Quality indicators for measuring the level of patients' involvement in the pharmaceutical care process

Patient-centred counseling is an integral part of the pharmaceutical care process. Quality in- dicators can be valuable tools to measure the level of patients’ involvement in their personal healthcare. The aim of the study was to validate two quality indicators for community pharmacy care focusing on patient involvement. As part of the EDQM Pharmaceutical Care Quality Indicators Project (Council of Europe), at least 10 patients per indicator were recruited in each community pharmacy in Serbia and Po- land. Pharmacists targeted patients aged 18-65 years starting chronic treatment (Indicator 1) and elderly patients with polymorbidity receiving at least five chronic treatment medicines (Indicator 2). Based on patients’ answers to a questionnaire, patient-pharmacist consultations took place. For Indicator 2, patients were also offered a medication review. In total, 66% of Serbian patients and 29% Polish patients, for In- dicator 1, were engaged in pharmacist-patient consultations; 96% of Serbian and 84% of Polish elderly patients subsequently participated in medication reviews. Community pharmacists can increase patients’ involvement in their own pharmaceutical care, and there is a need for such services. This study defines a pragmatic approach to encourage/support the implementation of the pharmaceutical care philosophy and working methods in European community pharmacies

Nitric oxide plays a role as a mediator of conjunctival edema in experimental allergic conjunctivitis

The role of nitric oxide in allergic conjunctivitis was studied in a guinea pig model. The eyes of sensitized guinea pigs were challenged with ovalbumin (20 μg per eye) or histamine (20 μg per eye). Synthesis of nitric oxide (NO) was inhibited using L-NAME (200 μg per eye) or aminoguanidine (200 μg per eye). The formation of conjunctival edema was graded and levels of nitrite, a breakdown product of nitric oxide were measured in lavage fluid. Conjunctival vasopermeability was determined by measuring the albumin concentration in the fluid on the surface of the eye (lavage fluid). Animals were treated with sodium nitroprusside (SNP) or phenylephrine after which histamine induced conjunctival vasopermeability changes were measured. Drugs were administered topically with the other eye serving as a control. Both ovalbumin and histamine produced a marked inflammatory response including hyperaemia and edema. At the top of the inflammatory response occurring 30 min after challenge, increased levels of nitrite, a breakdown product of NO, were measured in lavage fluid. Prophylactic treatment with L-NAME or aminoguanidine resulted in a significant inhibition of the NO synthesis. Both L-NAME and aminoguanidine decreased conjunctival vascular permeability and edema formation significantly. Administration of SNP resulted in a marked dilatation of conjunctival blood vessels and produced a dose-dependent increase of vascular permeability. Addition of SNP to histamine significantly enhanced conjunctival edema and potentiated vascular permeability. These results indicate that NO is produced in the acute phase of allergic conjunctivitis and mediates vasodilatation after topical provocation with ovalbumin or histamine in sensitized guinea pigs. The resulting increase of the conjunctival blood now subsequently increases the vascular permeability and enhances conjunctival edema formation. Inhibition of NO synthesis leads to a reduction of conjunctival hyperaemia and subsequently reduces the formation of edema.</p

The evaluation of patient self-completion concordance forms used in community pharmacy:a comparison of two European countries

OBJECTIVES: To evaluate the use of patient self-completion concordance forms in Dutch and Bulgarian pharmacies. Second, to show any differences in pharmacy practice and patient behaviour in two European countries: the Netherlands and Bulgaria. METHODS: A random sample of 500 pharmacies were approached per country. Patients at the start of a chronic treatment were invited to participate. At the first dispensing patients received a self-completion concordance form (SCCF). Patients were asked to fill in the SCCF at home and bring it to the appointment for their consultation at the second dispensing. After the consultations patients and pharmacists were asked to fill in a questionnaire. KEY FINDINGS: Twenty-four Dutch pharmacies (99 patients) and 41 Bulgarian pharmacies (241 patients) sent back study results. A higher proportion of Bulgarian patients answered questions on the SCCF compared to Dutch patients. Patients from both countries are satisfied with the SCCF, consultation and newly started medicine. CONCLUSIONS: Although differences between pharmacies from the Netherlands and Bulgaria exist, the SCCF can be used at the start of chronic treatment. More research in other European countries will be necessary to further develop the use of the SCCF in community pharmacies. Eventually this could be used to develop indicators to measure patient involvement in pharmaceutical care

Changes in cytokine mRNA levels in experimental corneal allografts after local clodronate-liposome treatment

PURPOSE. Corneal allograft rejection in rats can be prevented by subconjunctival injections of liposomes containing dichloromethylene diphosphonate (clodronate–LIP), which selectively eliminate macrophages. In this study, the effect of clodronate–LIP treatment on cytokine mRNA levels in corneal allografts was examined. METHODS. AO rats received corneal grafts of PVG rats. Rats were either not treated or injected subconjunctivally with clodronate–LIP on the day of transplantation and on postoperative days (PODs) 2, 4, 6, and 8. RNA was isolated from the graft and rim of corneas at different times after transplantation and from normal controls. Interleukin (IL)-1�, IL-1 receptor antagonist (IL-1RA), IL-2, IL-4, IL-6, IL-10, IL-12p40, tumor necrosis factor (TNF)-�, TNF-�/lymphotoxin (LT), interferon (IFN)-�, monocyte chemotactic protein 1 (MCP-1), and macrophage inflammatory protein 2 (MIP-2) mRNA levels were analyzed by semiquantitative reverse transcription–polymerase chain reaction (RT–PCR). RESULTS. Corneal rejection, observed in all untreated rats by POD 12, was associated with increased mRNA levels of all cytokines investigated in grafts and rims. Clodronate–LIP treatment prevente