Adoption of Medication Management Technologies by U.S. Acute Care Hospitals after the HITECH Act

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in the year 2011, is the most important regulation in recent years focused on enhancing the use of IT in the health care system.This study examined the organizational and environmental correlates of the adoption of Medication Management Technologies (MMTs) by U.S. acute care hospitals after the HITECH Act. The rational adaptation perspective of the resource dependence theory is utilized in this study, using panel data from 2009 to 2013 with a one-year lag for independent variables and mixed-effects regression models for analyses. The study operationalized adoption of MMTs through seven measures: global adoption of MMTs, adoption of closed loop medication management, adoption of meaningful use MMTs and adoption-levels for the four steps of the medication management process: ordering, transcribing, dispensing and administration. Hospitals were more likely to adopt MMTs in the time after the implementation of the HITECH Act (2012, 2013) and were less likely to adopt MMTs before the implementation of the HITECH Act (2009, 2010) as compared to the HITECH Act implementation period (2011). The study further found that the resource dependence construct of munificence, operationalized through organizational size, and the construct of interdependence, operationalized through private payer mix was significantly associated with the adoption of MMTs

Effect of automated unit dose dispensing with barcode scanning on medication administration errors:An uncontrolled before-and-after study

BACKGROUND: Medication administration errors (MAEs) occur frequently in hospitals and may compromise patient safety. Preventive strategies are needed to reduce the risk of MAEs. OBJECTIVE: The primary aim of this study was to assess the effect of central automated unit dose dispensing with barcode-assisted medication administration on the prevalence of MAEs. Secondary aims were to assess the effect on the type and potential severity of MAEs. Furthermore, compliance with procedures regarding scanning of patient and medication barcodes and nursing staff satisfaction with the medication administration system were assessed. METHODS: We performed a prospective uncontrolled before-and-after study in six clinical wards in a Dutch university hospital from 2018 to 2020. MAE data were collected by observation. The primary outcome was the proportion of medication administrations with one or more MAEs. Secondary outcomes were the type and potential severity of MAEs, rates of compliance with patient identification and signing of administered medication by scanning and nursing staff satisfaction with the medication administration system. Multivariable mixed-effects logistic regression analyses were used for the primary outcome to adjust for confounding and for clustering on nurse and patient level. RESULTS: One or more MAEs occurred in 291 of 1490 administrations (19.5%) pre-intervention and in 258 of 1630 administrations (15.8%) post-intervention (adjusted odds ratio 0.70, 95% confidence interval 0.51–0.96). The rate of omission fell from 4.6% to 2.0% and of wrong dose from 3.8% to 2.1%, whereas rates of other MAE types were similar. The rate of potentially harmful MAEs fell from 3.0% (n = 44) to 0.3% (n = 5). The rates of compliance with scanning of patient and medication barcode post-intervention were 13.6% and 55.9%, respectively. The median overall satisfaction score of the nurses with the medication administration system on a 100-point scale was 70 (interquartile range 63–75, n = 193) pre-intervention and 70 (interquartile range 60–78, n = 145) post-intervention (P = 0.626, Mann–Whitney U test). CONCLUSION: The implementation of central automated unit dose dispensing with barcode-assisted medication administration was associated with a lower probability of MAEs, including potentially harmful errors, but more compliance with scanning procedures is needed. Nurses were moderately satisfied with the medication administration system, both before and after implementation. In conclusion, despite low compliance with scanning procedures, this study shows that this intervention contributes to the improvement of medication safety in hospitals

Public procurement of innovation : Lessons learned from the procurement of comprehensive solution for pharmacy automation

Tässä tutkimuksessa tarkastellaan innovatiivista julkista hankintaa ja sen käytäntöjä suomalaisella terveydenhuollon sektorilla. Innovatiivi-nen julkinen hankinta nähdään nykyään hyödyllisenä välineenä innovaatioiden edistämisessä ja siksi se on laajalti omaksuttu kysyntälähtöi-sen innovaatiopolitiikan työkaluna. Ottaen huomioon tämän hetkisen poliittisen kiinnostuksen innovatiivisia hankintoja kohtaan sekä aihetta koskevan vähäisen tutkimuksen, tutkielman tavoitteena on lisätä tietämystä innovatiivisista julkisista hankinnoista ja sen käytännöistä. Tutkielmassa tarkastellaan hankintatapausta, jossa Kuopion yliopistollinen sairaala uudisti täysin lääkehuollon toimintansa. Hankinta koski lääkehuollon automaatioratkaisua. Tutkielmassa käytetään institutionaalista lähestymistapaa, jonka avulla voidaan tarkastella organisaa-tiokohtaisten instituutioiden vaikutuksia innovatiivisen hankinnan lopputuloksiin. Tutkielman tavoitteena on vastata kysymyksiin, miten Kuopion yliopistollinen sairaala toteutti lääkehuollon automaatioratkaisun hankinnan, ja miten organisaatiokohtaiset instituutiot vaikuttivat hankintaprosessin olosuhteisiin ja lopputuloksiin. Tämä tutkimus on laadullinen tapaustutkimus. Työn empiirinen materiaali koostuu asiantuntijahaastatteluista ja tapaukseen liittyvästä aineistomateriaalista. Aineistoa tarkastellaan laadullisen sisällönanalyysin avulla, jossa tutkielman teoreettista taustaa, innovatiivisista hankinnoista ja organisaatiokohtaisista instituutioista, hyödynnetään tulosten luokittelun perusteena. Luokittelun avulla saadaan kokonaisval-tainen käsitys hankintaprojektista ja hankinnan lopputulokseen vaikuttavista organisaatiokohtaisista instituutioista. Tutkielman tulokset osoittavat että Kuopion yliopistollisen sairaalan lääkehuollon yksikkö toteutti innovatiivisen julkisen hankinnan, tavoit-teenaan parantaa lääke- ja potilasturvallisuutta sekä lisätä lääkehuollon tehokkuutta. Hankintaprojekti sisälsi innovaatioystävällisiä hankin-takäytäntöjä, jotka mahdollistivat innovatiivisen ratkaisun syntymisen. Hankinnan johdosta useita tuotteita kehitettiin ja kaupallistettiin. Kaikki kehitellyt tuotteet pitivät sisällään radikaalin innovaation piirteitä. Uusi lääkehuollon automaatioratkaisu on parantanut sairaalan lääkehuollon turvallisuutta sekä tehokkuutta. Hankinnan vaikuttavuuden arviointi ja mittaaminen koettiin haasteelliseksi. Haasteet liittyivät ensisijaisesti kykyyn mitata uuden järjestelmän lopullista tuottavuutta. Hankinnalla oli myös suoria innovaatiovaikutuksia toimittajalle, joka pystyi hankinnan kautta kehittämään ja kaupallistamaan useita tuotteita. Hankinta siten avasi yrityksen tuotteille uusia markkinoita. Tutkimus osoittaa, että julkinen hankinta kykenee edesauttamaan innovaatioiden syntymistä, vaikka innovaatioiden edistäminen itsessään ei olisi ensisijaisena hankinnan tavoitteena. Kuopion hankintatapaus korostaa ammattirajojen ylittävää yhteistyötä ja luottamusta oleellisina tekijöinä innovatiivisen julkisen hankinnan toimeenpanon onnistumisessa. Tutkimuksessa käytetty institutionaalinen lähestymistapa osoit-tautui toimivaksi teoreettiseksi näkökulmaksi tarkastella erilaisia vuorovaikutustekijöitä, jotka voivat kontekstista riippuen edistää tai estää innovatiivisen julkisen hankinnan lopputulosta.This thesis examines public procurement of innovation and its operationalization in the Finnish public health care sector. Public procure-ment is currently recognized as a suitable instrument to foster innovation and it is thus widely recognized as a tool for demand-driven innovation policies. By recognizing this political interest and the lack of established academic research about public procurement of innova-tion, the primary objective of this thesis is to add knowledge about the practices of public procurement of innovation. This thesis examines a single case study in which the Kuopio University Hospital’s pharmacy service unit procured a comprehensive solution for pharmacy auto-mation. The perspective of institutional approach is adopted in order to find out how organization-specific, endogenous institutions affect the conditions and the results of a public procurement of innovation. This thesis is set to answer how the procurement of the pharmacy service automation in Kuopio University Hospital was implemented and how endogenous institutions affected the outcome of the procurement process. This thesis is a qualitative research of a case study. The empirical data of this study consist of elite interviews and relevant documentation. Qualitative content analysis is applied in order to examine the empirical data and it utilizes the theoretical framework of public procurement of innovation and endogenous institutions respectively in order to provide suitable classifications for the results. The classifications provide a comprehensive description of the procurement project and endogenous institutional factors that affected the outcome of the procurement. The results indicate that the Kuopio University Hospital’s pharmacy service unit initiated a public procurement of innovation due to an intrinsic need to improve its patient safety and the efficiency of its pharmacy supply processes. The implementation of the project included innovation-friendly procurement practices that enabled development of an innovative solution. Multiple products were developed and com-mercialized as a result of the procurement. All of the products included elements of radical innovation. Utilizing the new pharmacy supply system, the Kuopio University Hospital’s pharmacy supply service has increased its efficiency and safety. The challenges identified re-garding the effects of the procurement related to the difficulty of measuring the real productivity of the new system. The procurement also had direct effects for the supplier as multiple products were developed and commercialized in the process. In addition, the procurement opened new markets for the company. The key findings of this thesis indicate that public procurement can spur innovation even if it is not the primary goal of the procurement. The Kuopio University Hospital case points out the importance of multi-professional collaboration and trust as crucial factors in public procure-ment of innovation practices. The perspective of institutional approach also proved to be a suitable theoretical framework in examining the conditions that could affect the success or the hindrances of the public procurement of innovation implementation

A national survey of inpatient medication systems in English NHS hospitals

Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap

Optimising hospital electronic prescribing systems:A Systematic Scoping Review

Considerable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospital ePrescribing systems to maximize the benefits and minimize the risks of these expensive digital health infrastructures. METHODS: We undertook a systematic scoping review of the literature by searching MEDLINE, Embase, and CINAHL databases. We searched for primary studies reporting on ePrescribing optimization strategies and independently screened and abstracted data until saturation was achieved. Findings were theoretically and thematically synthesized taking a medicine life-cycle perspective, incorporating consultative phases with domain experts. RESULTS: We identified 23,609 potentially eligible studies from which 1367 satisfied our inclusion criteria. Thematic synthesis was conducted on a data set of 76 studies, of which 48 were based in the United States. Key approaches to optimization included the following: stakeholder engagement, system or process redesign, technological innovations, and education and training packages. Single-component interventions (n = 26) described technological optimization strategies focusing on a single, specific step in the prescribing process. Multicomponent interventions (n = 50) used a combination of optimization strategies, typically targeting multiple steps in the medicines management process. DISCUSSION: We identified numerous optimization strategies for enhancing the performance of ePrescribing systems. Key considerations for ePrescribing optimization include meaningful stakeholder engagement to reconceptualize the service delivery model and implementing technological innovations with supporting training packages to simultaneously impact on different facets of the medicines management process

Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature

Background: This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods: The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results: A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion: Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.Partial financial support for translation and publication was received from the Alicante Biomedical and Health Research Institute (ISABIAL).S

Robotic therapy : Cost, accuracy, and times. New challenges in the neonatal intensive care unit

Background: The medication process in the Neonatal Intensive Care Unit (NICU), can be challenging in terms of costs, time, and the risk of errors. Newborns, especially if born preterm, are more vulnerable to medication errors than adults. Recently, robotic medication compounding has reportedly improved the safety and efficiency of the therapeutic process. In this study, we analyze the advantages of using the I.V. Station\uae system in our NICU, compared to the manual preparation of injectable drugs in terms of accuracy, cost, and time. Method: An in vitro experimental controlled study was conducted to analyze 10 injectable powdered or liquid drugs. Accuracy was calculated within a 5% difference of the bottle weight during different stages of preparation (reconstitution, dilution, and final product). The overall cost of manual and automated preparations were calculated and compared. Descriptive statistics for each step of the process are presented as mean \ub1 standard deviation or median (range). Results: The median error observed during reconstitution, dilution, and final therapy of the drugs prepared by the I.V. Station\uae ranged within \ub15% accuracy, with narrower ranges of error compared to those prepared manually. With increasing preparations, the I.V. Station\uae consumed less materials, reduced costs, decreased preparation time, and optimized the medication process, unlike the manual method. In the 10 drugs analyzed, the time saved from using the I.V. Station\uae ranged from 16 s for acyclovir to 2 h 57 min for teicoplanin, and cost savings varied from 8% for ampicillin to 66% for teicoplanin. These advantages are also capable of continually improving as the total amount of final product increases. Conclusions: The I.V. Station\uae improved the therapeutic process in our NICU. The benefits included increased precision in drug preparation, improved safety, lowered cost, and saved time. These advantages are particularly important in areas such as the NICU, where the I.V. Station\uae could improve the delivery of the high complexity of care and a large amount of intravenous therapy typically required. In addition, these benefits may lead to the reduction in medication errors and improve patient and family care; however, additional studies will be required to confirm this hypothesis

Effects of Enterprise Digital Assistants in medication dispensing operations: Case hospital pharmacy

OBJECTIVES OF THE STUDY In this thesis, I study the effects of introducing automation in the form of barcode-reader enabled Enterprise Digital Assistants and their impact on work efficiency and medication safety in a hospital pharmacy setting. The goal is to determine whether the efficiency of the process can be improved without compromising medication safety. In addition to the quantitative objectives, employee perceptions on the likelihood of success of the implementation are studied to include a more qualitative approach on the subject. DATA AND METHODOLOGY The data include information on different phases of the medication dispensing process taking place in the HUS Hospital Pharmacy in Helsinki, Finland. My sample consists of 80 341 orders processed on 143 days between July 2014 and April 2015. I use statistical analysis to calculate pre- and post-implementation process throughput times and error rates. Employee perceptions are measured with a questionnaire and interviews. FINDINGS OF THE STUDY It is possible to improve the efficiency of the order-picking process by automating the pharmaceutical inspection phase with the EDAs without increasing the dispensing error rate. Firstly, The efficiency of the order-picking process improved by 34% from 1.40 rows per minute to 1.87 rows per minute. Secondly, the EDA implementation bears potential for further process streamlining, as the pharmaceutical inspection could be performed without an additional hospital pharmacist, freeing resources to perform more knowledge-intensive work tasks. The questionnaire and employee interviews revealed that employee perceptions on the usefulness and the ease-of-use of the implementation would seem to affect positively on the perceived likelihood of success of the implementation. Even though the implementation project had faced several difficulties, the employees considered that the devices are useful and thus have faith in the success of the implementation

Experiência Profissionalizante na vertente de Farmácia Comunitária, Hospitalar e Investigação

The present training report was developed to obtain the integrated master’s degree in pharmaceutical sciences. It is subdivided in three chapters that address the three main activities enclosed in the curricular unit “Internship” of the Integrated Master in Pharmaceutical Sciences. The first chapter detailed the laboratorial research component, developed at the Health Sciences Research Center from University of Beira Interior in the area of pharmaceutical chemistry. The ubiquitin proteasome system has been defined as potential target in the treatment of a range of clinical conditions, such as inflammation, neurodegenerative diseases and cancer, particularly, haematological malignancies. A variety of chemical synthesized and natural products have exhibited proteasome inhibitory activity from which three were approved for use in multiple myeloma treatment. 2-Thioxoimidazolidin-4-one arylaldehyde derivatives were described as novel noncovalent proteasome inhibitors in a recent study. Considering the structural similarity of thiobarbituric acid and 2-thioxoimidazolidin-4-one systems, 5-substituted (thio)barbiturate derivatives where designed and efficiently synthesized in this work as a potential novel class of proteasome inhibitors with anticancer interest. In this context, several barbiturate derivatives demonstrated promising antiproliferative effects in different cancer cell lines. Stability study of the 5-benzilidene(thio)barbiturates derivatives in solution was performed and led to the exclusion of 5-benzilidene thiobarbiturates due to their instability. Then, a xanthine oxidase and proteasome inhibition assay were performed. None of the compounds showed relevant inhibition of xanthine oxidase enzyme. However, 5-[1-[2-(4-nitrophenyl)hydrazinyl]ethylidene]barbiturate, 9b, showed interesting inhibitory activity in the proteasome inhibition assay. Cytotoxicity of the assayed compounds was evaluated by the MTT assay in healthy (NHDF) and antiproliferative effect of 9b in cancer cell lines (Caco-2 and PC-3) was assessed and compared with the effect of bortezomib, an approved proteasome inhibitor. Although 9b showed cytotoxicity against healthy and cancer cell lines, it was less potent than bortezomib. The second chapter describes the activities accomplished during the internship in Community Pharmacy that took place in the Pharmacy Holon Covilhã under the supervision of Dr. Patrícia Pais. It is divided to present generally the operations performed at the pharmacy, the legislation that regulates the sector, and the tasks and activities perform. The third chapter describes the hospital pharmacy internship at The Barts Heart Centre in St Bartholomew's Hospital in London, UK that was guided by my main supervisor and contact person, Paul Wright, the Lead Cardiac Pharmacist at Barts. It is organized based on the activity I observed or performed myself. It is divided into four main subchapters, The Barts Heart Centre, Oncology, Clinical trials, and Dispensary.O presente relatório de estágio foi elaborado com o objectivo de obter o grau de Mestre em Ciências Farmacêuticas. Encontra-se subdividida em três capítulos que abordam cada um dos períodos de aprendizagem inseridos na unidade curricular “Estágio” do Mestrado Integrado em Ciências Farmacêuticas. No primeiro capítulo é descrito todo o trabalho realizado no âmbito da área de investigação desenvolvida no Centro de Investigação em Ciências da Saúde da Universidade da Beira Interior, na área da química farmacêutica, sendo este intitulado “Synthesis and evaluation of 5-substituted (thio)barbiturates as proteasomal inhibitors for cancer therapy”. O sistema ubiquitina-proteassoma foi definido como um potencial alvo terapêutico no tratamento de uma série de condições clínicas, tais como inflamação, doenças neurodegenerativas e cancro, particularmente, malignidades hematológicas. Uma variedade de produtos sintéticos e naturais têm sido associados a atividade inibitória do proteassoma, dos quais três compostos, bortezomib, carfilzomib, e ixazomib foram aprovados para uso clínico no tratamento do mieloma múltiplo. Os derivados de arilaldeídos de 2-tioxoimidazolidin-4-ona foram descritos como novos inibidores não covalentes de proteassoma num estudo recente. Face a isso, e considerando a similaridade estrutural dos últimos com os ácidos (tio)barbituricos, hipotetizou-se que derivados 5-substituídos de ácidos (tio)barbitúricos também poderiam ter atividade inibitória do proteassoma. Neste contexto, é também conhecido que vários derivados de barbituratos demonstraram efeitos antiproliferativos promissores em diferentes linhas celulares de cancro. No presente trabalho, foram desenvolvidos varios derivados 5-benzilideno(tio)barbitúricos utilizando como precursores ácidos (tio)barbitúricos e benzaldeídos e água como solvente. Os compostos obtidos foram devidamente caracterizados por determinação dos seus pontos de fusão, e espectroscopia de ressonância magnética nuclear de protão e carbono-13. Verificou-se, durante o estudo, a degreadação dos derivados 5-benzilideno tiobarbitúricos e a formação de bis-(tio)barbiturates em soluções aquosas, levando à exclusão destes compostos da avaliação biológica. Assim, tentou-se sintetizar seletivamente os bis-(tio)barbiturates puros, embora sem sucesso. Alternativamente, realizou-se a redução da dupla ligação exocíclica de 5-benzilidenotiobarbituratos como uma tentativa de aumentar a estabilidade dos compostos sintetizados. Os compostos obtidos foram incluídos nos estudos biológicos. Nos estudos da avaliação biológica foram incluídos os derivados 5-benzilidenobarbitúricos e os 5-benzyl(thio)barbituratos, determinado-se a sua atividade como inibidores do proteassoma e da xantina oxidase, tendo sido também analisando os seus efeitos citotóxicos em linhas celulares saudáveis (NHDF) e cancerígenas (Caco-2 e PC-3). A atividade inibitória do proteasoma dos compostos foi determinada mediante o bioluminescent Proteasome-Glo™ Assay. Num screening inicial, incubaram-se os compostos com a enzima em duas concentrações (10 e 100 µM), tendo sido utilizado o bortezomib como controlo positivo. Para o 5-[1-[2-(4-nitrofenil)hidrazinil]etilideno]-barbiturato 9b, composto que demonstrou a melhor atividade inibitória, procedeu-se a ensaio posterior para determinar a curva concentração-resposta. Os valores de IC50 foram calculados por um ajuste sigmoidal dos resultados obtidos, considerando-se um intervalo de confiança de 95%. Adicionalmente, os compostos foram avaliados quanto à capacidade para inibir a xantina oxidase, não se verificando atividade inibitória da mesma. A similaridade estrutural de 9b e bortezomib foi verificada visualmente, sendo realizados estudos in silico de superposição bidimensional e tridimensional. Os estudos de viabilidade celular foram realizados em fibroblastos normais da derme humana em células de cancro da próstata, e em células de cancro de cólon. Num screening inicial, as células de NHDF foram expostas aos compostos, em concentração de 10 e 100 µM durante 72 horas, tendo sido utilizado o 5-fluorouracilo como controlo positivo. A determinação da proliferação celular foi realizada mediante o ensaio do brometo de [3-(4,5-dimetiltiazol-2-yl)-2,5-difenil tetrazólio]. Para o composto 9b, que apresentou a maior atividade inibitória no ensaio do proteassoma e para bortezomib, efectuaram-se estudos de concentração-resposta. Para tal, os compostos foram incubados com as células, em seis concentrações distintas de cada composto no mesmo período de 72 horas, e os valores de IC50 foram calculados por um ajuste sigmoidal, considerando-se um intervalo de confiança de 95%. Adicionalmente, as células PC-3 e Caco-2 foram expostas a 9b e a bortezomib em diferentes concentrações, igualmente durante um período de 72 h. O composto 9b demonstrou citotoxicidade nas linhas celulares saudáveis e cancerígenas mas, contudo, esta foi inferior à citotoxicidade apresentada pelo bortezomibe. Como trabalho futuro, propõe-se estudos de viabilidade celular linha celular Jurkat, linha de células T leucémicas. Adicionalmente, propõe-se realizar estudos do docking molecular para prever o modo de ligação e afinidade de ligação do 9b com o proteassoma. Por outro lado, será igualmente importante sintesar mais derivados destes compostos, variando os substituintes no seu esqueleto molecular de modo a otimizar os resultados biológicos obtidos. O segundo capítulo é dedicado ao estágio em Farmácia Comunitária orientado pela Dr.ª Patrícia Pais e realizado na Farmácia Holon Covilhã. O terceiro capítulo refere-se ao estágio em Farmácia Hospitalar, que foi realizado no Barts Heart Centre, no Hospital St Bartholomew, em Londres, Reino Unido orientado pelo Dr.Paul Wright, Lead Cardiac Pharmacist em Barts Health NHS Trust. Em ambos os relatórios são abordados as atividades desenvolvidas, os conhecimentos adquiridos ao longo dos meus estágios em farmácia comunitária e em farmácia hospitalar