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Objectives: To determine support of in-pharmacy human immunodeficiency virus (HIV) testing among pharmacy staff and the individual-level characteristics associated with in-pharmacy HIV testing support., Design: Descriptive, nonexperimental, cross-sectional study., Setting: New York City (NYC) from January 2008 to March 2009., Participants: 480 pharmacy staff, including pharmacists, owners/managers, and technicians/clerks., Intervention: 131 pharmacies registered in the Expanded Syringe Access Program (ESAP) completed a survey., Main Outcome Measure: Support of in-pharmacy HIV testing., Results: Support of in-pharmacy HIV testing is high among pharmacy staff (79.4%). Pharmacy staff who supported in-pharmacy vaccinations were significantly more likely to support in-pharmacy HIV testing. Pharmacy staff who thought that selling syringes to injection drug users (IDUs) caused the community to be littered with dirty syringes were significantly less likely to support in-pharmacy HIV testing., Conclusion: Support for in-pharmacy HIV testing was high among our sample of ESAP pharmacy staff actively involved in nonprescription syringe sales. These findings suggest that active ESAP pharmacy staff may be amenable to providing HIV counseling and testing to IDUs and warrants further investigation.

Introduction: There is a lack of comparative data with simulation-based learning (SBL) and other types of learning. The objective of the study was to determine whether high-fidelity simulation is superior to problem-based learning (PBL) for training pharmacy students in an acute care elective., Methods: Twenty-nine pharmacy students enrolled in the Acute Care Pharmacotherapy Simulation course over 2 years voluntarily participated in this randomized, crossover study. Students were randomized to group 1 or 2. The SBL group consisted of students in group 1 who had SBL during study week 1 and group 2 students who had SBL in week 2. The PBL group consisted of students in group 1 who had PBL cases during study week 2 and group 2 students who had PBL cases in week 1. The topics covered were management of dysrhythmias (week 1) and heart failure (week 2)., Results: The SBL group significantly improved compared with the PBL on postquiz scores. The SBL group performed at least 15% better in the clinical assessment (P = 0.013). Students in the SBL group performed significantly better in their critical thinking skills for problem list, pharmacotherapy plan, and monitoring plan., Conclusions: Learning was enhanced with the use of SBL compared with PBL.

Background/aims:   Enhanced communication and transfer of information between healthcare providers and healthcare settings can reduce medication and healthcare errors post-hospital discharge. The timeframes within which patients access community healthcare providers post-hospital discharge are not well studied. This study aimed to determine length of time from hospital discharge until a general practice, pharmacy or specialist visit, or care planning service., Methods:   We conducted a retrospective analysis of Department of Veterans' Affairs health claims data. All 109 860 veterans hospitalized in 2006 were included. Main outcome measures were time from first hospital discharge to first claim for a general practice, pharmacy, specialist visit and/or care planning service., Results:   Within 30 days of hospital discharge 71% of subjects visited a general practitioner (GP), 86% had medicines dispensed from a community pharmacy and 44% saw a specialist. Median time to first pharmacy visit was 6 days (interquartile range 2-14) and 12 days for a GP visit (interquartile range 4-31). Less than 2% of the cohort received a discharge plan, case conference or medication review in the month after discharge., Conclusions:   With 25% of patients having a claim for a GP service within 4 days of discharge, discharge summaries need to reach community-based health professionals within this time. Most patients visited their community pharmacy within 2 weeks of hospital discharge and before they saw their GP. Pharmacists are not routinely advised of hospitalization or provided with discharge summaries. More active engagement of this professional group in the continuum of care might improve care after hospital discharge., (© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.)

Ion chromatography (IC) has developed and matured into an important analytical methodology in a number of diverse applications and industries, including pharmaceuticals. This manuscript provides a review of IC applications for the determinations of active and inactive ingredients, excipients, degradation products, and impurities relevant to pharmaceutical analyses and thus serves as a resource for investigators looking for insights into the use of the IC methodology in this field of application.

Nepal experiences several medicine-use problems like any other developing country. In the recent years, there have been initiatives to introduce the concept of social pharmacy in Nepal, and there has been only a limited research in this area. The staff members at the Manipal College of Medical Sciences, Pokhara have shown keen interest in initiating several social pharmacy-related researches in the country. The members of this institute have been collaborating with two international universities, namely Universiti Sains Malaysia located in Malaysia and Chulalongkorn University located in Thailand, to get academic and technical supports. In this manuscript, the authors share their experiences in initiating social pharmacy research in the country. Authors have also mentioned the priority areas of social pharmacy research in Nepal and the importance of initiating this concept in the country.

Purpose: The development, implementation, and early evaluation of a postgraduate year 1 (PGY1) pharmacy residency program at a large tertiary care hospital are described., Summary: In keeping with long-range initiatives by the American Society of Health-System Pharmacists (ASHP) and other pharmacy organizations to increase pharmacists' involvement in direct patient care and expand opportunities for advanced training, a PGY1 program was developed at Baystate Medical Center (BMC), a 653-bed hospital in Massachusetts. A residency advisory committee appointed in the fall of 2006 led the program development process, including curriculum planning, establishment of initial funding, recruitment procedures, and integration of faculty at an affiliated school of pharmacy (Massachusetts College of Pharmacy and Health Sciences). Recruitment efforts began in the fall of 2006; in the summer of 2007 the first group of PGY1 residents began a curriculum of 12 one-month core and elective learning experiences, as well as longitudinal direct-care experiences (e.g., performing medication reconciliations and related duties at an affiliated outpatient pharmacotherapy clinic) and teaching and management requirements. In the spring of 2009, the residency program received ASHP accreditation and federal funding for program expansion. The residency advisory committee's evaluation of early experience with the program guided adjustments in areas such as recruitment, applicant screening, resident selection, preceptor scheduling, monitoring of residents' progress through the program, and accreditation survey preparation., Conclusion: A PGY1 residency at BMC was developed to enhance the pharmacy department's clinical services. Residents were successfully recruited, and the program received accreditation within two years.

Active pharmaceutical ingredients (APIs) are ubiquitous environmental contaminants, resulting primarily from excretion and bathing and from disposal of leftover drugs by consumers and healthcare facilities. Although prudent disposal of leftover drugs has attracted the most attention for reducing API levels in the aquatic environment, a more effective approach would prevent the generation of leftover drugs in the first place. Many aspects of the practice of medicine and pharmacy can be targeted for reducing environmental contamination by APIs. These same modifications--focused on treating humans and the environment as a single, integral patient--could also have collateral outcomes with improved therapeutic outcomes, and with a reduced incidence of unintended poisonings, drug interactions and drug diversion, and lower consumer costs.

Prescription or pill-based methods for estimating adherence to antiretroviral therapy (ART), pharmacy adherence measures (PAMs), are objective estimates calculated from routinely collected pharmacy data. We conducted a literature review to evaluate PAMs, including their association with virological and other clinical outcomes, their efficacy compared with other adherence measures, and factors to consider when selecting a PAM to monitor adherence. PAMs were classified into 3 categories: medication possession ratio (MPR), pill count (PC), and pill pick-up (PPU). Data exist to recommend PAMs over self-reported adherence. PAMs consistently predicted patient outcomes, but additional studies are needed to determine the most predictive PAM parameters. Current evidence suggests that shorter duration of adherence assessment (≤ 6 months) and use of PAMs to predict future outcomes may be less accurate. PAMs which incorporate the number of days for which ART was prescribed without the counting of remnant pills, are reasonable minimum-resource methods to assess adherence to ART.

The demand for public health services is being outpaced by a shrinking public health workforce. This creates a unique opportunity for pharmacists to become more engaged in public health activities, particularly in rural underserved areas. To meet the need for additional public health professionals, we designed a master of public health (MPH) program in a rural state under the leadership of a department of pharmacy practice. In addition to a core set of courses, the MPH program has public health specialty tracks (disease state management, emergency management, health promotion practice, infectious disease management, food safety, gerontology, and medical management and administration) that could be completed as a certificate program or used towards an MPH degree. The program allows students to complete the graduate degree with a minimum of prerequisite coursework. The MPH degree provides an opportunity for pharmacists and other health care professionals to gain an understanding of the interprofessional approach to solving public health problems and will enhance their role in public health and within their health care team.

A new set of standards, ACPE Standards 2007, adopted by the Accreditation Council for Pharmacy Education (ACPE), required all pharmacy programs to include introductory pharmacy practice experiences (IPPEs) to represent 5% of the curriculum and advance pharmacy practice experiences (APPEs) to represent 25% of the curriculum. This required many pharmacy programs to revise their curriculum to meet these requirements. The challenge of satisfying the increased accreditation requirements along with the increased number of new pharmacy programs in the United States has resulted in increased competition for experiential sites. Drake University College of Pharmacy and Health Sciences and the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy utilized innovative immunization services to help meet the ACPE Standards 2007. Drake utilized P2 and P3 students who were trained to give immunizations in an IPPE patient care elective in order to help experiential sites in their immunization efforts. Senior pharmacy students at UAMS were involved in expanding APPE opportunities by developing immunization clinics and providing immunizations at their experiential sites. Both pharmacy programs were successful in expanding experiential opportunities by focusing on immunizations. Students, preceptors, and patients all benefit from utilizing student pharmacist at experiential sites to provide patient care services.

Objective: Although pharmacist-participated warfarin therapy management (PWTM) has been accepted and implemented in various parts of the world, the evidence demonstrating the effects of PWTM compared with usual care on clinical outcomes is lacking. We performed a systematic review and meta-analysis to compare the effects of PWTM with usual care on bleeding and thromboembolic outcomes., Methods: We searched MEDLINE, SCOPUS, EMBASE, IPA, CINAHL, Cochrane CENTRAL, Thai Index Medicus and Thai Medical Index, and reference lists of studies, without language restriction. Databases were searched from their inception to July 2009. The studies using warfarin as an anticoagulant with sufficient data for compilation of 2 × 2 tables were included. Both randomized controlled trials (RCTs) and non-RCTs were considered. Two authors independently reviewed each study, assigned quality scores and extracted data for all outcomes using a standardized form. Pooled effect estimates (risk ratio; RR) were obtained using a random effects model., Result: Of 661 articles identified, 24 studies with 728,377 patients were included. In the random-effects meta-analysis of RCTs, the PWTM group had statistically significant effects on the prevention of total bleeding [RR, 0.51; 95% confidence interval (CI), 0.28-0.94]. However, the effects on major bleeding (RR, 0.64; 95% CI, 0.18-2.36), thromboembolic events (RR, 0.79; 95% CI, 0.33-1.93), all-cause mortality (RR, 0.93; 95% CI, 0.41-2.13) and warfarin-related mortality (RR, 0.65; 95% CI, 0.18-2.42) were not significant., Conclusion: Pharmacist's participation in the management of warfarin therapy significantly reduces total bleeding, with a non-significant trend towards decreases in other warfarin-related complications., (© 2010 International Society on Thrombosis and Haemostasis.)

Background: Internet-sourced drugs are often considered suspect. The World Health Organization reports that drugs from websites that conceal their physical address are counterfeit in over 50 percent of cases; the U.S. Food and Drug Administration (FDA) works with the National Association of Boards of Pharmacy (NABP) to regularly update a list of websites likely to sell drugs that are illegal or of questionable quality., Methods and Findings: This study examines drug purchasing over the Internet, by comparing the sales of five popular drugs from a selection of websites stratified by NABP or other ratings. The drugs were assessed for price, conditions of purchase, and basic quality. Prices and conditions of purchase varied widely. Some websites advertised single pills while others only permitted the purchase of large quantities. Not all websites delivered the exact drugs ordered, some delivered no drugs at all; many websites shipped from multiple international locations, and from locations that were different from those advertised on the websites. All drug samples were tested against approved U.S. brand formulations using Raman spectrometry. Many (17) websites substituted drugs, often in different formulations from the brands requested. These drugs, some of which were probably generics or perhaps non-bioequivalent copy versions, could not be assessed accurately. Of those drugs that could be assessed, none failed from "approved", "legally compliant" or "not recommended" websites (0 out of 86), whereas 8.6% (3 out of 35) failed from "highly not recommended" and unidentifiable websites., Conclusions: Of those drugs that could be assessed, all except Viagra(R) passed spectrometry testing. Of those that failed, few could be identified either by a country of manufacture listed on the packaging, or by the physical location of the website pharmacy. If confirmed by future studies on other drug samples, then U.S. consumers should be able to reduce their risk by relying on credentialing agencies recommended lists and by using common sense when examining packaging and pills.

Objective: To determine the impact of an introductory pharmacy practice experience (IPPE) on students' clinical skills during their initial advanced pharmacy practice experience (APPE)., Design: A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs., Assessment: During the third week of the first APPE, faculty members rated students' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01)., Conclusion: Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.

Background: The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications--Hypertension Adherence Program in Pharmacy (HAPPY)., Methods/design: The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data., Discussion: To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention., Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12609000705280.

Objective: To develop and validate a psychometric measure of cognitive moral development in professional ethics in pharmacy., Setting: Pharmacy practice in Australia., Method: A psychometric instrument, the Professional Ethics in Pharmacy (PEP) test, was developed and validated following a systematic procedure. The theoretical foundation of the instrument was based on a hypothesised theory of cognitive moral development in professional ethics, which was integrated into a selection of scenarios experienced in practice by pharmacists in NSW, Australia. The PEP, along with the well established DIT test, was mailed in the form of a questionnaire to a randomly selected sample of 1,500 practising pharmacists. Data collected from returned questionnaires were statistically analysed to establish validity and reliability of the instrument., Main Outcome Measures: The P-score calculated for each participant from DIT and PEP data and defined as a measure of principled moral reasoning, represented the main outcome measure for statistical testing. Pearson's correlation coefficient was used to determine the strength of the relationship of the PEP with the DIT (regarded as the "gold standard") in order to establish criterion and concurrent validity. Factor analysis was used to investigate construct validity. Cronbach's Alpha, a measure of reliability of the instrument, was used for indicating internal consistency. Linear regression models further investigated construct validity in relation to predictors of moral reasoning., Results: Face and content validity were established by pilot and peer review. Pearson's coefficient of 0.53 indicated an acceptable level of concurrent validity. Factor analysis yielded factors closely related to the theoretical stages of cognitive moral development hypothesised, which indicated construct validity. Cronbach's alpha of 0.75 demonstrated the reliability of the instrument, and linear regression models provided further evidence of construct validity. The PEP was established as a robust instrument on several dimensions of validity and reliability., Conclusion: The validated PEP test has the potential to provide the pharmacy profession with valuable information for use education and research. The validation process also provided evidence supporting the hypothesis that moral reasoning in professional ethics in pharmacy is a developmental process, which has profound implications for furthering the understanding of professional behaviour.

Purpose: An overview of the emerging field of comparative effectiveness research (CER) and its relevance to pharmacists and pharmacy-based decision-makers is provided., Summary: The U.S. government is investing over $1 billion on CER over the next two years. This investment is in part driven by the recognition that, despite having the highest per capita health care expenditures in the world, the United States does not always perform well on measures of health compared with other countries. There also is increased awareness of the limited information provided by results of traditional randomized clinical trials to inform decisions about therapeutic alternatives as applied in actual practice. Comparative effectiveness studies have two important principal components: (1) the comparison of two or more agents or interventions that are considered true therapeutic alternatives and (2) the examination of effects (outcomes) in actual practice. Comparative effectiveness studies differ from traditional efficacy studies in several ways, including the research question addressed, comparison groups, patient population, setting, outcomes measured, and validity. Studies that are within the scope of CER can be categorized as primary comparative effectiveness studies or secondary comparative effectiveness studies. CER also can be used to compare medical devices, procedures, health services, or any competing intervention., Conclusion: Comparative effectiveness is an emerging area of research relevant to many areas of health care, especially pharmacotherapy. The knowledge gained from CER is important to pharmacists when applying drug information and making decisions related to drug therapy.

Objectives: To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program., Methods: Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates., Results: Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities., Conclusions: Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.

Purpose: A brief overview is given of the types of statistical tests that are available to analyze pharmacy research data., Summary: The most important aspect of selecting the correct statistical test is defining the types of variables being analyzed. Variables that are controlled or determined by the researcher are referred to as independent variables. Dependent variables are those that are observed and are out of the researcher's control. There are two types of random error that exist with inferential statistics: rejecting a null hypothesis (H(0)) when it is true and failing to reject H(0) when it is false. There are two primary ways to interpret the significance of results from an inferential statistical test: (1) creation of a confidence interval and determination of whether a value falls within the interval and (2) calculation of a ratio and determination of whether the resultant value exceeds an established critical value. Student's t test is one of the simplest inferential tests and can be used to illustrate both the confidence interval and the ratio approaches to evaluating sample data. The p value indicates the amount of error that can exist if the researcher chooses to reject H(0). Parametric tests require two additional assumptions in order to be applied correctly. Some examples of these include the two-sample t test and the paired t test. Nonparametric tests are designed for small sample sizes and are easy to calculate. These tests use the median as the measure of center. Some examples of nonparametric tests include the chi-square test and the Fisher exact test. Other statistical tests that are available to help the pharmacist researcher include equivalency testing, survival statistics, and noninferiority studies., Conclusion: Selection of the proper statistical test depends on the type and number of variables and whether parametric conditions are met.

Although there has been a large number of trials on pharmacist care, often demonstrating clinically significant benefits, the trials generally have not changed practice or healthcare policy. What is needed are focused evidence syntheses, such as a systematic review. A systematic review is defined as a summary that addresses a focused clinical question, using methods to reduce the likelihood of bias. These reviews, which are the highest level of evidence, can help to impact policy by bringing together results of various trials. However, systematic reviews of practice research pose some unique methodologic challenges, including issues with searching, interpreting, and evaluating the available research. Well-conducted systematic reviews of pharmacist interventions could go a long way toward changing pharmacy practice and healthcare policy to recognize the important impact that pharmacists could have in the healthcare system.

The emergence of chemical imaging (CI) has gifted spectroscopy an additional dimension. Chemical imaging systems complement chemical identification by acquiring spatially located spectra that enable visualization of chemical compound distributions. Such techniques are highly relevant to pharmaceutics in that the distribution of excipients and active pharmaceutical ingredient informs not only a product's behavior during manufacture but also its physical attributes (dissolution properties, stability, etc.). The rapid image acquisition made possible by the emergence of focal plane array detectors, combined with publication of the Food and Drug Administration guidelines for process analytical technology in 2001, has heightened interest in the pharmaceutical applications of CI, notably as a tool for enhancing drug quality and understanding process. Papers on the pharmaceutical applications of CI have been appearing in steadily increasing numbers since 2000. The aim of the present paper is to give an overview of infrared, near-infrared and Raman imaging in pharmaceutics. Sections 2 and 3 deal with the theory, device set-ups, mode of acquisition and processing techniques used to extract information of interest. Section 4 addresses the pharmaceutical applications.

Over the last decade Fourier transform infrared (FT-IR) and near-infrared (NIR) spectroscopic imaging with focal plane array (FPA) detectors have proved powerful techniques for the rapid visualization of samples by a combination of spectroscopic and spatial information. Using these methods, selected sample areas can be analyzed with reference to the identification and localization of chemical species by FT-IR spectroscopy in the transmission or attenuated total reflection (ATR) mode and by NIR spectroscopy in diffuse reflection with a lateral resolution in the micrometer range. The present communication focuses on the quantitative determination of the active ingredient composition of a solid drug formulation by NIR spectroscopic imaging with a focal plane array detector and the results obtained are compared to the quantitative data obtained by conservative light-fiber NIR spectroscopic diffuse reflection measurements with a single-element detector. The communication also addresses the issue of penetration depth of NIR radiation into the investigated solid material.

The prevalence of suboptimal prescribing of medications is well documented. Patients are often undertreated or not offered therapeutic treatments that are likely to confer benefit. As a result, drug-related hospital admissions are common and often preventable. Improvements to the health-care system are clearly needed in order to maximize the benefits that can be derived from medications. Many countries are changing their primary health-care systems to improve the quality of health-care delivery. One main transformation is the use of multidisciplinary care teams to provide care in a coordinated manner often from the same location or by using the common medical record of the patients. It has been demonstrated that pharmacists can improve prescribing, reduce health-care utilization and medication costs, and contribute to clinical improvements in many chronic medical conditions, such as cardiovascular disease, diabetes, and psychiatric illness. However, the effect of integrating a pharmacist providing general services into a primary care group has not been extensively studied. The Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) project was designed to provide a real-world demonstration of the feasibility of integrating the pharmacist into primary care office practice. This article provides a description of the IMPACT project participants; the IMPACT practice model and the concepts incorporated in its development; some initial results from the program evaluation; sustainability of the model; and some reflections on the implementation of the practice model.

Chemical Imaging (CI) is an emerging platform technology that integrates conventional imaging and spectroscopy to attain both spatial and spectral information from an object. Vibrational spectroscopic methods, such as Near Infrared (NIR) and Raman spectroscopy, combined with imaging are particularly useful for analysis of biological/pharmaceutical forms. The rapid, non-destructive and non-invasive features of CI mark its potential suitability as a process analytical tool for the pharmaceutical industry, for both process monitoring and quality control in the many stages of drug production. This paper provides an overview of CI principles, instrumentation and analysis. Recent applications of Raman and NIR-CI to pharmaceutical quality and process control are presented; challenges facing CI implementation and likely future developments in the technology are also discussed.

Biosimilar medicines are biological medicinal products that can obtain a marketing authorization in the EU after the original product (biological reference medicine) has run out of patent. As a prerequisite, studies including clinical trials are to be conducted to compare the quality, safety, and efficacy of the biosimilar and reference medicine. Due to the specific characteristics of biopharmaceuticals like complex 3-dimensional (glyco) protein structure, immunogenicity, production in living organisms, which causes heterogeneity, complex manufacturing process and analysis, interchangeability of the biosimilar with its reference drug product is not guaranteed. In addition, INN (international non-proprietary name) naming and interchangeability, pharmacovigilance, and traceability are subjects for discussion. The aim of this article is to describe the pharmaceutical and pharmacological specialties of biosimilars and to inform about points to consider (like manufacturer, good handling practice, pharmacovigilance, costs), when the use of biosimilars comes into question.

Purpose: The extent of didactic and laboratory instruction related to compounded sterile preparations (CSPs) provided by U.S. schools of pharmacy was studied., Methods: A nine-item survey was developed and mailed to the deans of 82 U.S. schools of pharmacy in 2005. The survey instrument was designed to gather basic demographic information about the school of pharmacy, identify availability and characteristics of instruction offered on the compounding of sterile preparations, identify which of 20 topics were covered in either a didactic or laboratory setting, determine how students' skills in sterile preparation were assessed, and identify the compounding environment at the school of pharmacy. Data were analyzed using descriptive statistics., Results: A total of 53 surveys were returned, yielding a response rate of 65%. All schools included some instruction on CSPs; however, only 70% required students to compound on their own (rather than in groups or not at all), and only 21% offered a stand alone course on this topic. Most schools (88%) taught students about U.S. Pharmacopeia chapter 797 standards for sterile compounding. Only 13% of schools felt that their students had adequate training in compounding sterile preparations before graduation; however, most (88.7%) believed that students could only become fully competent in these skills over time in actual practice., Conclusion: A survey sent to deans of pharmacy schools revealed that instruction provided to pharmacy students in preparing CSPs varied widely. Only about a sixth of respondents believed that their students were adequately trained in compounding sterile preparations before graduation.

The initial courses in didactic pharmacy curriculum are designed to provide core scientific knowledge and develop learning skills that are the basis for highly competent application and practice of pharmacy. Commonly, students interpret this scientific base as ancillary to the practice of pharmacy. Physiology courses present a natural opportunity for the instructor to introduce basic pharmaceutical principles that form the foundation of pharmacological application early in the professional curriculum. Human Physiology I is the first of a 2-course physiology sequence that pharmacy students take upon matriculating into Midwestern University College of Pharmacy-Glendale. The endocrine physiology section of this course is designed to emphasize the regulatory and compensatory nature of this system in maintaining homeostasis, but also includes aspects of basic pharmaceutical principles. In this way the dependency of physiology and pharmacy upon one another is accentuated. The lecture format and content described in this manuscript focus on the central endocrine glands and illustrates their vital role in normal body function, compensatory responses to disease states, and their components as pharmacotherapy targets. The integration of these pharmaceutical principles at the introductory level supports an environment that can alleviate any perceived disparity between science foundation and practical application in the profession of pharmacy.

Background: Increased use of generic medications conserves insurer and patient financial resources and may increase patient adherence., Objective: The objective of the study is to evaluate whether physician, patient, pharmacy benefit design, or pharmacy characteristics influence the likelihood that patients will use generic drugs, Design, Setting, and Participants: Observational analysis of 2001-2003 pharmacy claims from a large health plan in the Western United States. We evaluated claims for 5,399 patients who filled a new prescription in at least 1 of 5 classes of chronic medications with generic alternatives. We identified patients initiated on generic drugs and those started on branded medications who switched to generic drugs in the subsequent year. We used generalized estimating equations to perform separate analyses assessing the relationship between independent variables and the probability that patients were initiated on or switched to generic drugs., Results: Of the 5,399 new prescriptions filled, 1,262 (23.4%) were generics. Of those initiated on branded medications, 606 (14.9%) switched to a generic drug in the same class in the subsequent year. After regression adjustment, patients residing in high-income zip codes were more likely to initiate treatment with a generic than patients in low-income regions (RR = 1.29; 95% C.I. 1.04-1.60); medical subspecialists (RR = 0.82; 0.69-0.95) and obstetrician/gynecologists (RR = 0.81; 0.69-0.98) were less likely than generalist physicians to initiate generics. Pharmacy benefit design and pharmacy type were not associated with initiation of generic medications. However, patients were over 2.5 times more likely to switch from branded to generic medications if they were enrolled in 3-tier pharmacy plans (95% C.I. 1.12-6.09), and patients who used mail-order pharmacies were 60% more likely to switch to a generic (95% C.I. 1.18-2.30) after initiating treatment with a branded drug., Conclusions: Physician and patient factors have an important influence on generic drug initiation, with the patients who live in the poorest zip codes paradoxically receiving generic drugs least often. While tiered pharmacy benefit designs and mail-order pharmacies helped steer patients towards generic medications once the first prescription has been filled, they had little effect on initial prescriptions. Providing patients and physicians with information about generic alternatives may reduce costs and lead to more equitable care.

Purpose: The attitudes of pharmacy residents toward pharmaceutical industry promotion and the perceived effects of such promotion on the knowledge and professional practice of the residents were studied., Methods: A questionnaire study of current postgraduate year 1 and postgraduate year 2 pharmacy residents was conducted. Questions were adapted from instruments used in studies of medical student or physician attitudes regarding the pharmaceutical industry. The questionnaire requested demographic information about the resident, information regarding the resident's exposure to specific types of pharmaceutical company-related activities, and the resident's perception of whether the residency program or department had policies or guidelines regarding interactions with the pharmaceutical industry. Questions investigated the attitudes toward pharmaceutical industry promotion and the perceived influence of pharmaceutical industry promotion on the professional knowledge and behavior of the residents., Results: Responses were received from 496 pharmacy residents. Nearly all (89%) residents agreed that pharmaceutical company-sponsored educational events enhance knowledge. Almost half (43%) of the respondents reported that information from educational events influences therapeutic recommendations. One quarter (26%) of the pharmacy residents indicated prior training regarding pharmacist-industry interactions, and most (60%) residents indicated that their institution's residencies or departments have policies regarding interactions with the pharmaceutical industry., Conclusion: Most surveyed pharmacy residents believed that educational events sponsored by pharmaceutical companies enhance knowledge. Respondents whose institutions had policies or who had received training about such events were less likely than other respondents to perceive an influence of the events on their knowledge and behavior.

Purpose: A strategic approach to improving the medication-use process in health systems by using a framework for setting priorities on the basis of feasibility, the potential for financial return, and the effect on quality and safety is described., Summary: A panel consisting of leaders in health-system pharmacy identified seven dimensions of high-performance pharmacy (HPP) framework: medication preparation and delivery, patient care services, medication safety, medication-use policy, financial performance, human resources, and education. Performance elements, which are specific policies, procedures, activities, and practices that indicate high performance and result in a financial or clinical return on investment of resources, within each dimension were identified. References, practice standards, and policies related to each performance element were also identified. By consensus, the panel assigned qualitative metric scores for each of the 69 performance elements that represent the panel's assessment of the resources necessary to achieve full implementation of the element and the potential financial and quality and safety returns if the element has not yet been implemented. It is noted that a pharmacy department's actual outlay of resources and expected financial return will differ depending on the size of the health system, the size of pharmacy staff, and the extent of previous implementation efforts. The framework can also be used to rejustify existing services and programs and identify opportunities for improvement., Conclusion: The HPP framework characterizes pharmacy performance elements on the basis of feasibility, financial return, and effect on quality and safety. The framework provides pharmacists with a means to establish priorities in improving the medication-use system.

Objectives: To develop a multidimensional scale to measure work satisfaction among pharmacy faculty members and determine its reliability and validity., Methods: A literature review was used to assist in the generation of 36 statements that putatively comprise the satisfaction construct. The 25 items meeting a priori criteria in a modified Delphi procedure were included in a questionnaire sent by e-mail to 4,228 pharmacy faculty members. Principal axis factoring and scale purification procedures were used to identify a plausible factor structure., Results: Using responses acquired from 885 pharmacy faculty members, 6 domains of work satisfaction were identified: resources for scholarship, institutional support and reward, requirements for tenure and promotion, availability of a graduate program, collegiality, and teaching environment. The overall measure demonstrated construct validity, while each domain subscale exhibited relatively high internal consistency reliability., Conclusions: The overall work satisfaction measure and each subscale derived from composite domains can be used to identify sources of discontent and/or track interventions designed to improve work satisfaction.

Objective: To offer a physics course that is relevant to pharmacy students, yet still contains many of the fundamental principles of physics., Design: The course was modified over a period of several years to include activities and examples that were related to other courses in the curriculum., Assessment: Course evaluations were given to assess student attitudes about the importance of physics in the pharmacy curriculum., Conclusion: Students' attitudes have changed over time to appreciate the role that physics plays in their studies. Students gained confidence in their ability to learn in other courses.