Current Online-canada-pharmacy- News Results

A blended learning approach to teaching basic pharmacokinetics and the significance of face-to-face interaction.

Am J Pharm Educ. 2010 Jun 15; 74(5):
Edginton A, Holbrook J

OBJECTIVE: To assess pharmacy students' attitudes towards a blended-learning pharmacokinetics course. DESIGN: Narrated visual presentations and animations that illustrated kinetic processes and guided students through the use of software programs used for calculations were created. Other learning techniques used included online self-assessment quizzes, practice problem sets, and weekly face-to-face problem-solving tutorials. ASSESSMENT: A precourse questionnaire to assess students' level of enthusiasm towards the blended-learning course and to solicit any concerns they had was administered at the beginning of the course. A postcourse questionnaire that included the same 4 Likert-scale items from the precourse questionnaire and follow-up open-ended questions was administered. Individual changes in level of enthusiasm were compared for individuals who completed both the precourse and postcourse questionnaire. Students' concerns about the blended method of learning had decreased postcourse while their enthusiasm for the benefits of blended learning had increased. CONCLUSION: Students' initial concerns about the blended learning experience were focused on their ability to communicate with the instructor about the online components, but shifted to their own time management skills at the end of the course. Face-to-face interactions with each other and with the instructor were more highly rated than online interactions in this course.

Canadian neonatologist practices regarding opioid use in ventilated and spontaneously breathing infants undergoing medical procedures.

Clin J Pain. 2010 Jun; 26(5): 422-8
Taddio A, Pulleyblank R, Stephens D, McNair C, Shah V

OBJECTIVES: Opioids are indicated for the management of procedural pain in neonates. There are limited data describing factors influencing patterns of use. PATIENTS AND METHODS: We conducted an online English survey of Canadian neonatologists using Survey Monkey, whereby they answered questions about the frequency and pattern of use of opioids, and specifically, of morphine and fentanyl, for ventilated and spontaneously breathing infants undergoing selected painful medical procedures. RESULTS: Hundred and twenty nine of 225 (57%) eligible neonatologists participated. They reported that opioids were part of their practice for managing procedural pain in 100% of ventilated infants and 93% of spontaneously breathing infants. Frequency of opioid use was associated with infant ventilation status: spontaneously breathing infants were 28% less likely to receive them (P=0.013). For morphine, the most commonly used dose was 100 microg/kg in ventilated infants and 50 microg/kg in spontaneously breathing infants. For fentanyl, 1 microg/kg was the most frequently used dose in both infant populations. Use of morphine and fentanyl were significantly associated with 2-way interactions (P<0.0001) between infant ventilation status, gestational age, and opioid dose. Eighty-two percent of respondents cited respiratory depression as a concern for spontaneously breathing infants compared with 31% for ventilated infants (P<0.0001). CONCLUSIONS: Neonatologists frequently report using opioids to manage procedural pain, however, spontaneously breathing infants are less likely to receive them, and their use varies according to infant and procedure characteristics. These data point to the need to further investigate, in a more controlled design, the pharmacologic effects of opioids in this population to better guide clinicians about their optimal use.

Alternative-splicing forms of the major phase II conjugating UGT1A gene negatively regulate glucuronidation in human carcinoma cell lines.

Pharmacogenomics J. 2009 Dec 8;
Bellemare J, Rouleau M, Harvey M, Têtu B, Guillemette C

The UDP-glucuronosyltransferase UGT1A gene is a major biotransformation gene involved in the metabolism of a vast array of molecules. Recently, we uncovered a new series of alternative spliced isoforms referred to as isoforms 2 or UGT1As_i2 that use an alternative exon 5 (5b). The function of such mRNAs and the corresponding 45 kDa proteins still remains unclear. Although devoid of glucuronosyltransferase activity, UGT1As_i2 are widely co-expressed with the enzymatically active and classical UGT1A isoforms (UGT1As_i1). In this study, we observed abundant signal in human colon tissue samples, predominantly along intestinal crypts. In human cells, UGT1A_i2 proteins are expressed in similar subcellular compartments as UGT1As_i1. Cellular properties of i2-spliced forms were then studied using synthetic small-interfering RNA (siRNA) in two human colon cancer cell lines that show a significant amount of exon 5a- and exon 5b-containing mRNAs and that display enzymatic activities for UGT1As substrates. We observed that siRNA-mediated knockdown of endogenous i2 upregulates cellular glucuronidation activities by 120-170% (P<0.01) for all substrates tested. Functional data support a dominant-negative function for endogenous exon 5b-spliced forms of UGT1A, hence potentially affecting in vivo glucuronidation capacity. This new regulatory strategy may ensure an additional mean to modulate cellular response to endo/xeno stimulus.The Pharmacogenomics Journal advance online publication, 8 December 2009; doi:10.1038/tpj.2009.64.

Assessing the need for communication training for specialists in poison information.

Clin Toxicol (Phila). 2009 Jul; 47(6): 584-9
Planalp S, Crouch B, Rothwell E, Ellington L

INTRODUCTION: Effective communication has been shown to be essential to physician-patient communication and may be even more critical for poison control center (PCC) calls because of the absence of visual cues, the need for quick and accurate information exchange, and possible suboptimal conditions such as call surges. Professionals who answer poison control calls typically receive extensive training in toxicology but very little formal training in communication. METHODS: An instrument was developed to assess the perceived need for communication training for specialists in poison information (SPIs) with input from focus groups and a panel of experts. Requests to respond to an online questionnaire were made to PCCs throughout the United States and Canada. RESULTS: The 537 respondents were 70% SPIs or poison information providers (PIPs), primarily educated in nursing or pharmacy, working across the United States and Canada, and employed by their current centers an average of 10 years. SPIs rated communication skills as extremely important to securing positive outcomes for PCC calls even though they reported that their own training was not strongly focused on communication and existing training in communication was perceived as only moderately useful. Ratings of the usefulness of 21 specific training units were consistently high, especially for new SPIs but also for experienced SPIs. Directors rated the usefulness of training for experienced SPIs higher for 5 of the 21 challenges compared to the ratings of SPIs. DISCUSSION: Findings support the need for communication training for SPIs and provide an empirical basis for setting priorities in developing training units.

Prince Edward Island implements province-wide drug information system. A small step for DIS; a giant leap for the pan-Canadian interoperable electronic health record.

Healthc Q. 2009; 12(1): 113-6, 4
Giokas D

On March 13, 2008, Friendly Pharmacy in Charlottetown made a small but significant piece of Canadian healthcare history. It was the first drugstore to go online with Prince Edward Island's Drug Information System (DIS), the centrepiece of the province's All Drugs All People program. PEI is the first province to implement a DIS solution using a common pan-Canadian messaging standard based on Health Level 7 Version 3, an internationally recognized set of standards for clinical, financial and administrative messaging. PEI's initiative has positive implications for the rest of Canada. It is an important step toward the creation of a pan-Canadian interoperable electronic health record system covering all facets of patient care.

Resident physician and hospital pharmacist familiarity with patient discharge medication costs.

Pharm World Sci. 2009 Apr; 31(2): 195-201
Wilbur K

OBJECTIVE: Cost-related medication non-adherence is associated with increased health-care resource utilization and poor patient outcomes. Physicians-in-training generally receive little education regarding costs of prescribed therapy and may rely on hospital pharmacists for this information. However, little is documented regarding either of these health care providers' familiarity with out-of pocket medication expenses borne by patients in the community. The purpose of this study was to evaluate and compare resident physician and hospital pharmacist familiarity with what patients pay for medications prescribed once discharged. Setting A major tertiary patient care and medical teaching centre in Canada. METHOD: Internal medicine residents and hospital pharmacists within a specific health care organization were invited to participate in an online survey. Eight patient case scenarios and associated discharge therapeutic regimens were outlined and respondents asked to identify the costs patients would incur when having the prescription filled once discharged. MAIN OUTCOME MEASURE: Total number and proportion of estimates above and below actual cost were calculated and compared between the groups using chi(2) tests. Responses +/-10% of the true cost were considered correct. Mean absolute values and standard deviation estimated costs, as well as cost increments above and below 10%, were calculated to assess the magnitude of the discrepancy between the respondent estimates and the actual total cost. RESULTS: Forty-four percent of physician residents and 26% of hospital pharmacists accessed the survey. Overall 39% and 47% of medication costs were under-estimated, 32% and 33% were overestimated, and 29% and 21% were correctly estimated by residents and pharmacists, respectively (P = NS). Incorrect estimates were evident across all therapeutic classes and medical indications presented in the survey. The greatest absolute cost discrepancy for both groups was under-estimation of linezolid ($800 and $400) and over-estimation of clopidogrel ($80) and bisoprolol therapy ($22) by residents and pharmacists, respectively. CONCLUSION; Resident physicians and hospital pharmacists are unfamiliar with what patients must pay for drug therapy once discharged.

Patient-oriented methotrexate information sites on the Internet: a review of completeness, accuracy, format, reliability, credibility, and readability.

J Rheumatol. 2009 Jan; 36(1): 41-9
Thompson AE, Graydon SL

OBJECTIVE: With continuing use of the Internet, rheumatologists are referring patients to various websites to gain information about medications and diseases. Our goal was to develop and evaluate a Medication Website Assessment Tool (MWAT) for use by health professionals, and to explore the overall quality of methotrexate information presented on common English-language websites. METHODS: Identification of websites was performed using a search strategy on the search engine Google. The first 250 hits were screened. Inclusion criteria included those English-language websites from authoritative sources, trusted medical, physicians', and common health-related websites. Websites from pharmaceutical companies, online pharmacies, and where the purpose seemed to be primarily advertisements were also included. Product monographs or technical-based web pages and web pages where the information was clearly directed at patients with cancer were excluded. Two reviewers independently scored each included web page for completeness and accuracy, format, readability, reliability, and credibility. An overall ranking was provided for each methotrexate information page. RESULTS: Twenty-eight web pages were included in the analysis. The average score for completeness and accuracy was 15.48+/-3.70 (maximum 24) with 10 out of 28 pages scoring 18 (75%) or higher. The average format score was 6.00+/-1.46 (maximum 8). The Flesch-Kincaid Grade Level revealed an average grade level of 10.07+/-1.84, with 5 out of 28 websites written at a reading level less than grade 8; however, no web page scored at a grade 5 to 6 level. An overall ranking was calculated identifying 8 web pages as appropriate sources of accurate and reliable methotrexate information. CONCLUSION: With the enormous amount of information available on the Internet, it is important to direct patients to web pages that are complete, accurate, readable, and credible sources of information. We identified web pages that may serve the interests of both rheumatologists and patients.

Evaluating the Quality of Randomized Controlled Trials that Examine the Efficacy of Natural Health Products: A Systematic Review of Critical Appraisal Instruments.

Evid Based Complement Alternat Med. 2009 Dec; 6(4): 441-8
Whelan AM, Jurgens TM, Lord L

The purpose of this project was to conduct a systematic review to identify instruments designed to evaluate the quality of randomized controlled trials (RCTs) of natural health products (NHPs). Instruments were examined for inclusion of items assessing methods, identity and content of the NHP, generalizability of results and instructions for use. Online databases, websites, textbooks and reference lists were searched to identify instruments. Relevance assessment and data extraction of articles were completed by two investigators and disagreements were settled by the third investigator. Data were analyzed using descriptive statistics. Of the 4442 citations identified, 29 were potentially relevant with 16 meeting the criteria for inclusion. None of the instruments stated they were validated; content in the four areas of interest varied considerably. The most common items included randomization sequence generation (100%), blinding (100%), allocation concealment (75%) and participant flow (75%). Only nine of the NHP instruments included at least one item to appraise the specific content of the NHP. The CONSORT Statement for Herbal Interventions most closely addressed the four areas of interest; however, this instrument was specific for herbs. There is a need for the development of a validated instrument for assessment of the quality of RCTs that would be useful for herbs as well as other NHPs.

Differences in generic drug prices between the US and Canada.

Appl Health Econ Health Policy. 2008; 6(1): 19-26
Gooi M, Bell CM

BACKGROUND: It has long been recognized that brand name prescription medications are more expensive in the US than in Canada. However, non-peer-reviewed reports contend that this is not the case for generic medications. OBJECTIVE: To compare prices for generic prescription medications in the US and Canada. METHODS: A telephone and internet survey of pharmacies was conducted for the top 19 dispensed generic medications available in both countries. Twelve pharmacies in total were selected: six from the US (three online and three 'walk-in') and six from Canada (three online and three walk-in). Data were collected from March to April 2007.The main outcome measure was the total purchase price in $US at the day's exchange rate in 2007, obtained from each of the 12 pharmacies, for 100 doses of each of the 19 selected drugs. RESULTS: Using the lowest quote for each selected drug, 12 of the 19 (63%) generic medications were least expensive in the US, with an average saving of 47% per drug for these 12 drugs. Seven of the 19 (37%) drugs were least expensive in Canada, with an average saving of 29% per drug for these seven drugs. Overall, there was a sizable variation in prices for the same generic medications within and between the US and Canada. CONCLUSIONS: The lowest priced generic medications were not consistently found in either the US or Canada. The price controls and ensuing savings applied in Canada to prescription patented medications do not fully extend to generic medications.

An efficient method for the detection and elimination of systematic error in high-throughput screening.

Bioinformatics. 2007 Jul 1; 23(13): 1648-57
Makarenkov V, Zentilli P, Kevorkov D, Gagarin A, Malo N, Nadon R

MOTIVATION: High-throughput screening (HTS) is an early-stage process in drug discovery which allows thousands of chemical compounds to be tested in a single study. We report a method for correcting HTS data prior to the hit selection process (i.e. selection of active compounds). The proposed correction minimizes the impact of systematic errors which may affect the hit selection in HTS. The introduced method, called a well correction, proceeds by correcting the distribution of measurements within wells of a given HTS assay. We use simulated and experimental data to illustrate the advantages of the new method compared to other widely-used methods of data correction and hit selection in HTS. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Laboratory monitoring in oncology.

J Oncol Pharm Pract. 2006 Dec; 12(4): 223-36
Duong CD, Loh JY

OBJECTIVES: To educate pharmacists about the application of laboratory values in oncology. METHODS: Research on drugs used in cancer therapy was conducted using multiple sources, including primary, secondary and tertiary references. Online searches were conducted on Medline (1966-2004), EMBASE (1996-2004) and Ovid databases, using a drug's generic name and key words, such as 'adverse effects', 'hematotoxicity', 'renal toxicity', 'hepatotoxicity', 'cardiotoxicity', 'organ dysfunction', and terms describing chemotherapy-related toxicity, such as 'tumour lysis syndrome'. RESULTS: Laboratory monitoring in oncology was separated into the hematologic, hepatic, renal, cardiovascular and pulmonary systems. Laboratory tests applicable to each system are discussed. In addition, tests pertaining to specific drugs used in cancer therapy are explained. This information was compiled into a comprehensive continuing pharmacy education module. CONCLUSION: Laboratory monitoring assists the pharmacist in the monitoring of chemotherapy. A general understanding of common tests used in cancer therapy and knowledge specific to drugs used can help the pharmacist tailor drug therapy monitoring.

Inappropriate prescribing practices: the challenge and opportunity for patient safety.

Healthc Q. 2005; 8 Spec No: 81-5
Taylor LK, Kawasumi Y, Bartlett G, Tamblyn R

Adverse clinical events related to inappropriate prescribing practices are an important threat to patient safety. Avoidance of inappropriate prescribing in community settings, where the majority of prescriptions are written, offers a major area of opportunity to improve quality of care and outcomes. Electronic medication order entry systems, with automated clinical risk screening and online alerting capabilities, appear as particularly promising enabling tools in such settings. The Medical Office of the Twenty First Century (MOXXI-III) research group is currently utilizing such a system that integrates identification of dosing errors, adverse drug interactions, drug-disease and allergy contraindications and potential toxicity or contraindications based on patient age. This paper characterizes the spectrum of alerts in an urban community of care involving 28 physicians and 32 pharmacies. Over a consecutive nine-month period, alerts were generated in 29% of 22,419 prescriptions, resulting in revised prescriptions in 14% of the alert cases. Drug-disease contraindications were the most common driver of alerts, accounting for 41% of the total and resulting in revised prescriptions in 14% of cases. In contrast, potential dosing errors generated only 8% of all alerts, but resulted in revised prescriptions 23% of the time. Overall, online evidence-based screening and alerting around prescription of medications in a community setting demands confirmation in prescribers' clinical decision making in almost one-third of prescriptions and leads to changed decisions in up to one-quarter of some prescribing categories. Its ultimate determination of clinical relevance to patient safety may, however, have to await more detailed examination of physician response to alerts and patient outcomes as a primary measure of utility. Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. It involves many issues, including delayed diagnosis and treatment, as well as inappropriate undertreatment and overtreatment. The common denominators, however, are that care and outcomes could be better, and there is a role for patients, providers and policy makers in making improvements.

A comparison of brand-name drug prices between Canadian-based Internet pharmacies and major U.S. drug chain pharmacies.

Ann Intern Med. 2005 Sep 20; 143(6): 397-403
Quon BS, Firszt R, Eisenberg MJ

BACKGROUND: Many Americans have been purchasing their medications from online Canadian pharmacies. Although it is commonly perceived that medications are less expensive in Canada than in the United States, little research has been done to quantify this difference. OBJECTIVE: To compare the prices of retail brand-name medications between Canadian Internet pharmacies and major U.S. drug chain pharmacies with online pricing. DESIGN: Cross-sectional study. SETTING: 12 Canadian Internet pharmacies and 3 major online U.S. drug chain pharmacies. MEASUREMENTS: The authors calculated the per unit and annual savings (in U.S. dollars) for an American if he or she were to buy the 44 brand-name medications most commonly purchased through the Internet from Canadian Internet pharmacies instead of from an online U.S. drug chain pharmacy. RESULTS: Americans can save a mean of approximately 24% per unit of drug if they purchase their medications from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies. Forty-one of the 44 brand-name medications examined were less expensive in Canada. The medications offering the largest mean yearly savings were Zyprexa (olanzapine) (Eli Lilly, Indianapolis, Indiana) (1159 dollars), Actos (pioglitazone) (Eli Lilly, Indianapolis, Indiana) (852 dollars), and Nexium (esomeprazole) (AstraZeneca, Wilmington, Delaware) (772 dollars). Only 3 medications, all in the erectile dysfunction category, were more expensive in Canada. LIMITATIONS: Potential savings may vary because of temporal fluctuations in drug prices. CONCLUSIONS: Brand-name medications are often substantially less expensive when purchased from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies.

A method for the direct analysis of drug compounds in plasma using a single restricted access material (RAM) column.

J Pharm Biomed Anal. 2004 Nov 15; 36(3): 457-64
Papp R, Mullett WM, Kwong E

We describe an automated approach to analyzing whole plasma samples using online extraction without the need for an analytical column. A single restricted access material (RAM) column provided online extraction and pre-concentration of analytes while effectively removing proteins, salts and other biological materials found in the plasma sample matrix. The reduction in the plasma matrix enabled direct elution of the analytes from the extraction column to the mass spectrometer for selective detection. The precision of the method was evaluated using a proprietary therapeutic agent (Compound A) and was less than 5% over the range of 1-500ng/ml in spiked whole plasma, with an LOQ of 1ng/ml. A side-by-side comparison of RAM results from a pharmacokinetic study in rats was made with a traditional protein precipitation LC-MS method and a correlation of 0.993 was obtained between both methods. The injection-to-injection cycle time for the RAM method was 8min. Further automation was demonstrated by addition and mixing of the internal standard to all samples via an injection program of the autosampler.

Pharmacist computer skills and needs assessment survey.

J Med Internet Res. 2004 Mar 29; 6(1): e11
Balen RM, Jewesson PJ

BACKGROUND: To use technology effectively for the advancement of patient care, pharmacists must possess a variety of computer skills. We recently introduced a novel applied informatics program in this Canadian hospital clinical service unit to enhance the informatics skills of our members. OBJECTIVE: This study was conducted to gain a better understanding of the baseline computer skills and needs of our hospital pharmacists immediately prior to the implementation of an applied informatics program. METHODS: In May 2001, an 84-question written survey was distributed by mail to 106 practicing hospital pharmacists in our multi-site, 1500-bed, acute-adult-tertiary care Canadian teaching hospital in Vancouver, British Columbia. RESULTS: Fifty-eight surveys (55% of total) were returned within the two-week study period. The survey responses reflected the opinions of licensed BSc and PharmD hospital pharmacists with a broad range of pharmacy practice experience. Most respondents had home access to personal computers, and regularly used computers in the work environment for drug distribution, information management, and communication purposes. Few respondents reported experience with handheld computers. Software use experience varied according to application. Although patient-care information software and e-mail were commonly used, experience with spreadsheet, statistical, and presentation software was negligible. The respondents were familiar with Internet search engines, and these were reported to be the most common method of seeking clinical information online. Although many respondents rated themselves as being generally computer literate and not particularly anxious about using computers, the majority believed they required more training to reach their desired level of computer literacy. Lack of familiarity with computer-related terms was prevalent. Self-reported basic computer skill was typically at a moderate level, and varied depending on the task. Specifically, respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. CONCLUSIONS: Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness.

Domperidone: a peripherally acting dopamine2-receptor antagonist.

Ann Pharmacother. 1999 Apr; 33(4): 429-40
Barone JA

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of domperidone in the treatment of gastrointestinal motility disorders and emesis. DATA SOURCES: MEDLINE and Excerpta Medica online databases were searched to identify published reports. STUDY SELECTION: Domperidone has been marketed worldwide outside the US since 1978, and extensive clinical data for this drug are available. This review focuses on the clinical experience from controlled studies of domperidone in the treatment of motility disorders, particularly diabetic gastroparesis. Also, case reports are used in summarizing safety. The control comparator groups included placebo or other prokinetic drugs (metoclopramide and cisapride). Controlled clinical trials of domperidone's efficacy and safety as an antiemetic are also briefly examined. Although a variety of domperidone dosage forms have been marketed, data generated from trials using the 10-mg tablet are highlighted because this is the only dosage form available in Canada and is under investigation in the US. DATA EXTRACTION: Because symptoms do not correlate with objective measures of gastrointestinal motility and they are the primary reason that patients with motility disorders seek treatment, the primary outcome extracted from the clinical studies was symptomatic response to treatment. Safety and efficacy between domperidone and placebo, metoclopramide, or cisapride were compared. DATA SYNTHESIS: Domperidone, a peripheral dopamine2-receptor antagonist, regulates the motility of gastric and small intestinal smooth muscle and has been shown to have some effects on the motor function of the esophagus. It also has antiemetic activity as a result of blockade of dopamine receptors in the chemoreceptor trigger zone. In controlled clinical trials, domperidone provided better relief of symptoms (anorexia, nausea, vomiting, abdominal pain, early satiety, bloating, distension) than placebo in patients with symptoms of diabetic gastropathy; symptomatic improvement was similar with domperidone and metoclopramide or cisapride. Domperidone also provided short-term relief of symptoms in patients with dyspepsia or gastroesophageal reflux, prevented nausea and vomiting associated with emetogenic chemotherapy, and prevented the gastrointestinal and emetic adverse effects of antiparkinsonian drugs. Because very little domperidone crosses the blood-brain barrier, reports of central nervous system adverse effects, such as dystonic reactions, are rare. CONCLUSIONS: Domperidone is a unique gastrokinetic and antiemetic drug. Because of its favorable safety profile, domperidone appears to be an attractive alternative to metoclopramide. In the management of diabetic gastropathy, domperidone's antiemetic activity distinguishes it from cisapride.