An overview of pharmacist roles in palliative care: a worldwide comparison

Background. In order to fulfil the complex needs of terminally ill patients, palliative care demands an in­ter-professional collaborative network, including doctors, nurses, dieticians and social workers. Pharmacists in particular are essential members of this team, given the level of reliance on medications in this setting. The purpose of this review is to identify roles and services performed by palliative care pharmacists in dedicated palliative care settings worldwide and to map these findings against the Advanced Pharmacy Practice Framework. Material and methods. Quasi-systematic review. Search strategy: Google Scholar, Medline/PubMed, Scopus and Embase were searched utilizing selected MeSH terms. Results. A total of 24 sources of information were included in the review. This literature was collected from a range of countries, predominantly from the USA, UK and Australia with singular reports from Mexico, Japan, Qatar, Canada, Poland and Sweden. The literature identifies that pharmacist roles in palliative care are varied and quite extensive. Roles that were specifically tailored to the palliative setting included: aggressive symptom management (in particular pain control), deprescribing, advising on the use of complementary and alternative therapies, extemporaneous compounding of non-standard dosage forms and maintaining a timely supply of medications. Pharmacists in the UK, USA, Canada and Australia were found to perform an advanced level of practice (as their reported roles fulfilled the criteria of the majority of the domains in the APPF). However, pharmacists in other countries, in particular Mexico and Poland, did not present such an extensive scope of practice. Conclusion. The literature identifies that there are differences in the types of palliative pharmacist practice between countries, which may have varying levels of impact upon patient outcomes. As pharmacists can make significant contributions to palliative care, it is important to encourage the benchmarking of practice across different clinical settings and countries to promote a consistent and equitable practice

An overview of the use of drugs in palliative care settings worldwide

Introduction: To provide an overview of drug use in palliative care worldwide and to identify the mostcommonly used medicines in palliative care settings.Methods: Quasi–systematic review. Search strategy: Medline/PubMed, Embase, SCOPUS and GoogleScholar were searched utilizing the selected MeSH terms: palliative care, hospice, drug utilization, andprescription patterns.Results: Overall, it is apparent that there is a significant lack of published literature outlining drug usage inpalliative care settings. Twelve sources of information were reviewed from 9 different countries includingAustria (n = 1), Brazil (n = 1), Canada (n = 1), Germany (n = 1), Italy (n = 2), Netherlands (n = 2), Norway(n = 1), Switzerland (n = 1) and USA (n = 3), as well as a multinational study comparing 11 European countries.Medication use between countries was similar. The most commonly prescribed classes of medicinesincluded non-opioid analgesics, opioids, laxatives, sedatives and antipsychotics and the most commonlyprescribed individual drugs comprised morphine, haloperidol, laxatives and paracetamol.Conclusions: The literature identifies that there is insufficient evidence to describe and compare what drugsare currently used in palliative care settings worldwide. This is attributed to the lack of recently publishedarticles leading to a large gap in knowledge in understanding drug utilization practices in palliative care.Further research is required to address these gaps in knowledge, and identify medication management issuesin palliative care and determining whether there are significant differences in drug management practices. Palliat Med Pract 2019; 13, 3: 134–14

Organizational Issues and Major Problems of Palliative Care Concerning Treatment of End-Stage Renal Disease in Polish Residential Hospices and Hospital-Based Palliative Medicine Wards

Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods. A self-administered questionnaire was distributed among Polish residential hos­pices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test. Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care. Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, devel­opment of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services.Background:Patients diagnosed with end-stage renal disease (ESRD) experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods:A self-administered questionnaire was distributed among Polish residential hospices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test.Results:73 of 166 permanent palliative care facilities registered in Poland took part in the survey. 81% of the aforementioned institutions identified that they cared for ESRD patients. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care.Conclusion:All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, development of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services

The Polish palliative care response to the war in Ukraine and the subsequent humanitarian crisis

The Russian invasion of Ukraine has caused a serious humanitarian crisis. The Ukrainian healthcare system has collapsed and many health care institutions, including palliative care facilities, have been destroyed. In Poland, hospices and palliative care centres, non-governmental and public organizations, local authorities as well as individual citizens have been involved in the provision of care and other forms of support for palliative care patients who fled Ukraine. Due to the implementation of new regulations, 1.5 million refugees have been granted access to Polish public services. The rapid aid response for Ukrainian refugees has provided these patients with dignity, by meeting their basic needs, and allowed them to experience some level of peace in a deeply troubling time

Pharmacist practice in neonatal intensive care units in Australia and Poland

University of Technology Sydney. Graduate School of Health.The quality and safe use of medicines is a global priority, particularly in high-risk patients such as those in the neonatal intensive care unit (NICU). Whilst medication misuse and errors have been widely reported in the published literature across all patient populations, of particular concern are those that occur in neonatal patients. Pharmacotherapy is heavily used within the NICU, with a reported average of 8.6 medications prescribed per patient. Furthermore, neonates have a unique set of challenges, including immature and constantly changing body-systems, a lack of suitable formulations for administration, as well as a lack of evidence to inform medicines use in infants, rendering this population particularly vulnerable to experiencing medication errors. Medication errors with the potential to cause harm are eight times more likely to occur in the NICU compared with adult wards, and are more likely to cause significant consequences ranging from pressure on clinical resources and increased healthcare costs, to adversely affecting the health outcomes of neonatal patients, i.e., impairing the development of organs and body systems due to neonates’ physiological inability to buffer errors. As key facilitators of the quality use of medicines (QUM), clinical pharmacists possess the skills necessary to improve medication management in the NICU. Whilst studies have showcased pharmacist interventions and reported significant decreases in medication errors in the NICU, they have failed to describe roles that are provided in actual NICU settings. As such, there is a distinct gap in knowledge relating to what roles and services are provided to NICUs in current pharmacy practice, as well as what impact pharmacist-led services have upon clinical outcomes in neonates. Without relevant practice standards, differences in healthcare systems, legislation, culture, and tertiary education across countries may lead to the variable provision of pharmaceutical care services to this setting. As a result, there is potential for the quality of pharmaceutical care provided to NICU patients to also differ, which may impact on patient outcomes. The World Health Organisation (WHO) reports that health inequalities are a major concern for health systems globally. Currently, there is no literature describing what a quality level of pharmacy practice entails in NICUs, nor are there any standardised means of measuring the quality of pharmaceutical care provided to NICU patients. Quality assurance is an important concept to confirm whether the level of pharmaceutical care being provided is optimal. Healthcare service quality is most commonly measured via key performance indicators (KPIs) or other quality indicators that assess practice performance, helping to identify service gaps. These indicators are formulated according to evidence-based national or international clinical practice guidelines. However, there is currently (and surprisingly) an apparent lack of medication management policies or KPIs/frameworks needed to guide QUM in the NICU. Health equity is a shared responsibility of all nations worldwide, and it is a fundamental right of each human being to receive the highest possible standard of healthcare. The RIO Political Declaration on Social Determinants of Health states that all nations should collaborate to identify best practices and adopt coherent policies that promote uniformity across health settings worldwide. Whilst there are significant differences in practice between third and first world countries, it is apparent that there are also variances in pharmacy practice between industrialised countries in Europe, as well as the US, UK, Australia, New Zealand and Canada. It is clear that many nations are challenged in striving for this global uniformity, regardless of their population, location, or wealth. This is also apparent in the context of pharmacy practice where, aside from large studies commissioned by the WHO, European Association of Hospital Pharmacists (EAHP) or the American Society of Hospital Pharmacists (ASHP) comparing general hospital pharmacy services around the world, there is little comparative research focussing on pharmacist practice in NICUs transnationally. Summarily, there is a need to better understand the current state of pharmacy practice in NICUs worldwide, to identify specific issues relating to medication management issues or pharmacy practice, and to create reference points for quality pharmaceutical care and/or benchmarks against which to compare changes in international hospital pharmacy practice

How to teach pharmacology to medical students during the COVID-19 pandemic?

BackgroundThe COVID-19 pandemic has forced the introduction of many changes into medical student education. The aim of the study was to evaluate medical students’ perceptions of a Pharmacology course delivered at a Polish medical university before and during the pandemic.Material and methodsA cross-sectional anonymous survey conducted among medical students.Results90 out 122 students participated in the study. The vast majority of students found pharmacology to be a difficult subject. The surveyed group of students preferred active methods of learning, including: teacher explanations (86.5%) and discussions (70.8%) during in-person classes, real-time student-teacher meetings via dedicated web-based platforms (73%) during online classes. Students most often described e-learning as interesting (58.9%) and timesaving (52.2%). Less than 30% described it as stressful, difficult, time-consuming and boring. The most commonly reported advantage was the possibility for students to adjust their pharmacology study-time to a more personalised schedule (82.5%). The main disadvantage included the loss of in-person face-to-face contact with the teacher (61.8%).ConclusionsOverall, students held positive attitudes towards the new teaching format and adapted well to the new conditions. Modern innovations enabling medical students to continue their studies efficiently and effectively during the pandemic must be developed and introduced into practice

Evaluation of Prostate-Specific Membrane Antigen (PSMA) Immunohistochemical Expression in Early-Stage Breast Cancer Subtypes

Breast cancer, known for its diverse subtypes, ranks as one of the leading causes of cancer-related deaths. Prostate-specific membrane antigen (PSMA), primarily associated with prostate cancer, has also been identified in breast cancer, though its role remains unclear. This study aimed to evaluate PSMA expression across different subtypes of early-stage breast cancer and investigate its correlation with clinicopathological factors. This retrospective study included 98 breast cancer cases. PSMA expression was examined in both tumor cells and tumor-associated blood vessels. The analysis revealed PSMA expression in tumor-associated blood vessels in 88 cases and in tumor cells in 75 cases. Ki67 expression correlated positively with PSMA expression in blood vessels (p p = 0.010, RSpearman 0.26). The estrogen and progesterone receptor expression correlated negatively with PSMA levels in blood vessels (p = 0.0053, R Spearman −0.26 and p = 0.00026, R Spearman −0.347, respectively). Human epidermal growth factor receptor 2 (HER2) status did not significantly impact PSMA expression. We did not detect any statistically significant differences between breast cancer subtypes. These findings provide evidence for a heterogenous PSMA expression in breast cancer tissue and suggest its correlation with tumor aggressiveness. Despite the limited sample size, the study provides valuable insights into the potential of PSMA as a prognostic, diagnostic, and therapeutic target in the management of breast cancer