Presence Of Pharmacist Research Articles

Challenges for Expansion of Thoracic Transplant Clinical Pharmacy in Brazil: Comparison with U.S. Accredited Centers and Call for Action

Clinical pharmacists' involvement in the care of transplant recipients has become a requirement in the accreditation process of transplant centers. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programs nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centers in Brazil and compared them with accredited U. S. programs. An electronic questionnaire was distributed to all heart and lung transplant centers registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. The survey consisted of 16 questions on presence, full-time equivalents (FTEs), practice-setting and training of clinical pharmacists at each center. Survey findings were compared to available published data from accredited U.S. centers. From 39 centers invited, 22 (16 heart and 6 lung) responded, representing 88.6% (n=420) of thoracic transplants performed nationally in 2018. Ten centers (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translates into 144 (35.2%) transplant recipients without any direct pharmaceutical care. In centers with pharmacists (n=12), none had a full-time professional dedicated to their programs. When compared to U.S. centers, there was a significantly lower expression of several aspects of transplant clinical pharmacist activities among Brazilian centers (Figure 1). Importantly, pharmacist FTE in Brazil was less than half of that observed in the U.S. Marked differences exist in Brazilian centers in comparison to the U.S. Our findings point to an unmet need related to clinical pharmacist activity within thoracic transplant programs, especially in developing countries, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

Knowledge and Attitude of Health Professionals Towards Clinical Pharmacy Services in Selected Hospitals in West Shoa Zone, Ethiopia

Clinical pharmacy services are patient oriented services developed to promote the rational use of medicines by maximizing therapeutic effect of medicines in individual patients. The service is at the infant stage in Ethiopia and there is no adequate information about it in the country. Therefore, the aim of this study was to assess the knowledge, attitude & practice of health professionals towards clinical pharmacy services in selected public hospitals in West Shoa Zone, Oromia Region, Ethiopia. A facility based cross sectional survey was conducted from April 2 to April 16, 2018. The study used a quantitative method of data collection. A total of 150 health professionals were involved in the study; and convenience sampling techniques was used to collect the data. Data was collected using structured and self-administered questionnaires and it was analyzed by using SPSS version 23. Descriptive statistics including frequency, mean, percentage and table was used to present the data. 128 (92.1%) of health professionals were heard about clinical pharmacy services in Ethiopia. 104 (74.8%) strongly agreed & agreed that they appreciated the presence of pharmacist in the ward all the times important for patient care. However, 67 (48.2%) of respondents said the performance of the pharmacists in practicing clinical pharmacy in the hospital was poor. Generally, majority of health professionals had adequate knowledge and positive attitudes towards clinical pharmacy services but their practice with clinical pharmacists was found poor. It is recommended that collaborative working relationship should be established among health professionals in order to optimize and monitor drug use problem in the hospitals.

Amputation rate of diabetic foot ulcer and associated factors in diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: prospective observational study

BackgroundDiabetes foot ulcer is a devastating and much-feared complication of diabetes. Diabetes foot ulcerations which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Despite this, there is no finding on predictors of the amputation rate of diabetes foot ulcers in Ethiopia. Hence this study was aimed to identify factors associated with the amputation rate of diabetes foot ulcer patients in Nekemte referral hospital.Patients and methodsA prospective observational study was conducted among adult diabetes foot ulcer patients admitted to Nekemte referral hospital from March 15 to June 15, 2018. A pus swab was obtained from the ulcers before any ulcer cleaning to conduct gram staining. The primary outcome was the amputation rate. Cox regression analysis was used to estimate the hazard ratios and time from study entry to healing was evaluated as censored event times by Kaplan-Meier curves.ResultOver the study period, 115 diabetes foot ulcer patients were admitted to the NRH; of these patients, 64(55.65%) were males while the mean age of participants was 44.4 ± 14.7. A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean ± standard deviation of body mass index (BMI) was 24.94 ± 3.69 kg/m2 and a total of 56(48.69%) diabetic foot ulcer had a diabetic complication.Of patients with diabetic foot ulcer, 35(30.43%) were undergone lower extremity amputations (LEA). Patients who were prescribed with inappropriate antibiotics were unlikely to heal. A total of 18(46.15%) of the patients who were taken inappropriate antibiotics were healed whereas 21(53.85%) were not healed (P = 0.017). Besides, the higher the Wagner grade, the worse the outcome of healing. A total of 19(21.84%) and 16(57.14%) of patients with grade < 4 and grade ≥ 4, respectively, did not heal (P = 0.005).ConclusionThe amputation rate of diabetes foot ulcers was rapid for patients prescribed inappropriate antibiotics and higher grades of the foot ulcer. Therefore, the presence of clinical pharmacists plays a pivotal role to promote the appropriate use of antibiotics and besides the daily care, special attention should be given for patients having an advanced grade of diabetes foot ulcer.

Pharmacists - Medical Doctors Work Relationship and Its Effect on Patient Care in Benin- City, Edo State

Purpose: To evaluate pharmacists- medical doctors work relationship, factors that affect it and its effect on patients’ treatment outcome. Methods: A descriptive cross-sectional survey of registered doctors and pharmacists was conducted in five hospitals. Socio-demographics, perception of roles and services, factors that affect work relationship; areas of poor work relationship and perceived effect of pharmacists-doctors work relationship on patient outcomes were assessed with a validated structured questionnaire. Data was analyzed with SPSS Version 22 for descriptive statistics and GraphPad Instat® Version 3.0 for inferential analysis. Results: About 305 (90.2%) respondents agreed that their work-relationship affects patient outcomes, 87 (88.8%) of pharmacists and 205 (85.4%) medical doctors agreed that poor communication affects their relationship. Also, 91% of the pharmacists and 77% of the medical doctors opined that joint clinical meetings as well as 96% pharmacists and 58% doctors agreed that grand ward rounds can help improve pharmacists- medical doctors work-relationship (p &lt; 0.01). Similarly, many pharmacists (97%) and doctors (46%) said presence of pharmacist in the wards will significantly improve patient outcomes (p &lt;0.01). About 177 (49.5 %) pharmacists and 129 (39.4%) medical doctors had a positive attitude to inter professional relationship and 185 (54.9%) pharmacists had positive influence on prescriptions. Majority, 85% of the respondents believed that collaboration will improve quality of service and interdisciplinary relationship with positive effect on patient care. Conclusion: There were positive views about collaboration, doctors agreed that joint clinical meetings and pharmacists acknowledged that grand ward rounds will help enhance their work relationship. This will improve quality of service and interdisciplinary relationship with positive effect on patient care. Keywords: Doctors, Pharmacists, work relationship, collaboration, patient care, communication

Pharmacist Presence Decreases Time to Prothrombin Complex Concentrate in Emergency Department Patients with Life-Threatening Bleeding and Urgent Procedures.

Reversal of anticoagulation with four-factor prothrombin complex concentrate (4F-PCC) is critical, yet the optimal timing to 4F-PCC administration and whether quicker administration improves hemostasis remains unknown. The objective of this study was to determine if pharmacist presence is predictive of faster time to 4F-PCC. This retrospective cohort study included patients receiving 4F-PCC for life-threatening bleeding or urgent procedure in the emergency department (ED) from 2014 to 2018. Patients with pharmacists at bedside (PharmD group) were compared with physician teams alone (control group). The primary outcome was time from ED presentation to 4F-PCC administration. Of 252 patients evaluated, 116 patients (46%) were included (n=50 PharmD group; n=66 control group). Most patients presented on warfarin (68.1%), and of the life-threatening bleeds (94%), intracranial hemorrhage was most common (67.2%). The median time to 4F-PCC administration was significantly shorter in the PharmD group (66.5 vs. 206.5min, p<0.001). Pharmacist at bedside was the only factor independently associated with reduction in time to 4F-PCC (β coefficient -163.5min, 95% confidence interval -249.4 to -77.7). Although there was no difference in hemostasis or mortality, patients in the PharmD group had a shorter intensive care unit length of stay (LOS) (2 vs. 5days, p<0.01) and hospital LOS (5.5 vs. 8days, p=0.02). A pharmacist at the bedside of patients who present to the ED with life-threatening bleeding or need for emergent procedure decreased time to 4F-PCC administration by 140min, even after accounting for confounders. Faster time to 4F-PCC was associated with significantly shorter intensive care unit and hospital LOS.

Introducing pharmacy students to the structure and function of general practice through undergraduate placements

Background and purposeThe aim of this study was to design and evaluate the introduction of a sustainable and feasible structure of placements in general practice for third-year pharmacy students at the University of Sunderland. The national agenda in the United Kingdom (UK) calls for an increased presence of pharmacists within general practice; therefore, development of placements in this is setting is aligned to the development of these new roles. Educational activity and settingThe placements were located in general practice surgeries in the North East of England in the UK. Students engaged in activities which introduced them to the structure and function of general practice and familiarise them with the role of pharmacists and other practice staff. Two cohorts undertook the education activity during the development process. The first cohort was comprised of 213 students, with 193 students the following year. FindingsAn action research approach was taken to evaluate and revise the design of the placement. The final design and delivery have been shown to have a positive impact on student learning experience, be feasible and sustainable. The placement was also successful at introducing students to potential future roles in general practice for pharmacists. SummaryThis model of general practice placement provision was found to be a feasible and sustainable delivery model, which was well received by undergraduate students.

Physician’s feedback on a clinical pharmacy program on geriatric wards

ABSTRACT Objectives As clinical pharmacy (CP) services can improve drug use and clinical outcome in older inpatients, a dedicated CP program was installed at the geriatric wards of an academic hospital. The aim of this study was to evaluate and potentially improve the CP program, by obtaining physician’s feedback. Methods An anonymous e-questionnaire was sent to all physicians who were active between October 2014 and March 2018 on the acute geriatric wards (80 beds) of the University Hospitals Leuven, Belgium. Thematic content analysis was applied. Six themes were defined: satisfaction with the service, time allocation of the clinical pharmacists, content and clinical relevance of pharmaceutical interventions, communication, time savings for the treating physician and future perspectives. Results A total of 45 physicians (59%) completed the e-questionnaire. All respondents were satisfied with the content of the provided pharmaceutical recommendations. A minority (44%) found that a 0.8 full-time equivalent clinical pharmacist presence was sufficient in terms of the expected workload. The provided CP interventions improved quality of care according to 38 (84%) physicians. Oral and written communication were considered necessary by 89% and 82% of physicians, respectively. On average, an estimated 30 minutes physician time (IQR: 15–60) per patient was saved as a result of the program. The majority (87%) preferred clinical pharmacist presence for discharge support in all geriatric patients. Conclusion Physician’s satisfaction with the CP service was very high. CP services in geriatric inpatients were perceived to be clinically relevant as well as time-saving by the involved physicians.

Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit

ObjectiveTo determine the clinical pharmacist‐generated cost avoidance and benefit‐cost ratio in a medical intensive care unit (MICU).MethodsAll accepted clinical pharmacist recommendations on a multidisciplinary, rounding service at an academic medical center over a 12‐month period were evaluated. Cost avoidance values from each intervention were determined using a systematic framework. Total cost avoidance was calculated by summing the cost avoidance for each general category. Average rates of cost avoidance per day and hour were calculated by dividing total cost avoidance by number of days and hours the clinical pharmacist provided care. Average interventions and cost avoidance per day and hour were calculated for weekday and call status. Differences between months, day of the week, and call status were evaluated using chi‐square goodness of fit tests.ResultsOver 12 months, 8866 clinical pharmacist‐recommended interventions were implemented, averaging 38.9 interventions per workday. The four most commonly accepted interventions were minor adverse drug event prevention (n = 4023, 45%), dosage adjustment: no continuous renal replacement therapy (n = 1162, 13%), antimicrobial therapy initiation and streamlining (n = 966, 11%), and antimicrobial pharmacokinetic evaluation (n = 777, 9%). All interventions resulted in a total cost avoidance of $3 270 178, averaging $14 731 per workday. Interventions per hour (P &lt; 0.001) and average cost avoidance per hour (P &lt; 0.001) differed significantly across workdays. For on‐call days compared with postcall days, there were a similar average number of interventions per hour (10.2 vs 9.8, P = 0.28) and average cost avoidance per hour ($3741 vs $3622, P = 0.47); the benefit‐cost ratio was 24.5:1.ConclusionsThe clinical pharmacist‐generated cost avoidance over a 12‐month period in the MICU was $3 270 178 and the benefit‐cost ratio was 24.5:1. Day of the week but no call status affected average cost avoidance. Employing a clinical pharmacist to be part of the multidisciplinary MICU team can reduce health care expenditures through cost avoidance.

Pharmacy services in the emergency department: not a butterfly effect

Pharmacy services in the emergency department: not a butterfly effect

EVALUASI PELAKSANAAN PELAYANAN KEFARMASIAN DI APOTEK WILAYAH KOTA TEGAL TAHUN 2018 (BERDASARKAN PERMENKES NO 35. TAHUN 2014)

The government issued Minister of Health Regulation No. 35 of 2014 concerning Pharmacy Standards at the Pharmacy to serve as guidelines for pharmacist practice in carrying out professional duties to protect the community from Services. The purpose of this study is to find out the evaluation of the standard implementation of pharmaceutical services at the Tegal City Regional Pharmacy in 2018. This research is a descriptive quantitative analysis research. The source of the primary research data and tools in this study is a questionnaire sheet. Research Results from the Management Aspects of Pharmaceutical Preparations and Pharmacy Health Supplies in the City of Tegal Has carried out the management of Pharmaceutical Preparations with Good Category, as well as the Aspects of Pharmacy Resource Management in terms of the presence of Pharmacists and Medical Personnel, but there is less to the presence or absence of pharmacists at the Pharmacy. The aspects of facilities and infrastructure in providing a closed space for counseling can only be said to be sufficient. Aspects of Clinical Pharmacy Services are said to be lacking for monitoring drug therapy, monitoring drug side effects, and home care1. From the aspect of evaluation of service quality, recording medication records is said to be lacking. Whereas the quality of clinical services is also said to be good for attention to allergies, pharmaceutical examination of drugs, and examination of drug availability, but lack of attention to dual medications and contraindications. As well as in the dimension of waiting time, drug service is said to be sufficient. Keywords: Pharmacy, Pharmacy Service, Permenkes No. 35 of 2014

Study of Prescribing Pattern, Identification of Drug Related Problems and Therapeutic Intervention in Cardio Vascular Diseases (CVD) Patients

Cardiovascular disease (CVD) is a disorder of heart and blood vessels. CVD is one of the major causes of deaths in India, which contributed around 30 to 40%. The aim of the study was to study the prescribing pattern of drugs, identification of drug related problems and therapeutic intervention in CVD patients. A hospital based prospective and observational study was carried out for a period of nine months in a south Indian tertiary care hospital. Among 120 selected patients, 79 were male (65.83%) and 41 were female (34.16%), more number of patients (35) were between the age group of 55-64 (29.16%) of which 27 were males &amp; 8 were females, and very less number of patients (6) were between the age group 85-94 (5%) of which all the 6 were male. Hypertension is the most commonest and dominant disorder, which affected 47(39.16%) patients, in which 30 were male (25%) and 17 were female (14.16%). Most common risk factor is HTN followed with smoking and diabetes of 45 patients (37.5%). The most often prescribed pattern adopted in CVD is Dual therapy, it is most frequently used therapy 50 (41.66%) and quadruple therapy is less frequently 6(6.5%) used. The diuretics and calcium channel blocker combination were maximally prescribed class of drugs as a dual therapy. A total of 47 drug-drug interactions were found, among 12 were major, 15 were moderate and 20 were minor interactions. Clinical pharmacist has intervened with the help of other health care professionals in order to reduce the risk factor and minimise the drug-drug interactions. The study provides the benefits of presence of clinical pharmacist in a hospital setting, in order to prevent the medication related errors and provide the expertise pharmacotherapy opinion in CVD patients, which improves the patient compliance. Hence study justifies a need of active collaboration between clinical pharmacist, physician and other health care professionals for the better management of CVD patients.&#x0D; Keywords: Prescribing Pattern; Cardio Vascular Diseases; Drug Related Problems; Therapeutic Intervention.

Possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure: a nationwide cross-sectional questionnaire survey.

Palliative care for end-stage heart failure should be provided by a multidisciplinary team. However, the influence of each occupational category on patients receiving palliative care for end-stage heart failure remains unclear. Thus, this study investigated the relationships between palliative care conferences and positive outcomes of palliative care for end-stage heart failure patients. We sent questionnaires to all cardiology training hospitals authorized by the Japanese Circulation Society (n = 1004); of these, responses from the directors at 554 institutions were analyzed. We divided the responding institutions into two groups according to their implementation of palliative care conferences for patients with end-stage heart failure. The institutions that had held such conferences (n = 223) had a larger number of hospital beds, beds in the cardiovascular department, and patients admitted to the cardiovascular department, compared with institutions that had not held these conferences (n = 321). The usage rates of opioids, non-steroidal anti-inflammatory drugs, and sedatives were significantly higher in institutions that held these conferences. Multivariate analysis revealed that nutritionists and medical social workers had greater involvement in the improvement of mental symptoms and ensuring that patients could stay where they wished, respectively. The presence of palliative care physicians, physical therapists, or pharmacists was associated with multiple positive outcomes. This study indicated that there are possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure.

Impact of pharmacist's directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting

Abstract Objectives To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies and improving patient's outcomes at discharge from hospital. Methods During the 3-month study period, 200 patients were randomly selected from internal medicine department from Jordan University Hospital (JUH) and allocated into two groups (intervention and control groups). The number and types of medication discrepancies were identified at admission. Then, pharmacist implemented medication reconciliation and medication counselling services to the intervention group patients. At discharge, the number of unintentional discrepancies was evaluated for both groups. Patients were assessed at 1 month following their discharge for any subsequent hospital readmissions, emergency department visits or side effects of medication therapy. Key findings The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group. Omission and addition represented the most common types of discrepancies for both groups. Of the 84 recommendations submitted by pharmacists, clinicians accepted 78 cases (92.8%), and implemented only 46 recommendations (54.7%). At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, P-value (0.014), while no significant change was found for the control group, P-value = 0.508. One month postdischarge, a significantly higher number of patients in the control group reported experiencing side effects compared with the intervention group, P-value = 0.020. Conclusion The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors and improving health outcomes.

Description of Professional Fee for Pharmacist in Sleman

Pharmacist is a profession whose existence is needed by community. However, within the community of pharmacy itself, the presence of pharmacist is quite alarming. One of the causes of low pharmacist who desire to practice in the community of pharmacy is the low level of professional fee offered. This study aimed to describe professional fee received by pharmacist and the workload of pharmacist in Sleman. This study was a descriptive non-experimental that was conducted in Sleman in August 2017. Population of this study was a pharmacist who practiced in community of pharmacy in Sleman. Total of 170 respondents from 128 pharmacies were involved in this research. However, 6 questionnaires cannot be analyzed because it is not completely filled. The highest amount of professional fee is between Rp 2.000.000-Rp 3.000.000. Almost all respondents (78%) stated the amount of professional fee that was received was not as expected. The workload of pharmacists is not so heavy and most of the patient are self medication. Pharmacists at the community of pharmacy should be able to show a better work performace, which is shown by increasing pharmacy revenues to get a better rewards.

MEDIKOLEGAL PENGOBATAN UNTUK DIRI SENDIRI (SWAMEDIKASI) SEBAGAI UPAYA MENYEMBUHKAN PENYAKIT

&lt;p&gt;It has become a habit of self-medication with non-prescription drugs done by most Indonesians. In the Regulation of the Minister of Health No. 924 / MENKES / PER / X / 1993 Regarding the Medication List of Pharmacies regulates certain hard drugs that pharmacists can give to people without a prescription. The purpose of the publication of Permenkes is to swamedikasi, a person can self- edicate rationally and supported by the pharmacy's mandatory drugs, although in general pharmacists can not sell hard drugs without a prescription, but there are certain hard drugs based on Permenkes may be sold without a doctor's prescription . The issue raised is how medikolegal swamedikasi in the perspective of healing disease? as well as how are the barriers and medicolegal swamedikasi solutions in the perspective of curing diseases? swamedikasi most places done in pharmacies, knowing drugs purchased through news media such as advertising the reason is the first attempt before treatment to health care facilities, swamedikasi actors get an explanation of doses and how to drink by pharmacist / clerk / drug seller, surveillance of swamedikasi drug use carried out with how to monitor / inspect pharmacies, the results obtained are frequent pharmacists are not in place at open pharmacy hours, selling OWA (Pharmacy Drug Compensation) without the presence of pharmacists and administrative violations. The obstacles are not yet optimal supervision from the government solution with counseling about the rule of law of drug delivery, the second barrier of the lack of awareness of drug sellers in pharmacies that do not fit the provisions of the solution by giving counseling to the owner of pharmacy facilities so as not to pursue Profit Oriented but pay attention to Patient Oriented, the third obstacle of lack of knowledge the swamediciator of the drug classes that the solution can buy is the government to increase socialization or counseling to the community about proper and responsible swamedication. &lt;/p&gt;

Hospital pharmacy workforce in Brazil

BackgroundThis study aims to describe the distribution of the hospital pharmacy workforce in Brazil.MethodsData were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19.ResultsThe number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals.ConclusionThis study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

Evaluation of Clinical Pharmacy Services in the Intensive Care Unit of a Tertiary University Hospital in the Northwest of Iran.

Objective:Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran.Methods:During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance.Findings:In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist.Conclusion:The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

Editor's Introduction

Editor's Introduction Filomeno V. Aguilar Jr. In the nineteenth century, pharmacy in the Philippines was an exclusively male profession in terms of both education and practice. Moreover, despite the presence of Spanish and native pharmacists, the profession was dominated by migrant male German druggists who owned the largest boticas (drugstores). Leo Angelo Nery explains what a prominent male pharmacist decried in 1929 as the "feminine invasion" of the profession. Nery shows that, under US colonial rule, new educational institutes arose starting in 1903 to cater to the demand of women for training in pharmacy. Most crucially, in 1910 the colonial education system introduced domestic science as a mandatory subject for girls from the fourth to the seventh grade, a subject that not only prepared them for secondary school science subjects but also influenced perceptions of what constituted women's work. Nery argues that the alignment of these subjects to the pharmacy course in college made the latter hugely popular such that, by the 1920s, the feminization of pharmacy education and practice had been completed. By the 1930s women pharmacists opened home-based boticas, which allowed them to combine pharmacy practice with familial responsibilities—pharmacy being an extension of women's work at home. Thus, the creative process of breaking established norms of male exclusivity had the effect of liberating educated, middle-class women to pursue a career aspiration on top of their household duties, a layered burden eased by poor women domestic workers who performed the hard labor. A different kind of breaking barriers is portrayed in Miguel Paolo Reyes's article on the making of Ferdinand Marcos's persona as a scholarly president and ruler. In power for two decades, Marcos caused several books to be published with him as the supposed author, including Tadhana (1976), the hefty series on Philippine history that many know was written by a group of professional historians. Reyes draws from the methods of book history to demonstrate that thirteen books, which were strategic for the [End Page 135] legitimation of the martial law regime, were written by minions who played key roles in constructing the fiction of a scholar-president. The first and most crucial among these books was Today's Revolution: Democracy (1971), which, argues Reyes, was beset by plagiarism and factual errors. That he could breach norms of intellectual honesty is not surprising; the bigger question is why Marcos desired the reputation of a scholar. Was he styling himself as a philosopher-emperor like Marcus Aurelius? Did he seriously think of himself as a political theorist? Did he believe people would read his books or even just behold them and be mesmerized by his intellect? Did he really think that those books would be the first and last word on his rulership? Reyes provides some clues to explain Marcos's scholarly dream, but it remains an enigma. Max Weber famously described the state as reserving for itself the monopoly on violence within its jurisdiction, thus drawing the line between the legitimate and illegitimate use of physical force. In discussing the relationship between the Philippine state and the Banwaon in Agusan del Sur province, Augusto Gatmaytan argues that the military's deployment of the katangkawan (Supreme Datu) in counterinsurgency operations since the late 1990s has punctured the boundary between state and private violence. The indigenous leader has become a paramilitary organizer, armed, paid, and supervised by the state through the military, but superimposed on his deathly actions is the pursuit of the traditional vendetta, which eludes the state's control and centralizing authority. Gatmaytan argues that in this frontier zone people live in fear of the underworld, where the state has been "tribalized," one in which the datu blurs the line between legal and extrajudicial violence. Colonial states encouraged this type of underworld, as James Rush has shown vividly in the opium trade in nineteenth-century Java; at present, the Philippine state has also relied upon an underworld in pursuit of its antidrug operations. What will make state actors realize that a stable state cannot be built on shifting sand? Some lines must not be crossed; some barriers are not meant to be breached. [End Page 136] Filomeno V. Aguilar Jr...

The Role of Clinical Pharmacists in the Emergency Department.

The ED is a unique setting with a diverse and complex patient population presenting around the clock with urgent and emergent needs. Emergency physicians readily utilize and value the presence of ED pharmacists to aid in this care [10, 52–54]. We support 24-h staffing of emergency departments with dedicated ED pharmacists as part of the clinical care team. ACMT also supports studies to further define the impact and value of pharmacists in the ED and other areas of ED expansion such as urgent care and observation units.

Pharmacist Participation in Acute Ischemic Stroke Decreases Door-to-Needle Time to Recombinant Tissue Plasminogen Activator.

Pharmacists are an important member of the stroke team and aid in obtaining medication and medical history, providing education, managing blood pressure, reviewing exclusion criteria for recombinant tissue plasminogen activator (rtPA), and facilitating reconstitution and administration of rtPA. To determine if pharmacist presence at bedside during acute ischemic stroke resulted in a reduction in door-to-needle (DTN) times. This was a retrospective cohort study between January 1, 2011 and December 31, 2015 of patients who received rtPA for acute ischemic stroke in either the emergency department or hospital. Of the 125 included patients, 45 patients (36%) had a pharmacist present (PharmD group) and 80 patients (64%) did not (no PharmD group). Median DTN time was significantly shorter in the PharmD group: 48 minutes versus 73 minutes in the no PharmD group ( P < 0.01). The goal of DTN ≤60 minutes was met in 71% of patients in the PharmD group compared to 29% ( P < 0.01). Pharmacist at the bedside was the only factor found to be independently associated with reduction DTN time (βcoefficient -23.5 minutes, 95% confidence interval [95% CI] -38.6 to -8.50 minutes). A pharmacist at the bedside of emergency department or in-patient stroke codes reduced DTN time by a median of 23.5 minutes after adjusting for confounding factors and increased the percentage of patients meeting DTN goal time of ≤60 minutes by 49%. These findings support the inclusion of a stroke-competent pharmacist in the bedside response team for acute ischemic stroke patients.