Search

Using two case studies from Europe, this paper illustrates that there is a need to understand the role of pharmacists' professional practice relating to traditional and complementary medicine. Especially in countries, where there is a strong ongoing tradition of using most notably herbal medicines and at the same time a limited focus on pharmacy practice research, there is a need for further studies. Comparing the role of community pharmacists in the context of herbal medicines and their use, two contrasting approaches emerge, and we exemplify this using a case study approach with two countries, which show the different approaches in the context of healthcare and specifically community pharmacy. In Germany (as in many other European countries) herbal medicines have remained a core element of community pharmacy, and are an important healthcare resource, while in the UK, these products are no longer primarily sourced through community pharmacies. This case study also highlights different regulatory approaches and classification in these countries to identical healthcare/medical products. Pharmacy practice research should endeavour to systematically compare the regulatory framework of this class of products and their importance in community settings.

Non-glandular and glandular trichomes (GTs) found on the stem and leaves of many plants act as a physical barrier against biotic and abiotic stresses. GTs store and secrete various materials including essential oils, which are of great interest in food, cosmetic and pharmaceutical industries (Rehman et al., 2016) Members of Lamiaceae, including Ocimum L. (basil), produce essential oils which have potent antioxidant, antiviral, and antimicrobial properties which could be used for treating various ailments (Shahrajabian et al., 2020). In this comparative study, Ocimum’s trichomes ultra-structure, pattern and distribution on leaves have been investigated, at different developmental stages of several Ocimum species, varieties, cultivars, and types, using Scanning Electron Microscopy (SEM). In the genus, both capitate and peltate types of GTs were present which were densely distributed on the leaf surface as compared to hairy non-glandular trichomes. Moreover, in the young leaves the density of GTs was very high compared to the mature leaves. It has been reported that basil oil’ concentration is controlled by density, size, and relative proportion of both types of GTs (Maurya et al., 2019). This study provides the basis for further investigation of the genetic and chemical mechanisms involved in the production of essential oils in Ocimum.

Background Community pharmacy teams (CPTs) were at the frontline of dealing with patients throughout the COVID-19 pandemic. This study aimed to explore the impact on professional practice and personal wellbeing of CPTs, in the UK. Method A 25-item survey was designed including a range of open and closed questions. The survey was piloted before being published online via SurveyMonkey and distributed using social media platforms. A combination of opportunity and snowball sampling were employed to recruit participants who worked in community pharmacy during the pandemic. Results In total 758 participants (75% completion rate) including pharmacists, owners, managers, technicians, dispensers, healthcare assistants and pre-registration pharmacists took part. Increased workloads and working hours coupled with staff shortages compromised professional practice (n=257, 35%). Some of the key challenges of working in community pharmacy during the pandemic included: a fear of contracting and passing the virus to others (n=578, 78%), patients stockpiling medicines (n=530, 71%) and doctors’ surgeries being closed (n=517, 70%) The impact on emotional wellbeing (n=433, 76%) included stress, anxiety, depression and loneliness; physically (n=322, 56%) it affected sleep, pain and weight. The effects of the pandemic left 45% (n=258/569) of participants reconsidering their future in community pharmacy as they felt demotivated, unsupported and undervalued. Conclusion Despite the enhanced pressures and lack of initial recognition CPTs played a vital role in caring for the population during the pandemic. Resources to better support pharmacy teams in the future not only rely on more funding for better provisions, but also investing in CPTs' wellbeing.

How a lack of training is dissuading patients – and healthcare professionals – from the benefits of traditional herbal medicine.

Objectives: To identify the effect of the Covid-19 pandemic on UK herbal medicine practice and how herbal medicine practitioners are supporting people with Covid-19. Design: Mixed method e-survey. Methods: The survey link was distributed through professional associations and social media. Quantitative data were descriptively summarised and qualitative data were analysed using content analysis. Results: Results from 59 responses indicated a profound effect of the pandemic on herbal medicine practice, with a move to remote working and a reduction in client numbers. Practitioners reported prescribing a wide range of medicinal plants, chiefly Glycyrrhiza glabra L. and Echinacea spp. alongside providing information and advice. Few reported inter-professional collaboration. Conclusions: Herbal practitioners need to build on current collaborations, research and experience to develop consistent approaches to support people with mild-moderate Covid-19 symptoms. More systematic exploration of herbal medicine practice during and as a consequence of the pandemic is needed.

Cannabidiol (CBD) products, derived from hemp (Cannabis sativa) are becoming more popular as people seek alternative ways of managing their health; sales rose 333% in the US in 20181. The market value of CBD is estimated to be worth £1billion by 20252. The objectives were to explore the public’s perceptions and use of CBD products including where products are sourced, how knowledge is obtained and opinions on quality, safety and efficacy of CBD products. A questionnaire comprising open and closed questions was developed to consider quantitative and qualitative perspectives. An online platform, SurveyMonkey, was used to distribute the survey using social and professional networks (September - November 2019), which led to snowball sampling. A total of 596 responses were collected (63% female, 40% White-British) internationally. In total, 11% (n=66) claimed to use CBD products including oils, balm, tinctures and vapes for a range of ailments such as pain, stress and anxiety. Participants who did not personally use CBD products (n=530), 35% claimed they would like to try them, while 42% of participants knew of someone who was already using a CBD product for conditions such as arthritis and epilepsy and “generally improving quality of life”. Knowledge of CBD was commonly attributed to social media and news articles. Perception on safety and efficacy were positive with the notion of natural medicines being superior. Quality of products was associated with well-known brands or products which had a marketing authorisation; participants identified it was difficult to determine the quality of products brought online and better regulation is required. This study identifies that people continue to seek natural alternatives to supplement and maintain their health, thus the popularity of CBD continues to rise. The lack of clinical evidence to help make informed decisions about using CBD products needs to be addressed with more research.

Timely detection and treatment of AF is amongst the Government’s cardiovascular priorities. Several initiatives have demonstrated the potential of AF detection using single-lead electrocardiogram (SLECG) technology in primary care settings, such as general practitioners’ (GP) surgeries. Unfortunately, some AF patients, including those from ethnic minorities, may not routinely engage with main-stream healthcare and may go undetected. Compared to White British, South Asians have a higher prevalence of cardiovascular risk factors, however fewer are diagnosed with AF. This study aimed to ascertain the feasibility of opportunistic AF screening within a South Asian community delivered by supervised pharmacy undergraduates using SL-ECG devices.

Non-glandular and glandular trichomes (GTs) found on the stem and leaves of many plants act as a physical barrier against biotic and abiotic stresses. GTs store and secrete various materials including essential oils, which are of great interest in food, cosmetic and pharmaceutical industries (Rehman et al., 2016) Members of Lamiaceae, including Ocimum L. (basil), produce essential oils which have potent antioxidant, antiviral, and antimicrobial properties which could be used for treating various ailments (Shahrajabian et al., 2020). In this comparative study, Ocimum’s trichomes ultra-structure, pattern and distribution on leaves have been investigated, at different developmental stages of several Ocimum species, varieties, cultivars, and types, using Scanning Electron Microscopy (SEM). In the genus, both capitate and peltate types of GTs were present which were densely distributed on the leaf surface as compared to hairy non-glandular trichomes. Moreover, in the young leaves the density of GTs was very high compared to the mature leaves. It has been reported that basil oil’ concentration is controlled by density, size, and relative proportion of both types of GTs (Maurya et al., 2019). This study provides the basis for further investigation of the genetic and chemical mechanisms involved in the production of essential oils in Ocimum.

Background: The ‘Clinical Pharmacists in General Practice’ (CPGP) pilot provided a template for general practice pharmacy professionals’ (GPPPs) roles encouraging NHS England to fund >2000 practice‐based pharmacists. However, many GPPPs work outside the CPGP initiative and little is known about the services they provide. Objectives: To explore services provided by all UK GPPPs (pharmacists/pharmacy technicians), including the types of services, perceived benefits and barriers to role development. Methods: A 26‐item electronic questionnaire was developed using SurveyMonkey and piloted during cognitive interviews. A cross‐sectional survey was conducted via social media, primary care organisations and emails to CPGP pilot sites between November 2018 and March 2019. Three reminders were sent 1 week apart. Key findings: Ninety‐one complete responses were received (81 pharmacists; 10 technicians). Over 80% of pharmacists provided clinical services, such as medication reviews or management of long‐term conditions. More pharmacists within CPGP pilot managed repeat prescribing requests (P = 0.035). Technicians took responsibility for primarily non‐clinical roles, including commissioning or safety alerts/drug recalls. A third of GPPPs wished to develop care home services. Perceived benefits of GPPPs’ services included improved utilisation/development of professional skills, identifying medicines‐related issues and reduction in medication waste. Respondents were satisfied with professional relationships but reported workload issues, limited patient awareness of their roles and restricted opportunities to contribute to service development, which was associated with unsatisfactory support/mentorship (P < 0.001). Conclusion: General practice pharmacy professionals deliver clinical and non‐clinical services which may benefit patients, general practice and the healthcare system. General practices and national organisations should provide GPPPs with tailored support and exploit the

Reducing AF-related stroke risk is both clinically and economically important, with AF-related illness costing the NHS over £2 billion per annum. Despite this, there is no national screening programme for AF. Growing medical consensus backed by public health policy, agrees that there is an unmet need to improve diagnosis and that primary care is an appropriate setting. This model is likely to be convenient for patients and cost effective, but with the current shortage of GPs and nurses, and increasing GP workloads, it is unlikely to succeed. Huge investment by NHS England to introduce new work role models to GP practices, could mean, by 2021, that over 34 million patients will have access to the expertise of a clinical pharmacist, making clinical pharmacists a viable option for such screening initiatives. AIM: To determine whether clinical pharmacists based within GP practices, were able to accurately and effectively screen and diagnose patients for AF, using pulse palpation and a single-lead ECG device (AliveCor Kardia Mobile®) during the influenza vaccination season.

Introduction: Atrial fibrillation (AF) affects >6% of people aged 65 years or older. Left undetected and untreated, patients may develop significant cardiovascular complications and have a fivefold increased risk of suffering a stroke. For 40% of all sufferers, AF can be asymptomatic. Every year in the UK, £2.2 billion is spent on AF-related strokes, so there is an urgent need to improve early detection of AF. This study aims to determine the feasibility of using trained clinical pharmacists based in general practices, to screen for AF, using pulse palpation and a single-lead ECG device on participants aged 65 years or older, attending influenza vaccination clinics. Methods and analysis: Seven clinical pharmacists will be trained by a cardiologist to pulse palpate and record single-lead ECGs using the AliveCor Kardia Mobile device. Quantitative analysis will assess the accuracy and ability of the clinical pharmacist to identify pulse irregularities using pulse palpation and to record and interpret a singlelead ECG. The level of agreement of pulse irregularities detected by pulse palpation will be compared with those detected by the single-lead ECG device, as will the level of agreement between the cardiologist and the device’s interpretation of the ECG. The proportion of people identified with AF (confirmed by the cardiologist) will be determined. Additional demographic data will be obtained from all participants through a questionnaire. Qualitative data will be captured from the participants, from the clinical pharmacists and from the general practitioners and practice staff to determine their views on this method of AF screening. We aim to recruit 600 participants across general practices within Kent. Ethics and dissemination: This protocol was approved by the London–Riverside Research Ethics committee. The findings of this study will be disseminated through forums including, but not limited to, peer-reviewed journals, national and international conferences.

Using the Indian medicinal plant Tulsi (Holy Basil) as a case study, we have tested to what extent the discrepancy between vernacular and scientific nomenclature can be resolved, whether the presumed chemical diversity underlying the medicinal use of Tulsi has a genetic component, and whether it is possible to detect this genetic component using genetic barcoding markers. Based on four plastidic markers, we can define several haplotypes within Ocimum that are consistent across these markers. Haplotype II is congruent with O. tenuiflorum, while haplotype I extends over several members of the genus and cannot be resolved into genetically separate subclades. The vernacular subdivision of Tulsi into three types (Rama, Krishna, Vana) can only be partially linked with genetic differences–whereby Rama and Krishna Tulsi can be assigned to O. tenuiflorum, while Vana Tulsi belongs to haplotype I. This genetic difference is mirrored by differences in the profiles of secondary compounds. While developmental state and light quality modulate the amplitude to which the chemical profile is expressed, the profile itself seems to be linked with genetic differences. We finally develop an authentication assay that makes use of a characteristic single nucleotide polymorphism in one of the barcoding markers, establishing a differential restriction pattern that can be used to discriminate Vana Tulsi.

Migrant South Asian communities in the UK have brought with them their own traditional forms of medicine, yet little is known about their current use of herbal medicines (HMs) in the UK. The aim of the study was to explore the origins, use and transmission of knowledge of traditional HMs used by diasporic South Asian communities in the UK. A researcher-administered questionnaire was used for data collection (n = 192). An opportunity sampling technique was used to recruit participants across several locations in Birmingham and Leicester. Two thirds of participants (n = 126) stated they used HMs to maintain their health and to treat various health conditions such as digestive problems, skin conditions and diabetes. Almost 2000 actively used HMs were documented including 123 plant species that were identified. Participants imported HMs from abroad as well as sourcing them locally and even growing some of their own plants. Up to 82% (n = 87) of participants who took prescription medicines did not tell their healthcare professionals about any HMs they consumed; this raises concerns about people’s knowledge of herb–drug interactions, compliance and effect on prescribed medicine regimens. Similar studies to explore the use of HMs by other ethnic groups are imperative to help optimise pharmaceutical care of patients.