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The ASHP Vision for the Pharmacy Workforce in Hospitals and Health Systems expresses a vision for building the workforce capacity of pharmacy departments in hospitals and health systems to meet the growing challenges related to optimizing the use of medicines in those settings.

Homeopathy has been the cause of much debate in the scientific literature with respect to the plausibility and efficacy of homeopathic preparations and practice. Nonetheless, many consumers, pharmacists, physicians, and other health care providers continue to use or practice homeopathic medicine and advocate its safety and efficacy. As drug experts, pharmacists are expected to be able to counsel their patients on how to safely and effectively use medications, which technically includes homeopathic products. Yet many pharmacists feel that the homeopathic system of medicine is based on unscientific theories that lack supporting evidence. Since consumers continue to use homeopathic products, it is necessary for pharmacists to have a basic knowledge of homeopathy and to be able to counsel patients about its general use, the current state of the evidence and its use in conjunction with other medications.

Objectives: To evaluate the effectiveness and impact of an elective service-learning course offered in cooperation with a charitable pharmacy providing services to the surrounding community., Methods: The 33 students enrolled in the service-learning elective were given a 23-question preservice survey instrument and a 32-question postservice survey instrument. The survey instruments were designed to measure change in the students' perceived knowledge and understanding regarding civic, cultural, and social issues and health disparities., Results: Significant differences in responses on the presurvey and postsurvey instruments suggested changes in students' attitudes and perceptions about the patients and the community in which they serve., Conclusions: Results of the survey indicated that by exposing students to issues affecting individuals and the community during this elective, a positive change in the student's perception of their knowledge and understanding of broader issues facing the community was observed. Service-Learning courses provide additional opportunities for students to develop as competent, engaged, and caring health care professionals.

Objective: To describe the use of student self-assessments as a measure of the effectiveness of a drug information advanced pharmacy practice experience (APPE) and to determine whether other APPEs reinforced information-related skills., Design: Students taking a drug information APPE completed a self-assessment survey instrument focusing on key information-related skills on the first day and again on the last day of that APPE. Findings were used to determine the effect of this and other APPEs on perceived information skills. Student ratings were compared with faculty ratings for items with similar wording., Assessment: Student self-ratings improved after completing the drug information APPE. Other APPEs, gender, and course grade did not significantly impact student perceptions of their information-related knowledge and skills. Student and faculty ratings were similar, although individual variability occurred., Conclusion: Student self-assessments, along with other direct and indirect data, can provide useful information needed to assess and change aspects of the experiential program and curriculum.

Objectives: To determine student perceptions regarding online lectures and quizzes during an introductory drug information course for first-year professional doctor of pharmacy students., Design: Formal and online lectures, online quizzes, written semester projects, a practice-based examination, a careers in pharmacy exercise, and a final examination were used to deliver the course content and assess performance. A multiple-choice survey instrument was used to evaluate student perceptions of WebCT and online lectures., Assessment: More than 47% of students reported that online lectures helped them learn the material better, 77% reported that lectures would be used to study for the final examination, and 59% reported that they would use WebCT lectures for future classes. Approximately 40% of students agreed that online lectures should be used in future courses., Conclusion: Students reported that WebCT was easy to use; however, the majority of students preferred in-class lectures compared to online lectures. A positive correlation was observed for those students who performed well on the online quizzes and those who performed well on the final examination.

A simply prepared DNA immobilized on a carbon nanotube paste electrode (CNTPE) was utilized to monitor dopamine ion concentration using the cyclic voltammetry (CV) and square-wave (SW) stripping voltammetry methods. The optimum analytical conditions were sought. The result obtained was a very low detection limit compared to other common voltammetry methods. The optimal parameters were found to be as follows: 3.5 pH, 0.48 V SW amplitude, 71 Hz frequency, 5 s accumulation time, 0.01 V increment potential, and -1.3 V (anodic-*-) and 1.2 V (cathodic-o-) accumulation potentials. Given these conditions, the linear working range was observed to be within 0.01-0.11 microg L(-1) (SW anodic and CV). The analytical detection limit was determined to be SW anodic and CV: 4.0 microg L(-1) (2.1 x 10(-11) mol L(-1)) dopamin, and the relative standard deviation at the dopamine concentration of SW anodic 0.05 microg L(-1) was 0.02% (n=15) at the optimum conditions.

Recommendations for the safe handling of hazardous drugs have been available for more than twenty years. Evidence for continued risk of occupational exposure is abundant; however, nurses' use of the recommended precautions is not universal. This may be related to a lack of information or to a lack of serious concern for the potential hazards. This article includes a discussion of current issues related to handling hazardous drugs in the workplace and a review of the history of safe handling guidelines, current recommendations, and barriers to implementing guidelines in health care settings.

Background: For many patients, the initial prescription is only the beginning of the prescribing process, with the prescription needing to be repeated, sometimes for the life of the patient., Objective: This article discusses the factors to consider when reviewing a patient for a repeat prescription and some approaches to long term pharmacotherapy., Discussion: When writing repeat prescriptions it is important to take time to consider the physiological changes of aging, emergence of new contraindications in the patient, emergence of new evidence regarding drug therapy, and whether it is appropriate to consider drug withdrawal. The role of the pharmacist in the prescribing process, particularly in performing home medicine reviews, is also briefly discussed.

In this essay it is argued that advertisements for medicines in the lay press constitute an important source for the patient in medical history. At first sight, advertisements only seem to document the supply side of the medical market. However, the image of the proactive manufacturer offering his goods to passive consumers is a misleading one. For a manufacturer to get and remain in business, it was crucial to develop a sensitive antenna for the needs of the public. In a highly commercial domain like health care around 1900 production, distribution and consumption of medicines constituted an interactive cycle of which advertisements were a part. They mirror a subtle play with dormant notions about health, illness and healing. When looking at it this way, the health care system (or rather: the medical market) becomes a place where meaning is being constructed, negotiated and exchanged. Thus, by taking a closer look at advertisements, the demand side comes in sight as well. By using advertisements for medicines in the lay press as a source, it seems possible to overcome the objection that much patient history is still too much focused on the academy and on physicians.

The Purdue Pharmacist Directive Guidance scale (PPDG), which is designed to measure patients' perceptions of the level of directive guidance received from pharmacists, was studied. Hypertension patients were interviewed by telephone between July 15 and August 15, 1998, with a survey including the PPDG, the Medication Adherence Scale (MAS), and the Friends and Family Support scale (FFS). The Behavioral Pharmaceutical Care Scale (BPCS) was mailed between May 15 and July 15, 1998, to pharmacies from which the patients obtained most of their prescriptions. The MAS measures patients' medication adherence, and the FFS measures their perceptions of the social support they receive from family and friends. Analysis of variance was used to assess whether there was significant variation in scale scores across pharmacies. Pearson correlation analysis was used to assess simple correlation among scales, and regression analysis was used to examine the association between scale scores while controlling for demographic variables, family support, and number of prescription drugs taken. Interviews with 163 patients were analyzed, and 64 pharmacists representing 32 pharmacies responded. The PPDG did not detect any difference across pharmacies in patients' perceptions of the level of directive guidance received. There was no significant correlation between PPDG scores and pharmacists' perceptions of the level of pharmaceutical care provided as measured with the BPCS or between PPDG scores and MAS scores. The findings reconfirmed the PPDG's reliability and factor structure and provided some evidence of convergent validity. The PPDG was reliable. Evidence of validity was not conclusive, although the high threshold for validity may have been responsible for this.

Chiroptical spectroscopy, and its double and triple hyphenated combinations with UV-VIS spectroscopy and/or separation techniques constitute great progress in pharmaceutical analysis, of which five recently developed methods are surveyed here, as follows: The determination of enantiomeric purity by double, CD/UV detection without, and with the latter one provides enhanced sensitivity and selectivity. The determination of chromatographic peak homogeneity, by double detection, and peak slicing by recording. The separation, identification and four stereoisomers of doubly chiral compounds, by HPLC separation on chiral column, and optical-chiroptical detection.

It has been investigated if UV-VIS spectroscopy and spectrophotometry can be regarded to be obsolete methods in pharmaceutical analysis. The conclusions are as follows. As a consequence of the introduction and spreading of highly efficient spectroscopic methods in the structural analysis of organic compounds the importance of UV-VIS spectroscopy as a structure elucidation tool has greatly decreased. At the same time, however, diode-array UV spectrophotometers used as HPLC detectors have created very convenient possibilities for the identification of minor components (impurities, degradation products, etc.) in drugs. This statement is illustrated by several practical examples. On the basis of some data taken from the British Pharmacopoeia 1998 it is stated that UV spectrophotometry as a quantitative analytical method still belongs to the most frequently used analytical techniques in pharmaceutical analysis. At the same time, however, the authors are of negative opinion about the up-to-dateness and usefulness of colorimetric methods still very often published for the determination of drug substances.

This article describes a research project concerning the professional practice of community pharmacists in Western Europe. In 1990 interviews were held with key figures and practising pharmacists in the Netherlands, Belgium, Great Britain, Sweden and Portugal. In 1991 a questionnaire was sent which was answered by 929 pharmacists. Concerning the quality of the professional practice it appeared that pharmacists have integrated certain structure aspects such as the use of a computer or a separate patient consultation room to varying degrees. Also concerning process aspects with regard to quality, for example the degree to which attention is given to counter work and prescription controls, there are large differences between pharmacists from the different countries. These differences between pharmacists appeared to depend upon differences in legal rules (such as the compulsory presence of a pharmacist in Belgium, Sweden and Portugal or the compulsory prescription control by a pharmacist before delivery in Great Britain), financial and economic circumstances, internal organizational characteristics of the pharmacy and the individual personal task conceptions of the pharmacist. New developments, for example in areas of patient information and computer use, seem to be followed most in the Netherlands and Sweden. General statements about differences in quality are not easily made because the community pharmacy in other countries also has certain positive aspects, such as being easily accessible (Portugal), personal involvement of the pharmacist (Belgium) and personal control by the pharmacist (Great Britain). Looking at the diversity within Europe the conclusion can be reached that the European pharmacist' does not yet exist.

High-performance capillary electrophoresis (HPCE) is a new separation technique that is applied in the pharmaceutical sciences. Separations by HPCE occur in a narrow-bore capillary under the influence of an applied electrical field. Components of the sample matrix are separated and migrate at different rates based on physicochemical properties, including ionic charge, charge to mass ratio, lipid solubility, and spatial orientation. Detection is achieved through an on-line capillary detection window. The technique has several advantages, such as rapid analysis times, automation, and minute sample volume requirements. However, a significant disadvantage of HPCE is the high concentration limit of detection. Although HPCE will not displace traditional separation techniques, it will add another dimension to existing laboratories.

Main applications of modern thermal methods in the pharmaceutical analysis are reviewed. While these methods are widely employed in pharmaceutical industry, they are only recommended--but not prescribed--in the general part of the VIIth Pharmacopoea Hungarica and consequently, this field is practically unknown for the pharmacists. The aim of this paper is to call attention to the advantage of the application of modern thermal methods (DTA, TG, DSC) in contrast to the classical ones. They permit a quick and accurate measurement of the melting point, the determination of purity and eutectic point, to clear up the possibility of conditions for the development of polymorphic modifications, and to follow the process of loosing the water of crystallization.

Objective: To review the expansion of ambulatory drug use evaluation (DUE). A description of ambulatory DUE characteristics and methodology is included. In addition, DUE computer usage, documentation concerns, and future research issues are addressed., Data Sources: A MEDLINE search was used to identify pertinent literature, including reviews., Study Selection: Primary and secondary literature describing ambulatory DUE was selected. Articles describing inpatient DUE were excluded., Data Extraction: Rigorous studies evaluating current ambulatory DUE programs are limited, but the available literature and a description of existing program characteristics are included. All studies available at the time of publication were reviewed., Data Synthesis: Ambulatory DUE can provide useful information to assist in providing pharmaceutical care. The Omnibus Budget Reconciliation Act of 1990 has prompted an expansion of DUE programs, and most of the formalized programs are retrospective in design. Prospective programs provide online, patient-specific drug use assessment whenever new prescriptions are entered into point-of-service databases., Conclusions: Although more well-designed evaluations of existing ambulatory DUE programs are needed, initial results indicate these programs may be extremely useful in identifying significant medication therapy problems and improving patients' drug therapy.

Medication record cards were kept for 1,366 patients over a three-year period at a neighbourhood pharmacy in north-west London. Eighty-six potential adverse drug reactions were detected. In 53 cases the general practitioner changed the prescription after being contacted by the pharmacist. In a further 15 cases advice intended to reduce the likelihood of an adverse drug reaction was given to the patients by the pharmacist. Seventy-six errors on prescriptions were also detected; these were mainly unintended changes in dose or strength of medication. Pharmacists could have a useful role to play in monitoring for potential drug reactions in general practice. Closer collaboration between the two professions would be of mutual benefit.

For institutional pharmacy to continue to be successful it must be able to adapt to an ever-increasing rate of change. The best type of scientific thinking will be required to attempt to understand these changes and to keep the profession relevant.