Pharmacy Practice in Quebec Emergency Departments: A Survey Study.

Background: According to a Canadian survey conducted in 2013, 37 of the 67 Quebec emergency departments (EDs) in hospitals with more than 50 beds reported having a pharmacist within the department. However, based on the 17 responses to the survey, it was not possible to determine patient care services offered by Quebec ED pharmacists, because the data were aggregated across all Canadian respondents. A provincial survey was undertaken to further define ED pharmacy practice within Quebec. Objectives: To measure pharmacist involvement in EDs in the province of Quebec and to describe patient care services and interventions offered by these pharmacists. Methods: A 47-question survey was sent to 33 directors of pharmacy departments, representing 90 hospitals and institutes with EDs in the province of Quebec. The directors of pharmacy were asked to forward the survey to an ED pharmacist for completion or to partially answer the survey themselves if their facilities had no pharmacists practising in the ED. The survey evaluated the presence of pharmacists in the ED, their training, the interventions they performed, and their involvement within the department. The presence and role of ED pharmacy technical staff were also evaluated. Results: Of the 43 completed surveys received, 30 reported at least 1 pharmacist providing patient care within the facility's ED. The most common tasks performed by ED pharmacists were, in decreasing order of frequency, answering questions from the multidisciplinary team, adjusting medications according to patients' allergies or their renal or hepatic function, managing drug interactions, and clarifying prescriptions. Pharmacists also reported teaching pharmacy students and residents and supporting the team in the resuscitation area. Conclusions: The majority of respondents reported having at least 1 pharmacist in the ED. Compared with previous Canadian results, this survey had more respondents from Quebec with better representation of ED pharmacy practice in the province. Patient care services provided by pharmacists were variable, possibly because of a lack of standardized practice guidelines.

Contexte: Selon une enquête canadienne menée en 2013, 37 des 67 services des urgences dans des hôpitaux québécois de plus de 50 lits ont déclaré avoir un pharmacien au sein de leur service. Cependant, à partir des 17 réponses de cette enquête, il n'a pas été possible de déterminer les services de soins aux patients offerts par les pharmaciens des services des urgences du Québec, car les données étaient agrégées pour tous les répondants canadiens. Une enquête provinciale a été menée pour mieux définir la pratique de la pharmacie au sein des services des urgences au Québec. Objectifs: Mesurer l'implication des pharmaciens dans les services des urgences du Québec et décrire les services de soins aux patients et les interventions offerts par ces pharmaciens. Méthodes: Un sondage comportant 47 questions a été envoyé à 33 chefs de départements de pharmacie, représentant 90 hôpitaux et instituts ayant un service des urgences au Québec. Les chefs de départements de pharmacie ont été invités à transmettre le sondage à un pharmacien du service des urgences pour qu'il y réponde; ou, si leur établissement ne comptait aucun pharmacien exerçant en service des urgences, à y répondre partiellement eux-mêmes. L'enquête a permis d'évaluer la présence des pharmaciens dans les services des urgences, leur formation, leurs interventions et leur implication au sein du département. La présence et le rôle du personnel technique en pharmacie des urgences ont également été évalués. Résultats: Sur les 43 questionnaires remplis reçus, 30 indiquaient avoir au moins un pharmacien prodiguant des soins aux patients dans le service des urgences de l'établissement. Les tâches les plus courantes consistaient, par ordre décroissant de fréquence, à répondre aux questions de l'équipe multidisciplinaire, à adapter les médicaments selon les allergies des patients ou leur fonction rénale ou hépatique, à gérer les interactions médicamenteuses et à clarifier les ordonnances. Les pharmaciens ont également déclaré former les étudiants et les résidents en pharmacie et soutenir l'équipe dans la salle de réanimation. Conclusions: La majorité des répondants ont déclaré avoir au moins un pharmacien au service des urgences. Par rapport aux résultats canadiens antérieurs, cette enquête comptait plus de répondants du Québec et indiquait une meilleure représentation de la pratique de la pharmacie au service des urgences dans la province. Les services de soins aux patients fournis par les pharmaciens étaient variables, peut-être en raison d'un manque de directives de pratique normalisées.

Infant Exposure to Methylphenidate and Duloxetine During Lactation.

BACKGROUND: Duloxetine and methylphenidate are commonly prescribed for the management of depression and attention-deficit/hyperactivity disorder (ADHD), respectively. However, little information is available concerning their safety during lactation. The purpose of this case series was to provide additional information to the medical literature concerning infant exposure to methylphenidate and duloxetine through breast milk. METHOD: Bioanalytical method (liquid chromatography coupled to mass spectrometry) was developed and validated before its use to determine the concentrations of both medications in breast milk samples. CASES: Case 1: A 30-year-old woman with depression and ADHD took duloxetine 90 mg daily and methylphenidate 36 mg daily during pregnancy and breastfeeding. The newborn was found to have a congenital pulmonary airway malformation. The breastfeeding status was nonexclusive. At week 4 postpartum, the concentration found in the milk was 32.8 ng/mL of duloxetine and 7.9 ng/mL of methylphenidate (estimated relative infant dose [RID] of 0.3% and 0.2%, respectively). Case 2: A 41-year-old women with depression took duloxetine 60 mg daily during pregnancy and lactation. She gave birth to a healthy child. The breastfeeding status was nonexclusive. Cord to maternal plasma concentration ratio was 0.4. At day 6 postpartum, the concentration of duloxetine was 23.6 ng/mL in the foremilk and 14.3 ng/mL in the hindmilk (RID of 0.4% and 0.2%, respectively). At week 6 postpartum, the concentration was 25.2 ng/mL in the foremilk and 29.3 ng/mL in the hindmilk (RID of 0.4% and 0.4%, respectively). CONCLUSION: In accordance with previously published data, this case series suggests a minimal exposure to duloxetine and methylphenidate through breast milk. Thus, these drugs are likely compatible with lactation. However, large cohort studies are necessary to evaluate their long-term impact on the exposed infants.

Proyecto colaborativo Chile-Paraguay en formación de postgrado / A Chile - Paraguay collaborative project for postgraduate education

Resumen:

Objetivo: este artículo da a conocer el proyecto colaborativo entre la Escuela de Enfermería de la Pontificia Universidad Católica de Chile (PUC) y la Escuela de Enfermería de la Universidad Católica “Nuestra Señora de la Asunción” de Paraguay. El objetivo es el de mejorar la calidad del cuidado de la salud que se otorga a la población, a través del perfeccionamiento de enfermeras y enfermeros a nivel de postgrado. Metodología: se revisan los principales aspectos considerados en la creación y puesta en marcha del postgrado, y su estado actual a junio de 2014. La participación de la Escuela de Enfermería de la PUC en este proyecto responde al llamamiento de la Santa Sede “de fortalecer la red de universidades católicas” y es considerado un deber de contribuir con su experiencia y experticia al desarrollo de la enfermería de un país amigo. Resultados: como resultado de este proyecto se creó y puso en marcha, en el año 2007, un programa de magister en Enfermería desa­rrollado en la ciudad de Asunción, que en el año 2014 ha graduado a 29 profesionales y que están contribuyendo al desarrollo de la enfermería de Paraguay. Conclusión: el modelo diseñado para el desarrollo de este magister ha demostrado ser exitoso, como también el establecimiento de alianzas y colaboración entre las universidades, lo que aporta beneficios a las instituciones involucradas tanto en los ámbitos académicos y profesionales como personales.

Abstract:

Purpose: A collaborative project by Nursing School, Pontificia Universidad Católica, Chile (PUC) and Nursing School, Universidad Católica “Nuestra Señora de la Asunción”, Paraguay is described. The project is aimed at improving healthcare quality provided to the community by means of an improved postgraduate education for nurses.

Methods: The main aspects taken into account to create and develop postgraduate courses, along with their present condition in June 2014, are reviewed. The involvement of PUC's Nursing School in this project results from the Holy See's calling for "strengthening the Catholic Universities network"; and offering its experience and expertise to help nursing development in a friend country is considered to be a duty. Results: As a result from the project, in 2007 a Master Program in Nursing was created and implemented in Asunción city, with 29 professionals having achieved graduation in it until 2014; such professionals are currently contributing to nursing development in Paraguay. Conclusion: The model that was designed in order to develop this Master course has proved successful. Alliances and collaboration between universities have also been satisfactory, with benefits being obtained by involved institutions at academic, professional, and personal levels.

Introduçao: trabalho colaborador entre a Escola de Enfermagem da Pontifícia Universidade Católica de Chile (PUC) e a Escola de Enfermagem da Universidade Católica “Nossa Senhora da Assunção”, Paraguai. Objetivo: melhorar a qualidade do cuidado de saúde que se outorga a população, usando como estratégia o aperfeiçoamento de enfermeiras e enfermeiros em nível de pós-graduação. Resultado: como resultado deste projeto se criou e pôs em marcha, o ano de 2007, um Programa de Mestrado em Enfermagem desenvolvido na cidade de Assunção, que até 2014 havia graduado 29 profissionais que estão contribuindo ao desenvolvimento da Enfermagem de Paraguai.

Conclusão: o modelo desenhado deste Mestrado tem demonstrado ser exitoso, bem como também o estabelecimento de alianças e colaborações entre as universidades o que oferece contribuições benéficas ás instituições envolvidas tanto nos âmbitos acadêmicos, profissionais como pessoais.