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Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.
Regular updates from the global world of pharmacy.
Practical experience is hard to acquire once you have finished your academic studies.
It is a process we all have to experience at one stage of our career.
The transition from being a student to a practising pharmacist can be a difficult time and unless early career pharmacists equip themselves for the new challenges they face, they may not be maximising their career opportunities.
It is also the type of program that could earn incentive payments for the workplaces providing the experience in the community.
The Pharmacy Council recently promoted a discussion document to encourage feedback from the health care environment on the impending legislative changes that are intended to provide the opportunity for pharmacists to prescribe.
The proposed legislation will enable suitably qualified postgraduate educated and skilled clinical pharmacists to prescribe from the drug tariff for patients under their care.
These pharmacists will have to work as part of a primary health care team and it is expected they will become an integral part of that team.
All very exciting for our profession to witness that there is a recognition that pharmacists are capable of stepping up to the mark and are worthy of greater responsibilities.
Pharma-Goss for August 2010
When selecting a team to participate in a primary health care review of the diagnosis and management of hypertension patient one would hope that a pharmacist would be a natural selection.
But in the case of a paper published recently in Australian Family Physician (http://www.racgp.org.au/afp/201007/201007howes.pdf) a pharmacist did not rate a mention in the panel set up to identify the problems associated with diagnosing hypertension and maintaining a dose that suited the needs of the patient with maximum adherence.
The thought that first struck me after reading ‘the clarification’ about the eRx Script Exchange on the editorial page of the May Issue of the Pulse+IT magazine was - Why is this clarification so necessary?
On the surface it seemed like a reasonable statement to make.
It read: “Clarification - in the March 2010 edition of Pulse+IT it was reported that the electronic prescribing service operated by eRx Script Exchange had received 7.5 million scripts "sent to the eRx script hub by prescribers" as of the middle of January.
Omitted from the article was reference to a workflow that allows pharmacists to send repeat prescriptions to the hub for later retrieval by any pharmacist connected to the eRx system.
The volume of transactions quoted in the March 2010 article included such scripts, in addition to scripts sent to the hub directly by prescribers.”
In The Australian Friday 23 July (Political creed: do no harm) Emma Connors reported that “sometime in the next four weeks both Julia Gillard and Tony Abbott are likely to sign a letter promising their support to a group of 5000 small business owners whose public standing allows them to extract an extraordinary pledge.”
She reported that the Guild had “asked the leaders of both sides of politics to agree that the terms of the recently enacted Fifth Community Pharmacy Agreement will be upheld, including the all-important promise to keep supermarkets out of pharmacy”.
Editor's Note - 15th November 2012:
When this article was first published in August 2010, Gollman-Bouw had entered into liquidation following a very turbulent period under the stewardship of Mark Bouw, managing director of the Australian enterprise.
Since that date the automated dispensing market has settled down and is now demonstrating steady and solid growth.
New people have entered into an agreement with German company Gollmann Systems and they have no relationship with any of the people associated with the former entity.
Many of the initial teething problems have been overcome and a better understanding of the Australian pharmacy market has emerged.
Gollmann Systems are globally competitive and contain innovations not seen in some of their competitors.
Any prospective purchaser should short-list this product when seeking a solution for their pharmacy.
Since the global financial crisis began to bite, Australians have shifted more of their weekly purchases into private label.
In respect of the $70 billion pa food market, private label currently accounts for 23%, with the prospect of moving to 30% within five years.
Many foods have health giving and medicinal properties.
Indeed, i2P reports frequently in its Preventive Medicine section, regular discoveries where food can be used to support various health conditions.
For example, raw beetroot juice has recently been found to be effective in treating high blood pressure (it contains nitrates) and is as effective as some antihypertensive drugs. Cinnamon is another food that is useful for diabetics, where cinnamon appears to have effects similar to metformin i.e. it sensitises insulin.
Ayurvedic medicine, developed in India over centuries, encompasses the use of many delicious foods enhanced with herbs and spices.
Ayurveda is an ancient Indian healing system. The central philosophy is that illness is caused by an imbalance of the body's three vital energies, or 'doshas'. Ayurveda uses a range of treatments including yoga, massage, acupuncture and herbal medicine.
More information can be found at the Australian government site - HealthInsite. http://www.healthinsite.gov.au/topics/Ayurvedic_Medicine
For Ayurveda diet and health information that can get you started, try this site http://www.joyfulbelly.com
People involved in e-health are bitterly disappointed with the "hung parliament" result.
At least Labour had a vision with its national broadband roll-out, even if it wasn't properly articulated in regard to cost.
Some proponents argue that the cost matters little - it is the advantage given to Australians who want to be pioneers in e-health. Opportunities could be lost and they may be priceless.
i2P went looking for some informed comment on the subject and found some excellent commentary written by Paul Budde, a telecommunications analyst.
His commentary follows:
Researchers have collected venom from octopuses in Antarctica for the first time, significantly advancing our understanding of the properties of venom as a potential resource for drug-development.
The study, conducted by an international team of researchers from the University of Melbourne, the Norwegian University of Technology and Science and the University of Hamburg, provides the first insight into the properties of Antarctic octopus venom.
It has also revealed the existence of four new species of octopus.
The effects of diabetes on organs such as the heart, eyes and kidneys are relatively well known, but women are now being warned of its potential to cause damage in another way – to sexual performance.
Victoria University’s Professor Lily Stojanovska and Dr Michael Mathai are conducting a study to assess the potential for improving sexual function in women with type 2 diabetes by taking a supplement from a plant traditionally used for this purpose in Peru.
The root of the plant Maca (Lepidium meyenii), which grows in the Peruvian Andes, has been used by locals for centuries, where it is reported to enhance fertility and to boost energy levels.
Some years ago an Australian hospital pharmacist pioneered wound management in Australian hospitals and went on to develop courses to train community pharmacists interested in setting up a specialty wound management clinic in their pharmacy setting.
This type of service initially established itself in a restricted number of pharmacy settings, but gradually faded away due to the pressure of PBS dispensing.
Now the opportunity is reappearing in WA at Curtin University with a purpose built facility established to train all health students (including pharmacy).
And here is the dilemma.
Many pharmacists would like to be involved in this type of activity but most community pharmacies are not physically designed to accommodate this service.
However, with the future development of Primary Health Care Organisations (PHCO's) under way, it may be possible for pharmacists to be part of the wound management team in that type of organisation.
Nicola Roxon is contributing $380,000 towards the project and is expected to be operational within three months.
University of Adelaide researchers are a step closer to finding a link between genetic susceptibility to cerebral palsy and a range of environmental risk factors during pregnancy, including infections and pre-term delivery.
During National Cerebral Palsy Awareness Week (August 1-7), Professor Alastair MacLennan from the University's Robinson Institute says their research shows that pregnant women who are genetically susceptible to infections and other environmental hazards could trigger cerebral palsy in their unborn babies.
Prescription vending machines are being deployed in the UK Sainsbury pharmacy chain. This is being done in conjunction with the normal in-store pharmacy service,
and is being promoted as an additional service for those who would prefer it.
It is not an automated dispensing solution.
Why do we grow old and what can we do to stop it? This is the question asked by many, but it appears that we are now closer to an answer thanks to new research published by Monash University researcher Dr Damian Dowling.
According to the research published in the August edition of the prestigious journal, The American Naturalist, a small set of genes in mitochondria (a membrane-enclosed organelle found in most eukaryotic cells), passed only from mothers to offspring, plays a more dynamic role in predicting life expectancies than ever previously anticipated.
In a shrewd management decision, the Board of the Pharmaceutical Society of Australia has announced the appointment of Liesel Wett as the organisation’s new Chief Executive Officer.
Ms Wett, who is currently Deputy Chief Executive Officer and Chief Operating Officer of the Australian General Practice Network, is expected to take up her appointment on 1 October 2010.
Given that the PSA will need to develop closer and stronger ties with GP organisations, this appointment may well prove to be critical for the future professional development of pharmacists.
Pharmacists will be enabled to get inside and understand GP thinking, guided by Liesel Wett.
Inflammation-causing cells in fat tissue may explain the link between obesity and diabetes, a team of Walter and Eliza Hall Institute researchers has shown.
The discovery, by Professor Len Harrison and Dr John Wentworth from the institute’s Autoimmunity and Transplantation division, opens the way for new anti-inflammatory treatments that prevent insulin resistance (where the body is unable to respond to and use the insulin it produces) and other complications associated with obesity.
The UK has started a new phase in private prescription discounting – no mark up on the drug and 50% off the dispensing fee.
“Millions could be saved every year if private prescription mark ups are abandoned, according to the Superdrug superintendent pharmacist.
Superdrug will dispense all private prescriptions with no mark up on the cost of the medicine, the company announced this week (3 August 2010).
It is also halving its minimum charge for dispensing medicines to £2.25.”
An opinion provided by the University of Sydney
By Professors Ben Eggleton and David Moss
Those who think our country can do without the national broadband network clearly do not fully understand the potential such a network offers to Australians. While other countries scramble to find ways to meet this exploding demand for global bandwidth, the opposition is wringing its hands and debating the need.
The network will do three things for Australia: it will pay for itself, it will stimulate the innovation economy and it will have multiple applications.
A University of Adelaide study shows that aged garlic extract may help lower blood pressure in the 3.7 million Australians who suffer hypertension.
Research trials by Dr Karin Ried and her colleagues from the University's Discipline of General Practice show that garlic could be used as an adjunct to conventional drugs for hypertension.
However, raw or cooked garlic, and garlic powder are not as effective in treating high blood pressure as aged garlic extract.
The world's first solar-diesel power station has opened in Western Australia's Pilbara region at Marble Bar, known for its record high temperatures.
WA's Mines and Petroleum Minister Norman Moore opened Horizon Power's Pippunyah Solar Diesel Power Station on Friday.
The new $34 million station is powered by the biggest sun-tracking solar panel farm in Australia.
Recently, a research report was published online in BMC Complementary and Alternative Medicine that highlighted Australian consumer attitudes towards complementary medicines and pharmacists selling complementary medicines.
An abstract is published below.
Consumers have indicated in earlier surveys that they wanted pharmacists to be the primary source of information for them and to keep a range of products that they could feel safe with.
The profession initially responded to those needs with the PGA setting up a College of Clinical Nutrition and many pharmacists (including this editor) completed the Advanced Diploma of Clinical Nutrition (Pharmacy).
Unfortunately, the college was closed and an alternative resource was never re-established.
People who did receive training in the use of nutritionals gained a new perspective in respect of practicing their profession and tended to work in the area of preventive medicine when an opportunity presented itself.
We have again asked Mark Coleman to comment on the survey and his report appears below the article abstract.
Dr Andrew Byrne & Associates
A Harm-Minimisation Research Perspective: Dr Byrne (and his associates) advocate for better policies which are proven to reduce risks for drug users and the general community, under a framework in parallel with Australia’s official policy of harm minimisation.
Note that the senior author of this review published a correction in January 2010 that he was an associate of Reckitt-Benckiser, buprenorphine manufacturer at the time of publication of this article. This information was not included in the May 2009 paper. Does electrocardiography improve methadone safety? Byrne A, Hallinan R, Newman RG. Am J Health Syst Pharm 2010 67:968-969
This was not the first such omission by a Reckitt associate. [The review recommended regular ECGs for all methadone maintenance subjects regardless of age, sex, race or other risk.]
Note that the senior author of this review published a correction in January 2010 that he was an associate of Reckitt-Benckiser, buprenorphine manufacturer at the time of publication of this article. This information was not included in the May 2009 paper.
Does electrocardiography improve methadone safety? Byrne A, Hallinan R, Newman RG. Am J Health Syst Pharm 2010 67:968-969
We commend Stringer and colleagues’ excellent summary of the literature on this subject. However we would question the recommendation to perform electrocardiography (ECG) prior to and during the course of methadone treatment as a measure to prevent torsade de pointes (TdP) tachycardia . Even close reading does not reveal a justification for such advice. The authors need to make a case that TdP is a problem in clinical practice and then demonstrate how ECG would or could prevent the occurrence of this serious event. We believe that neither of these requirements has been satisfied. Even if they were, the proposed intervention should still be tested in the field for efficacy. There is still no accepted incidence for torsade de pointes and we were unable to find any confirmed deaths resulting directly from this complication among the 105 cases reported in the literature. ‘Indirect’ or suspected deaths still only number in single figures to our best knowledge.
Stringer et al. cite 37 cases of TdP from 19 authors (refs 22 to 40). An analysis of these shows that of the 16 for whom a QTc measurement is quoted away from the torsade episode, only 4 were prolonged (>460ms). In addition, there was a clear precipitant in nearly all cases, commonly alcohol/cocaine use, hypokalemia or prescribed medication. Thus ECG could only have identified a small proportion of such reported cases (0-18%). Furthermore, any proposed clinical strategy of avoiding methadone or using lower doses would have negative consequences regarding retention and increased mortality, largely from overdose. This is based on a good quality studies showing somewhat better retention rates with methadone than buprenorphine as well as better retention rates with the use of high doses versus low doses of methadone.
Although surely used for decades by many addiction programs as well as in other clinical settings, the strategy of routine ECG has not been shown to reduce arrhythmia problems (if any) in methadone prescribed patients. Even where significant cardiac abnormalities are detected before or during treatment with methadone, the consequences of withholding this medication would have to be carefully balanced by the clinician. In this connection it is important to note that the likelihood of morbidity and mortality associated with untreated opioid dependence is vastly greater than what evidence suggests might be expected as a result of potential cardiac perturbations caused by methadone. Krantz has called the balancing of risks and benefits in this instance a clinical paradox  yet it is precisely what doctors do with all prescribing decisions, and indeed with consideration of any and all medical management options.
Stringer and colleagues quote Farnoe and Chugh [3,4] to justify the contention that there may be more torsade cases than currently reported, in non-fatal and fatal circumstances respectively. These studies use two indirect and questionable methodologies to conclude that TdP may be a frequent occurrence in methadone patients. Neither paper described any cases of tachycardia. Furthermore, of 22 deaths in Chugh’s paper seven (32%) used methadone from unknown or illicit sources.
More recently a large national study from Norway found fatal TdP to be rare to non-existent in methadone treatment for addiction . Anchersen and colleagues reported secure causes of death in 86 out of 90 sudden deaths in a 7 year period in over 2000 patients prescribed methadone maintenance for addiction. None was reportedly as a result of arrhythmia nor did any of their volunteer sample of 200 report arrhythmia. Even if all 4 uncertain deaths were taken as possible TdP case, the low rate of 0.06 per 100 patient years would have been inconsistent with the conclusions of Farnoe and Chugh.
In conclusion we would suggest that patients should be treated individually with a detailed history and focused physical examination before starting on methadone treatment. In the current state of knowledge ECG is just as likely to cause problems as avert them in our view. If funds are available for clinic screening then needs-based toxicology, hepatitis, HIV and lipid tests would be higher priority for most injecting drug users.
Authors: Andrew Byrne*; Richard Hallinan*; Robert G. Newman#
* Byrne Surgery, 75 Redfern St, Redfern, NSW, Australia.
# The Baron Edmond de Rothschild Chemical Dependency Institute, BMIC, 555 W. 57th St., NY NY 10019
Conflict statement: Dr Byrne owns a clinic which charges a fee for dispensing of medications in the treatment of addictions. [These include methadone and buprenorphine]
1. Stringer J, Welsh C, Tommasello A. Methadone-associated Q-T interval prolongation and torsades de pointes. Amer J Health-Syst Pharm 2009 May 1;66(9):825-833
2. Krantz MJ, Mehler PS. QTc prolongation: methadone's efficacy-safety paradox. Lancet 2006 368;9535:556-557
3. Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93;1051-1055
4. Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone. American Journal of Medicine 2008 121: 66-71
5. Anchersen K, Clausen T, Gossop M, Hansteen V, Waal H. Prevalence and clinical relevance of QTc interval prolongation during methadone and buprenorphine treatment: a mortality assessment study. Addiction 2009 104;6:993-999
Further comment on the Stringer paper: http://methadone-research.blogspot.com/2010/05/advice-to-stop-methadone-could-be.htmlReturn to home