The use of online debates in teaching pharmacotherapy

Given changes in the final year pharmacotherapy unit structure and calendar, along with a need to introduce assessments to encourage critical thinking, it was decided that online debates of therapeutic controversies would be beneficial. The primary objective was to assess the impact of teaching strategies on the development of argumentation skills and informal reasoning in pharmacy students. Students were provided with an introduction to argumentation followed by two formal debates, with feedback provided in between. Four debate groups were randomly selected for evaluation. In debate one, all groups posted one argument and all arguments were rationalistic and ranked as Level 3. For debate two, a total of 33 arguments were evaluated, with an overall median ranking of Level 2. Again, all debates were categorised as rationalistic. In general, students felt there was too much workload associated with the assignment. Changes in the future include providing the debates in patient scenarios to increase practical applicability

Pharmacist intervention for glycaemic control in the community (the RxING study)

OBJECTIVE: To determine the effect of a community pharmacist prescribing intervention on glycaemic control in patients with poorly controlled type 2 diabetes. DESIGN: Pragmatic, before–after design. SETTING: 12 community pharmacies in Alberta, Canada. PARTICIPANTS: Type 2 diabetes receiving oral hypoglycaemic medications and with glycated haemoglobin (HbA1c) of 7.5–11%.INTERVENTION: Pharmacists systematically identified potential candidates by inviting patients with type 2 diabetes to test their HbA1c using validated point-of-care technology. Pharmacists prescribed 10 units of insulin glargine at bedtime, adjusted by increments of 1 unit daily to achieve a morning fasting glucose of ≤5.5 mmol/L. The patients were followed up at 2, 4, 8, 14, 20 and 26 weeks. PRIMARY OUTCOME: Change in HbA1c from baseline to week 26. SECONDARY OUTCOMES: Proportion of patients achieving target HbA1c, changes in oral hypoglycaemic agents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes.RESULTS: We screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤7% at the end of the study.CONCLUSIONS: This is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes

Pharmacy student perceptions of pharmacist prescribing: A comparison study

Several jurisdictions throughout the world, such as the UK and Canada, now have independent prescribing by pharmacists. In some areas of Canada, initial access prescribing can be done by pharmacists. In contrast, Australian pharmacists have no ability to prescribe either in a supplementary or independent model. Considerable research has been completed regarding attitudes towards pharmacist prescribing from the perspective of health care professionals, however currently no literature exists regarding pharmacy student views on prescribing. The primary objective of this study is to examine pharmacy student’s opinions and attitudes towards pharmacist prescribing in two different settings. Focus groups were conducted with selected students from two universities (one in Canada and one in Australia). Content analysis was conducted. Four main themes were identified: benefits, fears, needs and pharmacist roles. Students from the Australian University were more accepting of the role of supplementary prescribing. In contrast, the Canadian students felt that independent prescribing was moving the profession in the right direction. There were a number of similarities with the two groups with regards to benefits and fears. Although the two cohorts differed in terms of their beliefs on many aspects of prescribing, there were similarities in terms of fears of physician backlash and blurring of professional roles

Simultaneous analysis of 10 trihalomethanes at nanogram per liter levels in water using solid-phase microextraction and gas chromatography mass-spectrometry

Trihalomethanes are predominantly formed during disinfection of water via reactions of the oxidant with natural organic matter. Even though chlorinated and brominated trihalomethanes are the most widespread organic contaminants in drinking water, when iodide is present in raw water iodinated trihalomethanes can also be formed. The formation of iodinated trihalomethanes can lead to taste and odor problems and is a potential health concern since they have been reported to be more toxic than their brominated or chlorinated analogs. Currently, there is no published standard analytical method for I-THMs in water. The analysis of 10 trihalomethanes in water samples in a single run is challenging because the iodinated trihalomethanes are found at very low concentrations (ng/L range), while the regulated chlorinated and brominated trihalomethanes are present at much higher concentrations (above μg/L). An automated headspace solid-phase microextraction technique, with a programmed temperature vaporizer inlet coupled with gas chromatography-mass spectrometry, was developed for routine analysis of 10 trihalomethanes i.e. bromo-, chloro- and iodo-trihalomethanes in water samples. The carboxen/polydimethylsiloxane/divinylbenzene fiber was found to be the most suitable. The optimization, linearity range, accuracy and precision of the method are discussed. The limits of detection range from 1 ng/L to 20 ng/L for iodoform and chloroform, respectively. Matrix effects in treated groundwater, surfacewater, seawater, and secondary wastewater were investigated and it was shown that the method is suitable for the analysis of trace levels of iodinated trihalomethanes in a wide range of waters.The method developed in the present study has the advantage of being rapid, simple and sensitive. A survey conducted throughout various process stages in an advanced water recycling plant showed the presence of iodinated trihalomethanes at ng/L levels

Ensuring consistent reporting of clinical pharmacy services to enhance reproducibility in practice: an improved version of DEPICT

Rationale, aims and objectivesDEPICT (Descriptive Elements of Pharmacist Intervention Characterization Tool) was created in response to the frequently reported issue of poor intervention description across studies assessing the impact of clinical pharmacy activities. The aim of this study was to create an improved version of DEPICT (i.e. DEPICT 2) to better characterize clinical pharmacy services in order to ensure consistent reporting, therefore enhancing reproducibility of interventions in practice.MethodA qualitative approach through a thematic content analysis was performed to identify components of pharmacist interventions described in 269 randomized controlled trials. A preliminary version of DEPICT 2 was applied independently by two authors to a random sample of 85 of the 269 RCTs and reliability determined by the prevalence‐adjusted bias‐adjusted kappa (PABAK) or the intraclass correlation coefficient (ICC). The final version of DEPICT 2 was compared against DEPICT 1.ResultsThe final version of DEPICT 2 comprised 146 items and 11 domains. The inter‐rater agreement analysis showed that DEPICT presented good to optimal reproducibility, with a mean PABAK value of 0.87 (95% CI 0.85–0.89) and a mean ICC value of 0.88 (95% CI 0.62–1.14). The mean difference between items checked in the two versions (DEPICT 2 – DEPICT 1) was 10.58 (95% CI 9.55–11.61), meaning that approximately 11 more components were identified in the new version of DEPICT.ConclusionsDEPICT 2 is a reliable tool to characterize components of clinical pharmacy services, which should be used to ensure consistent reporting of interventions to allow their reproducibility in practice.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112225/1/jep12339.pd

Isotope dilution liquid chromatography - tandem mass spectrometry for simultaneous identification and quantification of beta-casomorphin 5 and beta-casomorphin 7 in yoghurt

A highly selective and sensitive liquid chromatography–tandem mass spectrometry method was developed and validated for the simultaneous identification and quantification of beta-casomorphin 5 (BCM5) and beta-casomorphin 7 (BCM7) in yoghurt. The method used deuterium labelled BCM5-d10 and BCM7-d10 as surrogate standards for confident identification and accurate and quantification of these analytes in yoghurt. Linear responses for BCM5 and BCM7 (R2 = 0.9985 and 0.9986, respectively) was observed in the range 0.01–10 ng/μL. The method limits of detection (MLDs) in yoghurt extracts were found to be 0.5 and 0.25 ng/g for BCM5 and BCM7, respectively. Analyses of spiked samples were used to provide confirmation of accuracy and precision of the analytical method. Recoveries relative to the surrogate standards of these spikes were in the range of 95–106% for BCM5 and 103–109% for BCM7. Precision from analysis of spiked samples was expressed as relative standard deviation (%RSD) and values were in the range 1–16% for BCM5 and 1–6% for BCM7. Inter-day reproducibility was between 2.0–6.4% for BCM5 and between 3.2–6.1% for BCM7. The validated isotope dilution LC–MS/MS method was used to measure BCM5 and BCM7 in ten commercial and laboratory prepared samples of yoghurt and milk. Neither BCM5 nor BCM7 was detected in commercial yoghurts. However, they were observed in milk and laboratory prepared yoghurts and interestingly their levels decreased during processing. BCM5 decreased from 1.3 ng/g in milk to 1.1 ng/g in yoghurt made from that milk at 0 day storage and <MLQ at 1 and 7 days storage. BCM7 decreased from 1.9 ng/g in milk to <MLQ in yoghurts immediately after processing. These preliminary results indicate that fermentation and storage reduced BCM5 and BCM7 concentration in yoghurt

Screening Non Legume Species for Use as Cover Crop in Mixtures

Several non-legume species have been tested for their suitability as cover crops, especially as constituent of mixtures with common vetch (Vicia sativa) and subterranean clover (Trifolium subterrananeum) in field trials performed in southern Germany from 2013 to 2016. We present selected results. The highest amounts of biomass were produced by Glebionis segetum, Anethum graveolens and Borago officinalis, which were also able to compete with subterranean clover and common vetch. All other tested species produced less biomass than the two legume species and were outcompeted in mixtures

Screening New Legume Species for Use as Cover Crop in Southern Germany

A screening among more than 800 accessions, belonging to more than 100 species was performed in the frame of an international cooperative research program from 2012 to 2016. Aim of the screening was, to identify new species and suitableaccessions, suitable as cover crops and living mulches in Mediterranean, temperate and more continental climates. In this contribution, results obtained in southern Germany are reported, focusing on potential new cover crops. Several new cover crop species could be identified, which were characterized by high biomass production ad weed suppression, as well as by good seed production. Both species and accessions with early and late growth cycle could be identified

On the assimilation of optical reflectances and snow depth observations into a detailed snowpack model

International audienceThis paper examines the ability of optical re-flectance data assimilation to improve snow depth and snow water equivalent simulations from a chain of models with the SAFRAN meteorological model driving the detailed multi-layer snowpack model Crocus now including a two-stream radiative transfer model for snow, TARTES. The direct use of reflectance data, allowed by TARTES, instead of higher level snow products, mitigates uncertainties due to commonly used retrieval algorithms. Data assimilation is performed with an ensemble-based method, the Sequential Importance Resampling Particle filter , to represent simulation uncertainties. In snowpack mod-eling, uncertainties of simulations are primarily assigned to meteorological forcings. Here, a method of stochastic perturbation based on an autoregressive model is implemented to explicitly simulate the consequences of these uncertainties on the snowpack estimates. Through twin experiments, the assimilation of synthetic spectral reflectances matching the MODerate resolution Imaging Spectroradiometer (MODIS) spectral bands is examined over five seasons at the Col du Lautaret, located in the French Alps. Overall, the assimilation of MODIS-like data reduces by 45 % the root mean square errors (RMSE) on snow depth and snow water equivalent. At this study site, the lack of MODIS data on cloudy days does not affect the assimilation performance significantly. The combined assimilation of MODIS-like reflectances and a few snow depth measurements throughout the 2010/2011 season further reduces RMSEs by roughly 70 %. This work suggests that the assimilation of optical reflectances has the potential to become an essential component of spatialized snowpack simulation and forecast systems. The assimilation of real MODIS data will be investigated in future works

Odour reduction strategies for biosolids produced from a Western Australian wastewater treatment plant: Results from Phase I laboratory trials

This study investigated sources of odours from biosolids produced from a Western Australian wastewater treatment plant and examined possible strategies for odour reduction, specifically chemical additions and reduction of centrifuge speed on a laboratory scale. To identify the odorous compounds and assess the effectiveness of the odour reduction measures trialled in this study, headspace solid-phase microextraction gas chromatography-mass spectrometry (HS SPME-GC-MS) methods were developed. The target odour compounds included volatile sulphur compounds (e.g. dimethyl sulphide, dimethyl disulphide and dimethyl trisulphide) and other volatile organic compounds (e.g. toluene, ethylbenzene, styrene, p-cresol, indole and skatole). In our laboratory trials, aluminium sulphate added to anaerobically digested sludge prior to dewatering offered the best odour reduction strategy amongst the options that were investigated, resulting in approximately 40% reduction in the maximum concentration of the total volatile organic sulphur compounds, relative to control