Pharmacology Training Research Articles

The training of medical students in the field of phytotherapy

Now in its eigth year at the Medical University - Varna run elective course in the teaching discipline of Phytotherapy. Together with the study of medicinal plants and essential phytopreparations, during the course were monitored interests and attitudes of participants towards phytotherapy as a whole, and to individual phytotherapeutic methods and fields. At the end of each course in 2003 - 2011, a questionnaires were filled from the students-participants. Questionnaires and collected data are processed. According to them, average 94% of participants demonstrated considerable interest in the topics, and an average of 98% of the students wish to use phytopreparations in their future practice. Despite still tentative attitude of the Bulgarian phytotherapy for clinicians, medical students demonstrate a specific interest in the area of phytotherapy and willing to update their knowledge on it in the future. Given the increasing use of phytopharmaceuticals and phyto-supplements in the world is glad, that the future doctors have a very constructive attitude towards them. We believe it would be reasonable and practical to include some phytotherapeutic topics in the regular training in pharmacology. SSM, 2012;44(1):47-50

Safety Pharmacology Master of Science (MS) program: design and implementation

Safety Pharmacology is a rapidly growing component of drug development distinct from classical toxicology and pharmacology. The importance of training in Safety Pharmacology is underscored by current FDA regulations and the International Committee on Harmonization guidelines on preclinical drug safety studies. A specific advanced degree curriculum is required to prepare future Safety Pharmacologists. However, to our knowledge, none of the current Pharmacology MS programs incorporate a special emphasis in Safety Pharmacology. We describe the design and implementation of a new MS in Pharmacology with Safety Pharmacology emphasis for graduates in the life sciences. A Certificate in Safety Pharmacology program is also designed for training or retraining of employees in drug discovery/development enterprises and for individuals with non‐pharmacology degrees intending to enter the field of Preclinical Safety Pharmacology. The comprehensive curriculum includes a series of didactic courses on drug discovery and preclinical development as well as principles and experimental methods in Safety Pharmacology. The special emphasis Safety Pharmacology MS program begins in August 2012.

Isozyme‐specific interaction of protein kinase C δ with mitochondria dissected using live cell fluorescence imaging

Protein kinase C δ (PKCδ) signaling to mitochondria has been implicated in both mitochondrial apoptosis and metabolism. Using FRET‐based imaging, we observe that phorbol ester induces PKCδ to translocate to the outer membrane of mitochondria by an isozyme‐specific mechanism, resulting in increased mitochondrial respiration. A structure‐function study of the molecular mechanisms driving PKCδ's unique interactions with mitochondria reveals that the C1A and C1B domains and residues near the turn motif of PKCδ are required for its acute translocation to mitochondria and that the C2 domain, a critical charged residue in the activation loop, kinase activity, and mitochondrial transmembrane potential enable it to be retained there. PKCδ localized to the mitochondrial outer membrane has robust activity, as revealed by a FRET reporter of PKCδ‐specific activity (δCKAR). Perturbation of the kinase activity of PKCδ, by means of various kinase‐dead mutants, pharmacological inhibition, or a gate‐keeper mutant of PKCδ, demonstrates that its activity plays a role in both its translocation to and retention at mitochondria. These data support a model in which determinants unique to PKCδ drive a highly specific interaction with mitochondria. This work was supported by NIH GM43154 (ACN), UCSD Pharmacology Training Grant NIGMS T32 GM007752 (AXW), and UCSD GK‐ 12 STEM fellowship in education NSF 0742551 (AXW).

Measuring the Effectiveness of Pharmacology Teaching in Undergraduate Medical Students

Information overload and recent curricular changes are viewed as important contributory factors to insufficient pharmacological education of medical students. This study was designed to assess the effectiveness of pharmacology teaching in our medical school. The study subjects were 455 second-year medical students, class of 2010, and 26 pharmacology teachers at the National University of Mexico Medical School. To assess pharmacological knowledge, students were required to take 3 multiple-choice exams (70 questions each) as part of their evaluation in the pharmacology course. A 30-item questionnaire was used to explore the students' opinion on teaching. Pharmacology professors evaluated themselves using a similar questionnaire. Students and teachers rated each statement on a 5-point Likert scale. The groups' exam scores ranged from 54.5% to 90.0% of correct responses, with a mean score of 77.3%. Only 73 (16%) of 455 students obtained an exam score of 90% and higher. Students' evaluations of faculty and professor self-ratings were very high (90% and 96.2%, of the maximal response, respectively). Student and professor ratings were not correlated with exam scores (r = 0.291). Our study shows that knowledge on pharmacology is incomplete in a large proportion of second-year medical students and indicates that there is an urgent need to review undergraduate training in pharmacology. The lack of relationship between the subjective ratings of teacher effectiveness and objective exam scores suggests the use of more demanding measures to assess the effectiveness of teaching.

BCPT Nordic Prize in Basic & Clinical Pharmacology & Toxicology for 2011 to Pertti J. Neuvonen

The BCPT Nordic Prize of 10,000 € in Basic & Clinical Pharmacology & Toxicology for 2011 will be awarded to Professor Pertti J. Neuvonen from the Department of Clinical Pharmacology at the University of Helsinki, Finland. Professor Pertti J. Neuvonen has dedicated his working life for the benefit of basic and clinical pharmacology and toxicology. His main positions have been Lecturer or Acting Professor of Clinical Pharmacology at the University of Helsinki (1972–1988), Professor and Chairman of Pharmacology at the University of Turku (1988–1992) and Professor and Chairman of Clinical Pharmacology at the University of Helsinki (1992–present). Pertti J. Neuvonen is widely recognized for his outstanding contributions in the field of drug interactions. During his early career, he was interested especially in drug absorption and gained an international reputation already in the 1970s for characterizing the clinically important interactions of tetracyclines with iron and other bivalent cations. His studies on oral activated charcoal in the 1970s and 1980s consolidated his reputation and played a central role in the expansion of the use of activated charcoal in the treatment of acute poisonings during the 1990s. For his studies on drug absorption and activated charcoal, he was selected as Drug Absorption Foundation Lecturer in 1993 (Edinburgh, UK). In the early 1990s, Pertti J. Neuvonen focused his research efforts on the roles of inhibition and induction of cytochrome P450 enzymes in drug interactions. He was the first to demonstrate that plasma concentrations of drugs undergoing extensive first-pass metabolism may increase even more than 10-fold, as a result of inhibition of P450-mediated biotransformation. In recent years, he has also been heavily engaged in pharmacogenetics and genomics research. His findings have significantly improved the safety and efficacy of drug therapy and benefited the principles and guidelines applied in drug development. Pertti J. Neuvonen has published about 460 original articles and more than 150 review articles and chapters in textbooks. The high number of citations to his articles reflects the outstanding scientific quality of his work. His Hirsch-index is 57, the total number of citations to his publications is more than 13,000 (17 July 2011) and he is one of the most highly cited pharmacologists in the world (ISIHighlyCited.com). Pertti J. Neuvonen is distinguished for his groundbreaking work to create better possibilities for clinical drug research, to promote training in pharmacology and to develop the speciality of clinical pharmacology in Finland. He is the founder and director of the Clinical Drug Research Graduate School, which forms an important national resource for education in pharmacology and organizes several postgraduate courses annually. He has supervised 39 PhD doctoral theses and has currently six doctoral students. For his exceptional merits in research education in Finland, Pertti J. Neuvonen has received the Lauri Saxén prize in 1997 and the Maud Kuistila prize in 2003. He was the first chairman of the Finnish Society of Clinical Pharmacology (founded in 1994). Moreover, he is the chief editor of the Finnish textbook in clinical pharmacology and therapeutics (published in 1994, 2002 and 2011) and an editorial board member of four international journals. Since 1998, Pertti J. Neuvonen has been a member of the Finnish Academy of Science and Letters.

Nurse-initiation and maintenance of patients on antiretroviral therapy: Are nurses in primary care clinics initiating ART after attending NIMART training?

To determine the percentage of nurses initiating new HIV-positive patients on therapy within 2 months of attending the Nurse Initiation and Maintenance of Antiretroviral Therapy(NIMART) course, and to identify possible barriers to nurse initiation. A brief telephonic interview using a structured questionnaire of a randomly selected sample (126/1736) of primary care nurses who had attended the NIMART course facilitated by the Foundation for Professional Development (FPD) between October 2010 and 31 March 2011 at primary care clinics in 7 provinces. Outcome measures were the number of nurses initiating ART within 2 months of attending the FPD-facilitated NIMART course. Of the nurses surveyed, 62% (79/126) had started initiating new adult patients on ART, but only 7% (9/126) were initiating ART in children. The main barrier to initiation was allocation to other tasks in the clinic as a result of staff shortages. Despite numerous challenges, many primary care nurses working in the 7 provinces surveyed have taken on the responsibility of sharing the task of initiating HIV-positive patients on ART. The barriers preventing more nurses initiating ART include the shortage of primary care nurses and the lack of sufficient consulting rooms. Expanding clinical mentoring and further training in clinical skills and pharmacology would assist in reaching the target of initiating a further 1.2 million HIV-positive patients on ART by 2012.

Enfermeras de Atención Primaria opinan, analizan y proponen mejoras en el manejo de la adherencia farmacológica

Aim: To find out how primary care nurses perceive and handle pharmacological non-adherence and to identify areas for improvement. Methods: A qualitative study including focal groups and in-depth interviews was carried out in May-June 2009 in the Sanitary Area V of Asturias, Spain. Interviews were recorded and transcribed in order to analyze the contents. Results: Data on how nurses assess and handle pharmacological adherence are presented, as well as the difficulties they face and proposals for improvement. They believe this problem should be taken care of by both practitioners and nurses. The difficulties they find are: prescription fields deficiently recorded; the sparse revalidation of prescriptions by general practitioners; the lack of activity recording protocols; and the insufficient training on pharmacology nurses have. They reject the marker system used by the community Healthcare System because the daily routine of the nurses is not appreciated. They propose improving the records, the availability of pharmacology training and nursing training, the development of adherence assessment protocols in the Sanitary Area and the implementation of multidisciplinary programs.Conclusions: Nurses give great relevance to the pharmacological non-adherence issue, and they devote time and effort to it. The impediments they highlight reduce the effectiveness of the interventions carried out. Training is necessary for a better handling of this issue, as well as the joint multidisciplinary participation of practitioners, nurses, pharmacists, social workers, clinical psychologists and managers, patients and relatives so as to implement strategies which may optimize the outcomes.

Enfermeras de Atención Primaria opinan, analizan y proponen mejoras en el manejo de la adherencia farmacológica

Aim: To find out how primary care nurses perceive and handle pharmacological non-adherence and to identify areas for improvement. Methods: A qualitative study including focal groups and in-depth interviews was carried out in May-June 2009 in the Sanitary Area V of Asturias, Spain. Interviews were recorded and transcribed in order to analyze the contents. Results: Data on how nurses assess and handle pharmacological adherence are presented, as well as the difficulties they face and proposals for improvement. They believe this problem should be taken care of by both practitioners and nurses. The difficulties they find are: prescription fields deficiently recorded; the sparse revalidation of prescriptions by general practitioners; the lack of activity recording protocols; and the insufficient training on pharmacology nurses have. They reject the marker system used by the community Healthcare System because the daily routine of the nurses is not appreciated. They propose improving the records, the availability of pharmacology training and nursing training, the development of adherence assessment protocols in the Sanitary Area and the implementation of multidisciplinary programs.Conclusions: Nurses give great relevance to the pharmacological non-adherence issue, and they devote time and effort to it. The impediments they highlight reduce the effectiveness of the interventions carried out. Training is necessary for a better handling of this issue, as well as the joint multidisciplinary participation of practitioners, nurses, pharmacists, social workers, clinical psychologists and managers, patients and relatives so as to implement strategies which may optimize the outcomes.

Improving standards for paediatric clinical trials

Improving standards for paediatric clinical trials

Garrett Gross: Probing the Processes of Protection

In keeping with the idea that a little bit of bad can sometimes be good, transient ischemic episodes in the heart can be protective against more serious future attacks. This protective process, called preconditioning, was identified in 1986.1 Just a few years later, Garrett Gross and his colleagues discovered that drugs that opened cardiac ATP-sensitive potassium channels mimicked the preconditioning process.2,–,4 The gateway to the molecular understanding of preconditioning was opened, and the field grew and grew. Gross was, and still is, a preeminent leader in that field. In the late 1990s, work by his team showed that opioids, just like potassium channel openers, could mimic preconditioning.5,6 This discovery spawned yet more excitement and research activity, partly because of the ready availability of opioid drugs, such as morphine. Today, Gross, who is Professor of Cardiovascular Pharmacology at the Medical College of Wisconsin, Milwaukee, is still hunting for cardioprotective compounds and deciphering how they work. He talked to Circulation Research recently about his persistent passion for preconditioning and cardioprotective drugs. ### Where Did You Grow Up? Why did I grow up? That's a good question. Oh, where? [Laughs] I grew up in South Dakota. It was in a small town with only about 1500 people, so everybody knew everybody else's business. It was a farming and dairy community. I used to go out and work on the farms in the summer and bale hay and things like that. It was good exercise. My father was the local pharmacist, so I also worked in the drug store during my younger years, on and off throughout high school and college. It was the family business. My mother helped out too, as well as being a housewife. ### Did the Family Business Stimulate Your Interest in Science? I definitely would agree with that statement, that and the fact that at school, …

Clinical Manual of Psychopharmacology in the Medically Ill

Back to table of contents Previous article Next article Book ReviewsFull AccessClinical Manual of Psychopharmacology in the Medically IllDavid Gitlin, M.D.David GitlinSearch for more papers by this author, M.D.Published Online:1 Apr 2011https://doi.org/10.1176/ps.62.4.pss6204_0437AboutSectionsView articlePDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleClinical Manual of Psychopharmacology in the Medically IllFerrandoStephen J., M.D., LevensonJames L., M.D., and OwenJames A., Ph.D.; Washington, D.C., American Psychiatric Publishing, Inc., 2010, 640 pages, $75Over the past 20 to 30 years, there has been a massive proliferation in the pharmacologic armamentarium for virtually all medical and surgical illnesses. Although medical schools have stepped up training in pharmacology, most physicians are increasingly overwhelmed by the knowledge base necessary to keep track of all the medications available. Psychiatrists manage to develop expertise in the appropriate use of psychotropic medications to treat psychiatric illnesses but struggle to keep current with the pharmacotherapy of most medical and surgical conditions. Likewise, internists and surgeons are proficient in the use of pharmacotherapies in their own specialties but often lack essential knowledge about the use of psychotropic medications. And for all providers, understanding of the potential for interactions between the several classes of drugs is often beyond reach.Entering the fray is the Clinical Manual of Psychopharmacology in the Medically Ill, a text that aims to provide a single reference for both general physicians and psychiatrists. To the credit of the editors, the book comes quite close to hitting its mark.The text is divided into two main sections. The first is focused on general principles of psychopharmacology, which provide a context for understanding psychotropic medication issues in medical populations. The first two chapters on drug-versus-drug interactions and severe drug reactions are well organized but can be found in many other general psychiatry texts. For hospital-based physicians, the chapter on alternate routes of drug administration is useful and informative, providing some options for the complicated issue of patients unable to take oral medications because of medical circumstances.The second section is organized around organ systems. These chapters discuss common medical illnesses of each particular organ that may have neuropsychiatric sequelae or in which psychotropic treatments may play some role, adverse psychiatric effects of the typical medications used to treat those illnesses, the impact of psychotropic medications on the organ system under discussion, and finally a detailed review of medical-psychotropic drug interactions particular to that organ. Each chapter provides a series of easily referenced, organized tables of the relevant medications used for the organ system and drug-drug interactions. All chapters end with a summary of key clinical points, most of which are somewhat too general to be of significant value.Several of the chapters are especially beneficial to providers considering the complex interactions of a specific illness and its impact on the psychotropic treatment of patients. The chapter on gastrointestinal (GI) disorders, for example, discusses common disorders such as esophageal reflux and the potential indications for psychotropics, GI disorders on the interface of psychiatry (such as irritable bowel syndrome), GI side effects of psychotropic medications, and several important interactions. Special attention is given to patients with hepatic insufficiency, the pharmacologic impact of gastric bypass surgery, and antidepressant treatment issues with interferon-alpha hepatitis C treatment. The chapters on neurologic and endocrine disorders are equally superb. There is also an excellent discussion in the cardiology chapter on sudden death and QT prolongation due to psychotropic medications. Conversely, some of the chapters are a bit limited in the discussion of organ-specific illnesses, particularly the chapter on rheumatologic disorders.General psychiatrists who frequently treat patients with comorbid medical disorders will find this book to be a terrific reference and useful review. Primary care providers will also find this to be a helpful volume to keep at hand, especially for patients with chronic psychiatric disorders and new-onset general medical illnesses. Last, for those of us who are consultation-liaison and psychosomatic medicine psychiatrists, the editors have created an indispensable textbook.Dr. Gitlin is director of medical psychiatry at Brigham and Women's-Faulkner Hospitals, Boston.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 4 April 2011Pages 437-438 Metrics PDF download History Published online 1 April 2011 Published in print 1 April 2011

Current Status of Palliative Care in Israel

Pediatric cancer palliative care is characterized by diversity of care delivery models; effect of cancer on the family as the central focus of care and consideration of culture, spirituality, communication, and ethical standards. In Israel, children who are in palliative care are treated by the staff of the centers and about 70 to 80 % of the children are dying in the pediatric Hematology Oncology departments and units. Special efforts are also made in the pediatric departments in order to better treat adolescents in terminal phases. Palliative care education program in Israel was started several years ago together with adult palliative care specialists, the Israeli pediatric oncologists still witness many barriers for treatment amongst parents as well as in medical pediatric teams especially in pain management. During the last years, the Israeli pediatric palliative care teams improved the management of all symptoms in a dying child with special attention to existential, emotional and social demands of the child and the whole family. Education of the medical and nursing team is imperative, training in pharmacology and metabolism of antalgic drugs is also mandatory in order to better manage symptom control of the children at the end of life.

Drug policy in Europe: Research and funding in neonates: Current challenges, future perspectives, new opportunities

The availability of drugs for neonates is limited as evaluation is said more difficult in neonates than in older patients and adults, resulting in off-label drug use. Indeed, diseases may be specific to the neonatal period, the impact of immaturity and rapid developmental changes in the first days/weeks of life is important, and drugs may have short and long-term effects including developmental toxicity. To improve such situation, both the US and the EU have introduce paediatric legislation and the EMA has issued guidelines to optimize drug evaluation in paediatric populations including neonates. In addition, the following collaborative projects were funded by the EU in the co-operative programme of FP7. As preterm and term neonates are prone to infections which result in increase morbidity and mortality, the TINN (Treat Infections in Neonates) and TINN2 projects aim to evaluate off-patent anti-infectious drugs included in the EMEA priority list, ciprofloxacin/fluconazole and azithromycin respectively in the two projects. The final aim is to obtain a Paediatric Use Marketing Authorization for these drugs in neonates. In addition, TINN will build up a network of units with experience in evaluating anti-infective agents in neonates. An additional important initiative called GRIP (Global Research in Paediatrics) will focus on paediatric clinical pharmacology training and will facilitate the development and safe use of medicine in children.

Perception of risk of adverse drug reactions: a 3‐year follow‐up of a cohort of medical students

Previous studies have pointed out the question of effective training and information to health professionals on pharmacovigilance. The lack of training is known to induce inadequate use of drugs and noncompliance of patients. Pharmacology teaching is performed in the third year of medical studies at the Toulouse Faculty of Medicine. The aim of the study was to investigate the perception of risk of adverse drug reactions (ADRs) by medical students at the end of the one year pharmacology course and two years later, after clinical training period. Sixty-seven students were interviewed in May 2005 and in October 2007. Visual analogue scales were used to define a score of perceived risk of ADRs associated with each drug class (ranking from 0 to 10) before and after pharmacology training. The drug classes evaluated were antibiotics, anticoagulants, antidepressants, aspirin, contraceptive pill, corticosteroids, drugs for arterial hypertension, drugs for diabetes (other than insulin), hypnotics, hypocholesterolaemic drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), postmenopausal hormone replacement therapy and tranquilisers. After pharmacology courses (May 2005), antidepressants were ranked as the most dangerous drugs by medical students [median score (25th-75th centiles): 7.7 (6.3-8.6)], followed by anticoagulants [7.6 (6.6-8.4)] and hypnotics [7.4 (6.1-8.1)]. Contraceptive pills was listed in the last position [median score [4.7 (2.2-6.7)]. Two years later (October 2007), anticoagulants moved into the first position [8.3 (7.3-9.2)], followed by NSAIDs [6.9 (5.0-8.4)] and aspirin [6.8 (5.8-8.4)]. Contraceptive pills remained in the last position. No change was observed for NSAIDs and aspirin, still ranked as dangerous drugs by medical students after clinical training. Values of perceived risk were significantly increased for anticoagulant (+9.2%, P < 0.01) and hypoglycemiant drugs (+27.7%, P < 0.0001). The perceived risk significantly decreased for hypocholesterolaemic (-14.3%, P < 0.0001) and antidepressant drugs (-19.5%, P < 0.0001), but not for hypnotics. The study shows that the perception of risk of ADRs by medical students was modified after clinical training. They were still aware of potentially serious ADRs associated with anticoagulants, aspirin or NSAIDs, but they remained less cautious for drugs such as antidepressants. Additional pharmacology training at the end of medical studies will be useful.

Teaching of clinical pharmacology and therapeutics in UK medical schools: current status in 2009

Junior doctors feel poorly prepared by their training in Clinical Pharmacology and Therapeutics and commonly make prescribing errors. Since 1993 the General Medical Council's guidance on undergraduate medical education 'Tomorrow's Doctors' has emphasized the integration of Clinical Pharmacology and Therapeutics teaching within the medical curriculum. With the publication of a new version of Tomorrow's Doctors in 2009, medical schools will be further revising their Clinical Pharmacology and Therapeutics teaching. Although we know what the recommendations for undergraduate teaching of Clinical Pharmacology and Therapeutics teaching are, there are no published data describing what is currently happening in UK medical schools. This paper describes the course structures, volume and range of teaching and assessment of Clinical Pharmacology and Therapeutics in the UK in 2009. Our data provide a foundation for schools looking to revise the Clinical Pharmacology and Therapeutics Teaching in the light of Tomorrow's Doctors 2009. To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools. An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009. Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were 'fairly' to 'well' prepared for the foundation year but only 37% of schools gather data on the competence of their graduates. CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors.

Medical clerkships do not reduce common prescription errors among medical students

Prescribing correctly represents one of the most essential skills of a doctor when it comes to patient safety. Unfortunately, prescribing errors still account for a large proportion of avoidable drug-related problems (DRP). Despite this shortcoming, many medical schools do not provide specific prescribing training and assume that students acquire sufficient prescribing skills during regular medical clerkships. We therefore investigated whether there is an association between the individual time spent by students in internal-medicine clerkships and the number of prescription errors committed in a standardized prescribing test for common drug-related problems in a medical inpatient setting. Seventy-four fifth-year medical students (25 +/- 3 yrs, 24 m, 50 f) who had completed their formal pharmacology training filled in prescription charts for two standardized patient paper cases. The charts were rated by two blinded consultants from the field of internal medicine using a checklist for common prescription errors. Students were divided into three groups according to the number of weeks previously spent in internal-medicine clerkships. Group differences in the number of prescription errors made were subsequently examined. Students committed 69% +/- 12% of all possible prescription mistakes. There was no significant difference between the group without clerkships in internal medicine (G1) (71 +/- 9%), the group with one to four weeks (G2) (67 +/- 15%), and the group with more than five weeks of clerkships (G3) (71 +/- 10%), p = .76. Medical students do not seem to acquire the necessary skills to avoid common prescription errors during regular clerkships in internal medicine. This study provides evidence to suggest that specific prescription training within medical education is warranted in order to prevent DRP.

A randomised controlled trial of the effects of note-based medication review by community pharmacists on prescribing of cardiovascular drugs in general practice

Abstract Objective Recent trends in primary care have seen closer working relationships between community pharmacists and general practitioners (GPs) in an attempt to improve the effectiveness and efficiency of prescribing. Community pharmacists are appropriate for a role in the management of prescribed medicines because of their detailed training in pharmacology, therapeutics and pharmaceutics. The aim of this project was to quantify the benefit of a general practice-based, community pharmacist-led, note-based medication review of patients with hypertension or angina. Method Trained community pharmacists (20), attached to Grampian general practices (43), reviewed repeat prescriptions of a random sample of patients taking cardiovascular drugs for the treatment of angina or hypertension, and made recommendations to the GP for changes, where appropriate. The effect of the pharmaceutical intervention was measured in terms of prescribing indicators, patient outcomes (quality of life, symptom control), and physiological and biochemical markers at baseline, 6 and 12 months. A control group was treated following standard practice. An economic evaluation of the interventions was also conducted. Key findings The baseline standard of treatment as measured against guidelines was good. At 12 months, there was a small improvement in prescribing of antiplatelet drugs, but overall changes were minimal. Average overall cost per patient was higher in the intervention group. The quality of life measures showed no change between the groups. Conclusions Improvements in the intervention group were small and less than in other reported studies of pharmacist interventions. The National Health Service (NHS) costs of the intervention group were higher than those of the controls. Note-based medication review by community pharmacists was found to be associated with minimal changes in prescribing.

Re-engineering pharmacology teaching and research: Can we adopt translational approach?

Re-engineering pharmacology teaching and research: Can we adopt translational approach?

Providing safe medicines for children in Nigeria: The impediments and remedies

Promoting safety of medicines for children is a global concern which has prompted the World Health Organization (WHO) to launch a campaign of "Making Medicines Child Size". Children in Nigeria were once victims of unethical clinical medicine trials and repeated victims of use of fake and adulterated medicines. Considering the magnitude of harms children had suffered in Nigeria from the use of medicines, there is a need for literature review to identify the factors preventing children from accessing safe medicines and to suggest remedies to the problems. Lack of access to up- to- date medicine information, lack of training and research in pediatric clinical pharmacology, deficiencies in undergraduate and postgraduate teaching of medicine risk management and clinical pharmacology and therapeutics, irrational medicine use due to lack of pediatric focus on essential medicine list and inappropriate home storage of medicines by parents, lack of evidence- based medicine (EBM) practice, lack of national adverse drug reaction surveillance among children, and weak national drug policies were the major problems identified. It is to be hoped that development and provision of a pediatric national drug formulary for health professionals in Nigeria, creating a comprehensive national pediatric drug research network in collaborations with developed countries, reviewing the undergraduate and postgraduate curriculum in pediatrics to include teaching of basic elements of rational prescribing, drug dose calculations, adverse drug reactions and pharmacovigilance, increasing access to essential medicines for children, postgraduate teaching of EBM, and strengthening of the national drug policies would improve children's access to safe medicines in Nigeria.

John Feely

John Feely