Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region

Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018

Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Risk factors in childhood ALL have changed during recent decades, mostly due to treatment personalization. The aim of this study was to analyze therapy results and prognostic factors in childhood ALL in the Kujawsko-Pomorski region of Poland between 1976 and 2018. Material and methods: Data from 495 patients (0–18 years old) diagnosed with ALL from the Kujawsko-Pomorski region between 1976 and 2018 was analyzed. Prognostic factors were analyzed separately in specific therapeutic groups, which were defined by several therapy protocols. Results: Prognostic factors have changed over the course of consecutive therapeutic periods. Between 1976 and 1988 (the first and second therapeutic protocols), central nervous system involvement was the most important risk factor. During the third therapeutic period, an unsatisfactory treatment response on days 8 and 14 was related to a poor outcome. In 1995–2002, the risk factors were hepatomegaly, splenomegaly, lymph nodes involvement, and unsatisfactory therapy response on days 15 and 33. Between 2002 and 2011, immunophenotype other than ‘common’ and hemoglobin level at diagnosis were the risk factors, and a lack of BCR-ABL aberration was related to better therapy results. During the final analyzed period (2011–2018), failure to achieve remission on day 33 was a risk factor, and patients classified as non-high risk group and those aged <6 years had better outcomes. Conclusions: The changing profile of risk factors in ALL has reflected progress in ALL therapy, with the gradual elimination of factors related to poor outcomes, mostly due to modifications in treatment and the development of diagnostic methods as well as therapy monitoring

Relapsed childhood acute myeloid leukemia: prognostic factors and outcomes: experience from a single oncology center

Introduction: Over recent decades, significant progress in the treatment of childhood acute myeloid leukemia (AML) has been made. However, the relapsed disease remains a challenge. The aim of this study was to analyze therapy results in pediatric patients treated for relapsed AML in a single oncology center, with a particular focus on prognostic factors. Materials and methods: Data from patients younger than 19 years with AML diagnosed between January 1994 and December 2020 treated in the Department of Pediatric Hematology and Oncology in Bydgoszcz, Poland was analyzed, with detailed analysis of patients with relapsed disease. Results: A total of 77 children were diagnosed with AML in the analyzed period and 21 had a relapsed disease (27.3%). Bone marrow relapse was the most common. The risk factors of relapse included white blood cells >100 G/L at initial diagnosis and classification to the high risk group. Late relapse was related to poorer outcomes. The 5-year probability of overall survival for the entire group was 28.6%, and this was significantly higher in patients who achieved second remission compared to those who did not (44.9% vs. 0.0%, p <0.001). The main reason for death was progression of disease, which occurred in 10 patients. Conclusions: Outcomes in relapsed AML in children are still dismal. Lack of second remission suggests the need for experimental therapy

Clinical pharmacy - at what stage are we in Poland?

The functioning of health care centers is highly dependent on the quality of cooperation between medical staff - doctors, nurses, but also pharmacists. Pharmaceutical knowledge about medicines, combined with daily practice and supervision of the pharmacotherapy used, can bring a number of benefits, primarily increasing effectiveness and safety of treatment, as well as reducing the cost of treatment. Despite numerous difficulties, in some hospitals in Poland pharmacists undertake various types of clinical activities by directly joining the work of a hospital ward or remote monitoring of patient's pharmacotherapy using electronic systems. It should be emphasized that these are often tasks carried out outside the basic dimension of working time. The initiative taken in 2017 by the Director of the Provincial Specialist Hospital in Wroclaw, Research and Development Center, deserves a mention. Pharmacist (during the specialization in clinical pharmacy) was fully engaged in the work of hospital wards focusing first in the Department of Vascular Surgery, and then also General Surgery. Her daily duties include participation in medical celebrations, conducting medical history with newly admitted patients, optimization of pharmacotherapy, consultation with the medical and nursing team, control of orders and results of laboratory tests, giving advice to staff and educating patients in correct use of medicines. This kind of multidisciplinary cooperation has become a standard of care, which has been approved by the accreditation committee of the Center for Quality Monitoring in Health Care. In Poland, clinical pharmacy is constantly developing and gaining importance every year, but as of today, there are still no clear law regulations. Will the draft Act On The Pharmacy Profession adopted by the Council of Ministers introduce regulations and clearly define the place of a clinical pharmacist in the healthcare system? Undoubtedly, it would be a basic step to the further development of clinical pharmacy services.Funkcjonowanie placówek ochrony zdrowia w dużym stopniu zależne jest od jakości współpracy między personelem medycznym – lekarzami, pielęgniarkami, ale także farmaceutami. Wiedza farmaceutyczna na temat leków, połączona z codzienną praktyką i sprawowowanie nadzoru nad stosowaną farmakoterapią, może przynieść szereg korzyści, przede wszystkim zwiększenie skuteczności i bezpieczeństwa leczenia, a także obniżenie jego kosztów. W Polsce obserwuje się rozwój farmacji klinicznej, jednak jego tempo jest wolne, gdyż stale brak jest jednoznacznych umocowań prawnych do zatrudniania farmaceutów klinicznych. Czy przyjęty przez Radę Ministrów, projekt Ustawy o zawodzie farmaceuty wprowadzi takie możliwości i wyraźnie określi miejsce farmaceuty klinicznego w systemie opieki zdrowotnej? Bez wątpienia byłby to podstawowy krok do dalszego rozwoju usług farmacji klinicznej