Economic Evidence for Pharmacist-Led Medicines Use Review and Medicines Reconciliation

Pharmacist-led medicines use review (MUR) and medicines reconciliation (MedRec) aim to identify, resolve and prevent patient-related drug-related problems (DRP) and medication discrepancies in order to optimize medicines use and ensure the patient safety. As “diagnostic-resolution” interventions, the question of their economic impact and cost-effectiveness from healthcare systems perspective is crucial, and the level of their related evidence could support or challenge the dissemination and sustainability of these interventions in health systems. This chapter addresses two main questions: how is the economic impact and cost-effectiveness of these interventions modelling in the literature? And what is the economic evidence for these interventions? This content derives from the identification and selection of full economic evaluations of MUR and MedRec and systematic reviews or meta-analyses for which the main outcome was to assess their economic impact. Despite the demonstration of their effectiveness in identifying and resolving safety issues (patient-related DRP and edication discrepancies), studies have struggled to demonstrate their clinical and economic impact, probably due to the poor quality and heterogeneity of the studies, as well as the debatable accuracy of the outcomes. Future research and high-quality studies are needed to address these issues

Clinical relevance and implementation into daily practice of pharmacist-prescribed medication for the management of minor ailments

Background: Autonomous pharmacist prescribing was legally introduced in Switzerland in 2019 with the reclassification from prescription medication to pharmacist prescribing of 105 medications for sixteen indications. Its aim was to limit medical consultations and healthcare costs.Objectives: To evaluate the clinical relevance of the pharmacy prescribing medications compared to the over-the-counter medications (OTCs) and to evaluate its implementation into daily practice.Methods: A comparison was undertaken by clinical pharmacists to evaluate chemical and galenical equivalences between pharmacy prescribing medications and OTCs using compendium. ch and pharmavista. ch. Then, a scoping review was carried out in October 2021 to determine clinical relevance according to clinical guidelines’ recommendations. Clinical relevance was completed by determining if pharmacy prescribing medications were part of a homogeneous therapeutic class (no differences in efficacy and safety considered in clinical guidelines, but rather inter-molecular differences) that included an OTC medication. To identify the most clinically relevant pharmacy prescribing medications, first-line treatments were considered. The implementation into daily practice in Swiss community pharmacies was evaluated through an online questionnaire distributed via e-mail from the national pharmacists’ association and LinkedIn®. It included 15 questions divided in: pharmacy demographics, experience on pharmacy prescribing, use of prescribing medications and opinion about the them.Results: Of the 105 pharmacy prescribing medications, 20 (19.0%) were first-line treatments without OTC equivalences. Six of them were OTCs reclassified for safety reasons. Ten medications (9.5%) showed a negative clinical relevance (they were not first-line therapeutic options to support pharmacist when managing patients or considered as to be avoided) compared to the OTCs available. For the questionnaire, 283 pharmacists from the German (40.3%), French (37.1%) and Italian-speaking regions (16.9%) answered. In the previous 6 months, 41.7% pharmacies had delivered 10–50 medications and 30.0% between 1 and 10 medications. In situations where patients could be equally treated with a pharmacy prescribing medication or OTC (with an identical OTC, similar OTC or an OTC for the same therapeutic group): 75.6%, 74.9% and 84.8% of pharmacists, respectively, would have chosen OTCs because it required less documentation and it did not require patients’ payment for the service. In addition, pharmacists’ lack of training was also mentioned as barrier for providing the service.Conclusion: Most pharmacist prescribing medications do not present clinical advantages compared to OTCs. In addition, other barriers for implementation were also pharmacists’ training and patient medications costs

Dynamic saturation in semiconductor optical amplifiers: accurate model, role of carrier density, and slow light

We developed an improved model in order to predict the RF behavior and the slow light properties of the SOA valid for any experimental conditions. It takes into account the dynamic saturation of the SOA, which can be fully characterized by a simple measurement, and only relies on material fitting parameters, independent of the optical intensity and the injected current. The present model is validated by showing a good agreement with experiments for small and large modulation indices.Comment: 9 pages, 5 figure

The Role of Community Pharmacists in Travel Health and Vaccination in Switzerland.

This review presents the Swiss strategy initiated over the last several years to implement vaccination by community pharmacists. National health authorities aimed to integrate community pharmacists in the National Vaccination Strategy (NVS) in order to increase the vaccination rate in the Swiss population. To support this aim, universities and the Swiss Association of Pharmacists developed pre- and post-graduate education programmes on vaccination for pharmacists. Finally, each Swiss canton (sovereign for health-related aspects) set proper regulations to authorize pharmacists to vaccinate and to determine which vaccines could be administered. As of September 2018, 19 cantons (out of 26) had authorized influenza vaccinations under the sole responsibility of an accredited community pharmacist. Additional vaccinations were available in 13 cantons (e.g., tick-borne encephalitis or hepatitis A, B, or A and B). Such implementation in other countries should follow a similar top-down (following a national strategy to improve vaccination coverage) and stepwise (starting with influenza to demonstrate the competencies of community pharmacists) strategy, supported by the development of research, education and accreditation. The development of health advice related to travels in community pharmacies should follow the same development in Switzerland. Currently, it offers the opportunity for strengthening travellers' safety, beyond vaccination issues

A unique spinodal region in asymmetric nuclear matter

Asymmetric nuclear matter at sub-saturation densities is shown to present only one type of instabilities. The associated order parameter is dominated by the isoscalar density and so the transition is of liquid-gas type. The instability goes in the direction of a restoration of the isospin symmetry leading to a fractionation phenomenon. These conclusions are model independent since they can be related to the general form of the asymmetry energy. They are illustrated using density functional approaches.Comment: 4 pages, 5 figures, to appear in Phys. Rev.

Formation and characterization of hydride blisters in Zircaloy 4 cladding tubes

International audienceThis article is focused on the formation of hydride blisters in zirconium alloys an experimental and theoretical standpoint, and their characterization in terms of morphology, hydrides crystallographic phases, hardness and hydrogen concentration. An experimental setup was developed to grow hydride blisters on pre-hydrided Zircaloy-4 cladding tubes by thermo-diffusion. The thermal conditions were optimized based on thermo-diffusion calculations, that take into account the hysteresis in the hydrogen solubility limit, to obtain a high blister growth rate. Micro-X-ray Diffraction (XRD), nano-hardness and Elastic Recoil Detection Analysis (ERDA) showed that the blisters contain a hydrogen gradient, with pure δδ-hydride phase close to the external surface over one third of the blister depth. Thermo-diffusion calculations showed these half thickness blisters should grow in only a few days in PWR conditions. Eventually, the Diffusion Equilibrium Threshold (DET) was defined as a criterion that limits the blister growth, and emphasizes that the hysteresis in the hydrogen solubility limit in zirconium must be taken into account to model hydrogen thermo-diffusion in zirconium alloys

Novel polyvinylpyrrolidone-based lipoplex modifiers for siRNA delivery

The abstract is provided as supporting informatio

Neoproterozoic magmatic evolution of the southern Ouaddaï Massif (Chad)

This paper presents new petrological, geochemical, isotopic (Nd) and geochronological data on magmatic rocks from the poorly known southern Ouaddaï massif, located at the southern edge of the so-called Saharan metacraton. This area is made of greenschist to amphibolite facies metasediments intruded by large pre- to syn-tectonic batholiths of leucogranites and an association of monzonite, granodiorite and biotite granite forming a late tectonic high-K calc-alkaline suite. U-Pb zircon dating yields ages of 635 ± 3 Ma and 613 ± 8 Ma on a peraluminous biotite-leucogranite (containing numerous inherited Archean and Paleoproterozoic zircon cores) and a muscovite-leucogranite, respectively. Geochemical fingerprints are very similar to some evolved Himalayan leucogranites suggesting their parental magmas were formed after muscovite and biotite dehydration melting of metasedimentary rocks. A biotite-granite sample belonging to the late tectonic high-K to shoshonitic suite contains zircon rims that yield an age of 540 ± 5 Ma with concordant inherited cores crystallized around 1050 Ma. Given the high-Mg# (59) andesitic composition of the intermediate pyroxene-monzonite, the very similar trace-element signature between the different rock types and the unradiogenic isotopic signature for Nd, the late-kinematic high-K to shoshonitic rocks formed after melting of the enriched mantle and further differentiation in the crust. These data indicate that the southern Ouaddaï was part of the Pan-African belt. It is proposed that it represents a continental back-arc basin characterized by a high-geothermal gradient during Early Ediacaran leading to anatexis of middle to lower crustal levels. After tectonic inversion during the main Pan-African phase, late kinematic high-K to shoshonitic plutons emplaced during the final post-collisional stage