Risk of congenital anomalies in pregnant users of statin drugs

What is already known about this subjectCholesterol is known to be essential for fetal development.Statins, which inhibit cholesterol production, have therefore been considered as potential teratogens and are contraindicated in pregnancy.Data available thus far on the risks of congenital anomalies associated with statin therapy have come from non-analytic postmarketing surveillance studies.Given the increasing use of statins in women of childbearing age, there is a need for a population-based study on the risks of congenital anomalies associated with gestational statin use.What this study addsIn this pharmacoepidemiological study, we determined the risk of congenital anomalies in women who filled prescriptions for statins during the first trimester of pregnancy, compared with women who had stopped statins before pregnancy or those who used fibrates during pregnancy.We found no evidence of an increased risk of fetal anomalies among first-trimester statin users, or any discernable pattern of congenital anomalies among live births.However, in the absence of outcome data on nonlive births, conclusions remain uncertain

The global pharmacy workforce: a systematic review of the literature

The importance of health workforce provision has gained significance and is now considered one of the most pressing issues worldwide, across all health professions. Against this background, the objectives of the work presented here were to systematically explore and identify contemporary issues surrounding expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation working group on the workforce

Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement

<p>Abstract</p> <p>Background</p> <p>There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.</p> <p>Methods</p> <p>To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature.</p> <p>Results</p> <p>Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education.</p> <p>Conclusion</p> <p>Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates.</p

Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature

BACKGROUND: Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners. METHODS: Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS. RESULTS: Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources. CONCLUSION: The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes

Stakeholders' views and experiences of pharmacist prescribing: a systematic review.

While prescribing has been traditionally been the domain of physicians, prescribing by pharmacists has been implemented successfully in countries across the world. Developments are supported by evidence of effectiveness and safety. To facilitate further development and implementation, there is a need to review the evidence of views and experiences of stakeholder groups both pre- and post-implementation. The aim of this review is to critically appraise, synthesise and present the available evidence on the views and experiences of stakeholders pre- and post-implementation of pharmacist prescribing globally. Setting and Method: A systematic review protocol was developed according to the PRISMA_P standards and registered on the PROSPERO database at the Centre for Reviews and Dissemination. Search databases were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Pharmaceutical Abstracts, PsychArticles, and Google Scholar with no date limits. Studies selection, quality assessment and data extraction were conducted independently by at least two reviewers. A narrative approach to data synthesis was undertaken due to heterogeneity of study outcome measures. Main outcome measures: Views and experiences around pharmacist prescribing as well as the facilitators and barriers to its development and implementation. Results: Sixty-three studies were included in the review. The UK was the main country studies (n=34) compared to Australia (n=13), USA (n=5), Canada (n=5), Nigeria (n=3), New Zealand (n=1), Ireland (n=1) and India (n=1). In addition, different stakeholders were researched. The majority of papers investigated perceptions and views of pharmacists (n=25) while few discussed patients (n=12), general practitioners (n=6), the public (n=4), nurses (n=1), policy makers (n=1) or had multiple stakeholders (n=14). Positive findings were reported by the majority of studies. The main benefits described were improved access to healthcare services and patients' outcomes, better utilisation of pharmacists' skills and knowledge, improved job satisfaction and reduced physicians' workload. Lack of support for this role reported was mainly due to liability issues, poor pharmacists' diagnosis skills and access to medical records and lack of organizational and financial support. Conclusion: There is an accumulation of evidence around improving healthcare delivery and patients' outcomes with the introduction of competent pharmacist prescribers. While there may be issues to resolve such as liability and financial considerations, these findings may support developments of pharmacist prescribing