influence of pharmaceutical care on patients' knowledge, quality of life and blood pressure and to determine whether new type of pharmaceutical services changes the pharmacists' satisfaction and knowledge. METHODS: Community pharmacies were randomly assigned to study and control group and pharmacists from both groups included patients with hypertension, who meet inclusion and exclusion criteria. Study group provided the pharmaceutical care (education, pharmacotherapy monitoring, detecting and solving drug related problems) for their patients, while the control group provided the standard pharmaceutical services (dispensing medicines with or without counseling). At the beginning and the end of the study pharmacists and patients filled in the knowledge test. Pharmacists fulfilled also satisfaction questionnaire. RESULTS: Survey data were collected from 28 and 56 patients from community pharmacies in study and control group respectively. At the last meeting the normal blood pressure achieved 79% and 55% patients in study and control group, respectively (p>0,05). The pharmaceutical care improved patients' knowledge about disease. Pharmacists from study group, who provided pharmaceutical care, had higher level of pharmacotherapy knowledge and professional satisfaction than the control group. CONCLUSIONS: Implementation of pharmaceutical care into the pharmacy practice benefits both, patients and pharmacists.

[Competence of pharmacy students of the Jagiellonian University Medical College, Department of Pharmacy in Cracow in the problem of tobacco addiction]. / Stan wiedzy studentów farmacji wydzialu farmaceutycznego Uniwersytetu Jagiellonskiego Collegium Medicum w Krakowie o uzaleznieniu od palenia papierosów.

Over 1.2 billion people in the world are addicted to tobacco products. Tobacco smoke contributes to increased risk cardiovascular diseases, respiratory diseases and development of cancers. A survey carried out in lines of medical students was assessed prevalence of smoking and attitudes toward the problem of smoking. This research has never been carried out with departments of pharmaceutical students. The aim of this work was to assess the level of knowledge of students Pharmaceutical Faculty of the Jagiellonian University in Krakow addiction from smoking cigarettes, the harmfulness of smoking, knowledge of preparations used in the course of emergence from addiction and move topic dependence on tobacco smoking during the study. Carried a voluntary and anonymous survey, allow for verify and compare the knowledge of issues related to smoking, as well as some idea of how many students smoke cigarettes. The study was performed in the group of 485 students, including 378 from the Pharmaceutical Faculty and 107 from Medical Laboratory Department from all years. As is clear from the survey conducted students from higher years to cope better with questions about carcinogens, diseases caused by tobacco smoking and have bigger knowledge about antinicotine preparations. Among students from IV and V years is also the most people claiming that they can provide anti-smoking advice. It was found the largest proportion of smoking students on the IV and V year. The greatest knowledge of tobacco dependence Faculty of Pharmacy students acquired in class with toxicology, physiology and biology. Universities have a huge scope for action in conducting antinicotine programs.

[Assessment of the effectiveness of pharmacists' activities in treatment of tobacco-addicted patients in the context of pharmacists' counselling in Cracow's pharmacies]. / Ocena skutecznosci dzialan farmaceutów w leczeniu pacjentów uzaleznionych od tytoniu na tle doradztwa farmaceutów w aptekach Krakowa.

Tobacco-related diseases killed 100 millions people in 20th century and unless urgent action is taken, it is predicted that 1 billion people in total will be killed by smoking in this century. Pharmacists as health-care professionals should support the healthy lifestyle campaign and motivate smokers to quit smoking especially as they have the theoretical basis for such counselling. The aims of the study were: 1. to evaluate the readiness of pharmacists employed in public pharmacies to manage patients who would like to stop smoking; 2. to assess the pharmacists' current knowledge of the harmfulness of smoking and methods of treatment of this addiction. The pharmacists were interviewed for readiness to help addicted people and for knowledge of health promotion problems. A study was carried out do determine pharmacists counselling skills. Investigator (monitor) visited pharmacies passing him(her)self off as a smoker who would like to quit smoking and enquired about methods of the addiction cessation. Next the investigator filled in questionnaires according to the pharmacists' answers. Sixty pharmacists were interviewed. The results showed that pharmacists were willing to help tobacco-addicted patients and although they strongly recommended smoking cessation, their knowledge of methods of tobacco-addiction treatment was restricted. The strongest interest and most extensive knowledge of smoking cessation problems was observed in pharmacists ranging in age from 30 to 50 whereas pharmacists over 50 showed the worst results. The reason of this result was due to imperfect factual knowledge and unawareness of the value of pharmaceutical care in the oldest group of pharmacists. Insufficient education of pharmacists may influence the effectiveness of counseling.

Antibacterial drug prescription for outpatients: age, seasonal and pulmonary disease dependency.

The goal of this study was to analyze antibacterial drug prescribing in the 1-million-plus, strictly defined population in Poland. For the 2002-2005 years, data from National Health Fund on outpatient purchasing of antibiotics in Lubuskie's Province were collected and expressed in DDD per 1-thousand inhabitants per day (DID). In the period 2002-2005 the average rate of antibiotics purchasing was 19.8 DID. During the 3-year period, at least 64.3% of the population had prescribed antibiotics. 22.7% of patients purchased 62.6% of a three-year total purchasing of antibacterial drugs in the province. A tiny 1.9% of the population purchased 10.0% of the total. From the different age-group, the study showed that special attention should be paid to two different and relatively small groups of patients - those utilizing significant percentage of the year's supply, and group of 5-9 year-old children. Seasonal variation in antibiotic prescribing was strictly linked with the age of patients. Pulmonary diseases were indentified as a factor considerably elevating antibacterial drugs purchasing frequency. A useful way to present recurring patterns in this frequency has been proposed.

Analysis of non-hospital antibacterial pharmacotherapy in Poland.

OBJECTIVES: The aim of this research was to analyze the antibacterial drug consumption pattern in a 1-million-plus strictly defined population in Poland. We assessed outpatient antibiotic sales (ATC J01) in relation to patient age and season of the year, and sought to determine the group of patients with the most frequent recurrence of bacterial diseases. METHODS: The Lubuskie Regional Unit of the National Health Fund (NHF) and the Central Statistical Office (GUS) were the main sources of data. For the period 2002-2005, data on outpatient sales of antibiotics (ATC J01) in Lubuskie Province were collected and expressed in DDD (defined daily dose; World Health Organization anatomical therapeutic chemical (ATC)/DDD version 2006) per 1000 inhabitants per day (DID). RESULTS: During the period 2002-2005, the average level of antibiotic use amounted to 19.8 DID in the Lubuskie population. During the 3-year period, 64.3% of the population was treated with antibiotics. This value varied for different age groups. Of the patients, 22.7% utilized 62.6% of a 3-year supply of antibiotic therapy in the province; a small 1.9% of the population used 10.0% of the supply. The seasonal variation of antibiotic consumption in different age groups showed a strong tendency to be flatter as the older age groups were analyzed. CONCLUSIONS: The data gained from the payers, i.e., the healthcare system, is a very valuable source of information for pharmacoepidemiological studies. Our study shows that seasonal variation in antibiotic use is strictly linked with the age of patients. Special attention should be paid to the relatively small group of patients that utilizes a significant percentage of the year's supply. We have established an effective way to present recurrence data (a map showing the infectious disease incidence). This could be a very useful tool for comparing antibiotic consumption in different countries.

Artificial neural network in pharmacoeconomics.

Pharmacoeconomics research identifies, measures, and compares the costs (resources consumed) and consequences of medical products and services, where at least one of the compared alternatives is pharmacotherapy. Pharmacoeconomics has been designed to enable the decision maker to identify the preferred choice among existing alternatives. The decisions are often important for the patients' lives on the one hand, and for payers on the other (where the payer is understood as the institution responsible for financial resources allocation). One of the most commonly used types of pharmacoeconomic analysis is cost-effectiveness analysis. Two different alternatives can be compared using cost-effectiveness analysis if only their medical and clinical consequences could be measured in similar units (clinical or physical parameters). The aim of the project is to use an artificial neural network (ANN) for medical effect prediction, which could help in the extrapolation of pharmacoeconomic analysis' results. To depict neural data analysis tools, a database containing 100 non-small cell lung cancer (NSCLC) patients in non-operative IIIB and IV stage has been used. Each patient was described using 30 factors (i.e. sex, age, anticancer drugs dosage) and, as an output value, the expected survival time was established. The role of the ANN system was to predict the patient's survival time based on the above mentioned information. Binary values were tested as outcomes. Positive values (coded as 1) meant that patient survival time would be equal to or longer than 35 weeks. Negative values (coded as 0) meant that the patient survival time would be shorter than 35 weeks. Binary values were obtained using a threshold, which based on the mean survival time of patients derived from literature. Back-propagation as well as fuzzy-logic neural networks were applied. A 10-fold cross validation method was used to obtain the appropriate models. Final results were compared with the generic, logistic regression-based model. The best prediction score of the ANN model was 82%; higher than logistic regression prediction rate.