Pharmacy Practice <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge any publication fee to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> Centro de Investigaciones y Publicaciones Farmaceuticas en-US Pharmacy Practice 1885-642X <p>The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to <strong>Pharmacy Practice</strong> with this document.</p> <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_blank" rel="noopener">Creative Commons Attribution License</a> (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Peer review and publication delay <p>Selecting peer reviewers is a crucial stage of the editorial process that ensures the quality of scholarly publications. An alternative to selecting peer reviewers from data bases created with expressions of interest of volunteers consists in systematically searching PubMed for similar articles and inviting their authors to act as peer reviewers. Although this process might identify more appropriate peers, it also can increase the time of the editorial process. In 2018, Pharmacy Practice had to invite 4.70 (SE=0.33) potential reviewers per one accepting. The time from the first reviewer invitation to the last reviewer report received was 61 days (SE=2.1). These figures confirm the existence of a peer review crisis which is significantly increasing the publication delay.</p> Fernando Fernandez-Llimos ##submission.copyrightStatement## 2019-03-20 2019-03-20 17 1 1502 1502 Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review <p>Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers.</p> John Mishriky Ieva Stupans Vincent Chan ##submission.copyrightStatement## 2019-02-18 2019-02-18 17 1 1410 1410 Effect of a smoking cessation educational intervention on knowledge and confidence of pharmacy students versus community leaders <p><strong>Background</strong>: Training programs of various intensities and durations have been implemented to assist healthcare providers and students in leading smokers in a quit attempt. While some training programs have been developed to help community leaders provide these services, the focus for community leaders has been to assist with recruitment efforts.</p> <p><strong>Objective</strong>: The objective of this study was to compare knowledge and confidence of students and community members before and after a smoking cessation educational intervention.</p> <p><strong>Methods</strong>: After approval from the institutional review board, pharmacy students and community members were recruited for two-hour educational interventions. Topics covered included smoking health risks, benefits of quitting, behavioral, cognitive, and stress-management techniques, smoking cessation medications, and how to start a formal class. Pre- and post-intervention survey instruments were given to all participants with comparisons made via Student’s or Paired T-tests, as appropriate.</p> <p><strong>Results</strong>: Knowledge scores increased significantly (p&lt;0.05) after the educational intervention for pharmacy students (n=30) and community members (n=8). Confidence scores increased significantly for pharmacy students (p&lt;0.05), but not for community members. Pharmacy students had significantly greater knowledge score changes (53.7%, pre-intervention; 81.8%, post-intervention; p&lt;0.05) versus community members (32.1%, pre-intervention; 50.1%, post-intervention; p&lt;0.05). When comparing individual confidence questions, only scores evaluating the change in confidence for providing counseling were higher for students versus community members (2.13 vs. 1.8, respectively; p&lt;0.05).</p> <p><strong>Conclusions</strong>: Pharmacy students and community leaders exhibited increased knowledge after a smoking cessation educational intervention, and pharmacy students had increased confidence scores. All confidence scores did not change significantly for community members. Developing coalitions between healthcare providers and community leaders, focusing on the roles of each, may be productive in initiating smoking cessation programs.</p> Justin J. Sherman Brett L. Smith ##submission.copyrightStatement## 2019-03-24 2019-03-24 17 1 1302 1302 Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon <p><strong>Background</strong>: Inappropriate medication dosing in patients with chronic kidney disease can cause toxicity or ineffective therapy. Patients are at a high risk of developing related adverse events caused by the altered effect of drugs in conjunction with the use of polypharmacy to treat comorbid conditions. This necessitates adequate renal dosing adjustments.</p> <p><strong>Objective</strong>: The current study aims at assessing whether appropriate dosing adjustments were made in hospitalized patients with chronic kidney disease.</p> <p><strong>Methods</strong>: A retrospective descriptive study was conducted at two university hospitals in Beirut between January and December 2016. All adult CKD patients with creatinine clearance less than 60 ml/min and receiving at least one medication that require renal dosing adjustment were included. Kidney function was estimated from serum creatinine using Cockcroft-Gault equation, and dose appropriateness was determined by comparing practice with specific guidelines. The rates of renal drug dosing adjustment were investigated, in addition to the influence of possible determinants, such as the severity of renal impairment, reason of hospital admission, and other patient characteristics.</p> <p><strong>Results</strong>: 2138 patients admitted in 2016 were screened. 223 adults receiving 578 drug orders that require adjustment were included. Among the 578 orders, 215 (37%) were adjusted adequately, 284 (49%) were adjusted inadequately, and 79 (14%) were not adjusted at all. Beta-blockers were the most inadequately dosed (83.6%) class of medication, whereas lipid-lowering agents had the highest percentage of adequate dosing (65.1%). As per patient, 84.3% of patients appeared to be receiving at least one inappropriate drug dose.</p> <p><strong>Conclusions</strong>: Our study confirms that physicians are not prescribing appropriate dosing adjustments in chronic kidney disease inpatients, which may have deleterious effects. This highlights the need for more nephrology consultation and the implementation of physician education programs.</p> Rayane Saad Souheil Hallit Bahia Chahine ##submission.copyrightStatement## 2019-02-27 2019-02-27 17 1 1304 1304 Effect of the pharmacist-managed cardiovascular risk reduction services on diabetic retinopathy outcome measures <p><strong>Background</strong>: Diabetic retinopathy (DR) is a progressive, sight-threatening long-term complication of diabetes. Diabetes disease management reduces the risk of developing or progression to a severe form of DR. However, there are no reports of the potential role of pharmacists in DR progression.</p> <p><strong>Objective</strong>: For this study, we performed a retrospective data analysis of patients with diabetes seen at cardiovascular risk reduction services provided by pharmacists with an objective to determine the potential role of pharmacists in the DR progression. These services involve pharmacists working in collaborative drug therapy management (CDTM), using a collaborative practice agreement (CPA) with primary care physicians.</p> <p><strong>Methods</strong>: Patient records and ophthalmological notes were collected for 317 individuals seen by the pharmacists (intervention group) and 320 individuals seen only by a physician (control).</p> <p><strong>Results</strong>: Statistical analysis was performed on 148 individuals in an intervention group and 120 individuals in the control group for which complete records were available. Retinopathy progression remained stable in 89.6 % of individuals in the intervention group compared to 87.9% in the control group. Moreover, the relative risk of retinopathy progressing to a severe form was 1.17 for the control group compared the intervention group.</p> <p><strong>Conclusions</strong>: Our studies provide a proof-of-concept that pharmacists-managed care possesses a potential role in protection from DR, and paves a way for future pharmacists managed care with an emphasis on reducing diabetic complications.</p> Zachary A. Weber Palakpreet Kaur Amrita Hundal Somnooma H. Ibriga Ashay D. Bhatwadekar ##submission.copyrightStatement## 2019-03-04 2019-03-04 17 1 1319 1319 Clinical pharmacist implementation of a medication assessment tool for long-term management of atrial fibrillation in older persons <p><strong>Background</strong>: Optimisation of drug therapy is important in the older population and may be facilitated by medication assessment tools (MATs).</p> <p><strong>Objective</strong>: The purpose of the study was to evaluate whether appropriateness of drug therapy and clinical pharmacist intervention documentation improved following implementation of a previously developed MAT for the long-term management of atrial fibrillation (MAT-AF).</p> <p><strong>Methods</strong>: Adherence to MAT-AF review criteria and clinical pharmacist intervention documentation was assessed by the researcher pre-MAT implementation in 150 patients aged ≥60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. MAT-AF was introduced as a clinical tool in the hospital for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher post-MAT implementation for a further 150 patients with the same inclusion criteria. Logistic regression analysis and measurement of odds ratio was used to identify differences in adherence to MAT-AF pre- and post-MAT implementation. The differences between two population proportions z-test was used to compare pharmacist intervention documentation pre- and post-MAT implementation.</p> <p><strong>Results</strong>: Adherence to MAT-AF criteria increased from 70.9% pre-implementation to 89.6% post-implementation. MAT-AF implementation resulted in a significant improvement in prescription of anticoagulant therapy (OR 4.07, p&lt;0.001) and monitoring of laboratory parameters for digoxin (OR 10.40, p&lt;0.001). Clinical pharmacist intervention documentation improved significantly post-implementation of MAT-AF (z-score 20.249, p&lt;0.001).</p> <p><strong>Conclusions</strong>: Implementation of MAT-AF within an interdisciplinary health care team significantly improved the appropriateness of drug therapy and pharmacist intervention documentation in older patients with atrial fibrillation.&nbsp;</p> Marise Gauci Francesca Wirth Lilian M. Azzopardi Anthony Serracino-Inglott ##submission.copyrightStatement## 2019-03-18 2019-03-18 17 1 1349 1349 The impact of turmeric or its curcumin extract on nonalcoholic fatty liver disease: a systematic review of clinical trials <p><strong>Background</strong>: Turmeric and its curcumin extract have been evaluated in patients with nonalcoholic fatty liver disease (NAFLD), a common ailment that can lead to irreparable liver damage.</p> <p><strong>Objective</strong>: To identify the evidence supporting the use of turmeric or curcumin therapy in NAFLD.</p> <p><strong>Methods</strong>: We searched PubMed, EMBASE, and Cochrane Central from the earliest possible date to 12/17/18 including terms for turmeric, curcumin, and NAFLD. We assessed the impact of turmeric or its curcumin extract on alanine transaminase (ALT), aspartate transaminase (AST), and NAFLD severity via ultrasound.</p> <p><strong>Results</strong>: Five trials assessed the comparative efficacy of curcumin/turmeric in NAFLD. One trial was single armed with comparisons only versus baseline and another trial was only available in abstract form. All of the trials had small sample sizes, 4 of 5 trials had limited durations of follow-up, and all trials had methodological limitations that negatively impacted the strength and applicability of evidence. Clinical and methodological heterogeneity precluded statistical pooling. Three of the 4 trials with evaluable data for turmeric or curcumin versus their own baseline demonstrated significant reductions in ALT, AST, and NAFLD severity grade. Two of the 4 placebo controlled trials had significant mean difference reductions in ALT and AST for turmeric or curcumin versus placebo while 2 of 3 of these trials found significant reductions in NAFLD severity grade. Among these trials, only one used turmeric instead of a curcumin extract and this turmeric trial did not demonstrate any differences in ALT, AST, or NAFLD severity between the turmeric and placebo groups.</p> <p><strong>Conclusions</strong>: Curcumin extract is a promising, but not proven, treatment for NAFLD while the role for turmeric is less clear. The general findings are that ALT, AST and NAFLD severity are reduced with the use of curcumin.  </p> C. Michael White Ji Y. Lee ##submission.copyrightStatement## 2019-03-04 2019-03-04 17 1 1350 1350 A qualitative assessment of the pediatric content in pharmacy curricula adopted by pharmacy schools in Jordan <p><strong>Objective</strong>: The present study aimed to explore faculty (i.e., professors of various ranks) opinions and views regarding the pediatric content in courses taught to pharmacy students in Jordan.</p> <p><strong>Methods</strong>: Purposeful sampling was used to identify faculty from ten pharmacy schools. Participants were identified through their institutions’ websites. After obtaining required approvals, twelve in-depth interviews were conducted, recorded, transcribed and analyzed using NVivo 11 Software. Interviews followed a previously prepared and validated interview guide. The interview guide covered various aspects of pediatric undergraduate education and training.</p> <p><strong>Results</strong>: Twelve professors (eight assistants and four associate professors) agreed to take part in the study. Qualitative analysis revealed four themes each with regard to respondents’ knowledge of the pediatric content and their students’ competency in dealing with pediatric patients. The emerging themes were: the lack of pediatric content in their current curriculum, the need for exposing students to more courses teaching pediatrics, and future aspirations to deal with this, and implications on practice.</p> <p><strong>Conclusions</strong>: This study highlights the deficiency of pediatric courses in pharmacy curriculum in Jordan. Respondent believed that this will have negative implications on pediatric pharmaceutical care and treatment efficacy and safety. It was thought that adding more pediatrics topics to undergraduate curricula, offering pediatric specialized postgraduate education, and implementing pre-registration training could alleviate the current situation.</p> Tareq L. Mukattash Anan S. Jarab Rana K. Abu-Farha Mohammad B. Nusair ##submission.copyrightStatement## 2019-03-14 2019-03-14 17 1 1355 1355 Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review <p><strong>Background</strong>: Although the management of hyperkalemia follows expert guidelines, treatment approaches are based on traditionally accepted practice standards. New drugs have been assessed such as sodium zirconium cyclosilicate and patiromer; however, their safety and efficacy or effectiveness have not yet been compared to traditional pharmacotherapy.</p> <p><strong>Objective</strong>: The present systematic review had the purpose to evaluate the efficacy, effectiveness, and safety of hyperkalemia pharmacotherapies.</p> <p><strong>Methods</strong>: PubMed, LILACS, Cochrane Library, and ClinicalTrials were searched through November 2018. Clinical trial, cohort and case-control were searched. The risk of bias (RoB v2.0 and ROBINS-I) and quality of evidence (GRADE) at the level of outcomes were assessed.</p> <p><strong>Results</strong>: Sixteen clinical trials and one retrospective cohort were identified regarding efficacy and safety of 24 different alternatives. The management of hyperkalemia remains empirical and off-label, since sodium zirconium cyclosilicate and patiromer are not available in several countries and further studies are required to assess efficacy, effectiveness and safety. Sodium or calcium polystyrene sulfonate (moderate confidence), sodium zirconium cyclosilicate (moderate confidence), and insulin plus dextrose (moderate confidence) showed superior efficacy to, respectively, placebo, no treatment, placebo, and dextrose. Other therapies (low confidence) showed similar efficacy compared to active or inactive alternatives. Most of the adverse events reported were nonspecific, so it was not possible to assign the cause and to classify as defined or probable.</p> <p><strong>Conclusions</strong>: Comparative cohort and case-control studies are need to evaluate the safety and effectiveness of new and traditional pharmacotherapies to support the development of guidelines about acute and chronic hyperkalemia, with high-quality evidence.</p> Fabiana R. Varallo Victória Trombotto Rosa C. Lucchetta Patricia C. Mastroianni ##submission.copyrightStatement## 2019-03-04 2019-03-04 17 1 1361 1361 Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq <p><strong>Background</strong>: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq.</p> <p><strong>Objective</strong>: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines.</p> <p><strong>Methods</strong>: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as &lt;50% of the target dose.</p> <p><strong>Results</strong>:&nbsp; 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days).&nbsp; In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively.</p> <p><strong>Conclusions</strong>: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.</p> Ola A. Nassr Paul Forsyth Chris F. Johnson ##submission.copyrightStatement## 2019-03-11 2019-03-11 17 1 1372 1372 Evaluation of aldosterone antagonist utilization in heart failure with reduced and preserved ejection fraction at an academic medical center <p><strong>Background</strong>: Aldosterone antagonists (AA) have historically been underutilized despite evidence that they reduce morbidity, mortality, and readmission rates to the hospital when used appropriately.</p> <p><strong>Objective</strong>: We sought to determine if AAs were being prescribed in accordance with the 2013 ACCF/AHA guidelines and if there was any benefit surrounding 30-day readmissions or 30-day mortality for patients taking AAs with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF).</p> <p><strong>Methods</strong>: We performed a retrospective chart review of adult patients who were discharged between October 1, 2015 and February 1, 2016 with any ICD-10 code for heart failure to assess compliance with guideline directed medical therapy. At baseline, patients were stratified by HFpEF and HFrEF. Patients were excluded if they died during the admission, discharged with hospice care, received a heart transplant or ventricular assist device, if they were miscoded or left against medical advice. Descriptive statistics, and Chi Square were used to evaluate the data.</p> <p><strong>Results</strong>: We reviewed 601 patient charts for eligibility in our study, and determined 438 met the criteria for inclusion. Ninety-seven patients (22%) received an AA. Within the HFrEF group, only 37% of patients who were eligible per 2013 ACCF/AHA guidelines, received an AA at time of discharge. Fourteen percent of HFpEF patients were discharged on an AA. We found a trend towards decreased rates of our 30-day outcomes in patients who took AAs in both the HFpEF and HFrEF groups.</p> <p><strong>Conclusions</strong>: AAs were underutilized during the timeframe we evaluated, despite the evidence for their use.</p> Daniel Bradley Jean Nappi ##submission.copyrightStatement## 2019-03-10 2019-03-10 17 1 1376 1376 Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers <p><strong>Background</strong>: Having a local code of ethics, based on moral obligations and virtues, known to all practicing pharmacists is important in order to guide them in relationships with patients, health professionals, and society.</p> <p><strong>Objective</strong>: To investigate pharmacists’ attitude and barriers towards applying the ethical principles published by the Jordanian Pharmacists Association in the Jordanian code of ethics.</p> <p><strong>Methods</strong>: The study objectives were addressed in a cross-sectional study completed by a convenience sample of community pharmacists, in both cities; Amman and Irbid A questionnaire was used to achieve the study objective. The questionnaire was developed and validated, investigating pharmacists’ socio-demographic and practice characteristics, perceived attitude toward certain practice scenarios, and perceived barriers towards applying the locally published ethical principles while dealing with their patients. The questionnaire was self-completed by pharmacists between January and August 2017. Collected data was analyzed using SPSS version 21. Descriptive statistics and parametric tests were used with p&lt;0.05 set a priori as significant.</p> <p><strong>Results</strong>: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to the questionnaire, providing completely answered questionnaires with a response rates of 69.4% in Amman and 99.6% in Irbid. Pharmacists from both cities revealed that they use the Internet as their main resource to obtain ethical information when they need it, to help them deal with their patients (34.0% from Amman and 31.5% from Irbid). More pharmacists in Amman (57.0%) had access to resources regarding ethical information at their practice sites compared to pharmacists in Irbid (24.0%). Significant differences in attitude was found between pharmacists practicing in both cities, as significantly less pharmacists from Amman (37.8%) declared that they would sell a medication for an unreported indication according to national and international guidelines, if recommended by the consultant, compared to pharmacists from Irbid (77.7%, p&lt;0.001).</p> <p><strong>Conclusions</strong>: Despite having ethical guidance from the Jordanian Pharmacists Association, the majority of pharmacists in Jordan do not use this resource; instead, most choose to access ethical guidance on-line. Pharmacists from the capital, Amman, reported to adhere more with the guidelines when selling a medication for an unreported indication compared to pharmacists from the smaller city, Irbid. Results of this study call for more actions from the authorities in the country responsible for setting and enforcing the pharmaceutical Code of Ethics.</p> Rajaa A. Al-Qudah Omar Tuza Haneen Tawfiek Betty Chaar Iman A. Basheti ##submission.copyrightStatement## 2019-03-17 2019-03-17 17 1 1386 1386 Perceptions in the community about the use of antibiotics without a prescription: Exploring ideas behind this practice <p><strong>Objective</strong>: The use of antibiotics without prescription is common in Colombia as well as in other developing countries. The objective of this study is to explore the attitudes and motivations associated with the use of antibiotics without prescription.</p> <p><strong>Methods</strong>: Focus group sessions were held with residents of Bogotá. Different socioeconomic groups were approached to identify possible differences of opinion. A semi-structured interview guide was used to guide the discussion, with thematic analysis used to identify central themes.</p> <p><strong>Results</strong>: In total, 21 people, aged between 25 and 50 years participated in four focus groups. The results suggest that the use of antibiotics without prescription is common practice. The main reasons included barriers to access to prescribed medications due to limited health insurance. Even those with adequate access to health insurance report being willing to use a treatment without a prescription if they have confidence in its effectiveness. The relationship with the physician is important, but pharmacy storekeepers are also highly trusted. While some participants understood that antibiotics can cure infections but cause serious adverse events, several misconceptions about antibiotics therapy were identified. These included a lack of knowledge of resistance transmissibility among communities.</p> <p><strong>Conclusions</strong>: The results have implications for interventions aimed at reducing inappropriate use of antibiotics, highlighting i) how lack of access to timely care creates an incentive to self-prescribe, ii) the key role that pharmacy storekeepers play in the Colombian healthcare system and the need to include them in interventions, and iii) the misconceptions about inappropriate use of medications that need to be addressed by educational programs. These findings provide insights to other countries where antibiotics misuse is also a problem.</p> Johanna Aponte-González Angélica González-Acuña José Lopez Paul Brown Javier Eslava-Schmalbach ##submission.copyrightStatement## 2019-03-10 2019-03-10 17 1 1394 1394 Communication skills in Brazilian pharmaceutical education: a documentary analysis <p><strong>Objective</strong>: To characterize the inclusion of the teaching of communication skills in the curriculum of Pharmacy Schools of Federal Institutions of Higher Education.</p> <p><strong>Methods</strong>: An exploratory study of documental analysis of curriculum of Pharmacy Schools was carried out. A convenience sample was selected from undergraduate pharmacy courses of Federal Institutions of Higher Education (IFES). The variables collected were related to the identification of the course, its nature (elective or mandatory), workload, semester, and program content.</p> <p><strong>Results</strong>: Among the 49 undergraduate pharmacy courses of IFES, 35 (71.4%) had their curriculum available online. The teaching of communication in health was identified in 26 (74.3%) curriculum. In this study, three courses (7.2%) specifically aimed at teaching communication skills, while 39 (92.9%) had content related to this subject. Most courses (22; 52.4%) belonged to the field of Social, Behavioral, and Administrative Sciences. As for the course period, there was a concentration in the third (19%) and fourth (28.6%) years. The main content present in the curriculum was related to the principles and techniques of health communication (42.8%).</p> <p><strong>Conclusions</strong>: Data obtained enabled the identification of gaps in the curricula of undergraduate courses in pharmacy concerning the inclusion of the teaching of communication skills. These results can be used to reflect the current models adopted in Brazil for the teaching of this skills, especially after the recent publication of the new curricular guidelines for undergraduate pharmacy courses.</p> Dyego C. Araujo Janiely S. Santos Izadora M. Barros Afonso M. Cavaco Alessandra R. Mesquita Divaldo P. Lyra, Jr ##submission.copyrightStatement## 2019-03-19 2019-03-19 17 1 1395 1395 Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit <p><strong>Background</strong>: Pain remains one of the most common and debilitating symptoms of advanced cancer. To date, there is a lack of studies on pain and its treatment among Malaysian palliative care patients.</p> <p><strong>Objective</strong>: This study aimed to explore the prevalence of pain and its treatment outcomes among adult cancer patients admitted to a palliative care unit in Sabah, Malaysia.</p> <p><strong>Methods</strong>: Of 327 patients screened (01/09/15-31/12/17), 151 patients with assessed self-reported pain scores based on the numerical rating scale of 0-10 (current, worst and least pain within the past 24 hours) upon admission (baseline), 24, 48 and 72 hours post-admission and discharge were included. Pain severity and pain score reductions were analysed among those who experienced pain upon admission or in the past 24 hours. Treatment adequacy was measured by the Pain Management Index (PMI) among discharged patients. The PMI was constructed upon worst scores categorised as 0 (no pain), 1 (1-4, mild pain), 2 (5-6, moderate pain), or 3 (7-10, severe pain) which is then subtracted from the most potent level of prescribed analgesic drug scored as 0 (no analgesia), 1 (non-opioid), 2 (weak opioid) or 3 (strong opioid). PMI≥0 indicated adequate treatment.</p> <p><strong>Results</strong>: Upon admission, 61.1% [95%CI 0.54:0.69] of 151 patients presented with pain. Of 123 patients who experienced pain upon admission or in the past 24 hours, 82.1% had moderate to severe worst pain. Throughout patients’ ward stay until discharge, there was an increased prescribing of analgesics and adjuvants compared to baseline, excluding weak opioids, with strong opioids as the mainstay treatment. For all pain score types (current, worst and least pain within the past 24 hours), means decreased at each time point (24, 48 and 72 hours post-admission and discharge) from baseline, with a significant decrease at 24 hours post-admission (p&lt;0.001). Upon discharge (n=100), treatment adequacy significantly improved (PMI≥0 100% versus 68% upon admission, p&lt;0.001).</p> <p><strong>Conclusions</strong>: Accounting for pain’s dynamic nature, there was a high prevalence of pain among cancer patients in the palliative care unit. Continuous efforts incorporating comprehensive pain assessments, evidence-based treatments and patient education are necessary to provide adequate pain relief and end-of-life comfort care.</p> Melissa Mejin Thamron Keowmani Syuhaidah Abdul Rahman Jerry Liew Jacqueline Lai Morna Chua Ilmiyah Che Wan ##submission.copyrightStatement## 2019-03-18 2019-03-18 17 1 1397 1397 Anaemia in heart failure patients: the prevalence of haematinic deficiencies and the role of ACE inhibitors and aspirin doses as risk factors <p><strong>Background</strong>: Patients with heart failure often have comorbidities that alter the progression of heart failure and impact on prognosis. One such comorbidity is anaemia, and clinicians have started to appreciate the full gravity of its impact on heart failure patients. Yet, the extent of the problem is not fully understood, particularly the role of heart failure therapy itself as a risk factor for developing anaemia.</p> <p><strong>Objective</strong>: This study aimed to investigate the prevalence of anaemia in a cohort of heart failure patients. The impact of using different ACEIs and different doses of aspirin was also explored, together with the prevalence of haematinic deficiencies.</p> <p><strong>Methods</strong>: Medication lists and pathology results were examined to establish the prevalence of ACEIs use, and the use of aspirin at its most common doses of 100mg and 150mg, together with haematinic deficiencies. Multinomial logistic regression and the Student’s t-test were utilised for the analysis of data. Statistical significance was pre-set at p&lt;0.05.</p> <p><strong>Results</strong>: Ninety-six patients were eligible for analysis, with 26% having anaemia. The use of ACEIs had a RR of 17.4 for the presence of anaemia. Perindopril was associated with a RR of 20.8, while the use of ramipril was not significantly associated with such a high RR. Haematinic anaemia occurred only at a rate of 3.3%, but borderline deficiencies were found in more than a third of all patients. An aspirin dose of 150mg was associated with a higher risk for anaemia, compared to a dose of 100mg.</p> <p><strong>Conclusions</strong>: ACEIs are associated with the presence of anaemia, with perindopril posing more risk than ramipril when used in heart failure patients. The dose of aspirin may also be a factor in the development of anaemia, with lower doses being safer. Despite the lack of high prevalence of haematinic anaemia among this cohort of patients, borderline haematinic deficiencies were common.</p> Kyrillos Guirguis ##submission.copyrightStatement## 2019-03-13 2019-03-13 17 1 1406 1406 Practice Forum: A new section led by the Center for Pharmacy Practice Innovation at Virginia Commonwealth University School of Pharmacy Teresa M. Salgado Dave L. Dixon ##submission.copyrightStatement## 2019-03-18 2019-03-18 17 1 1495 1495 Table of Contents . . ##submission.copyrightStatement## 2019-03-24 2019-03-24 17 1 Cover page . . ##submission.copyrightStatement## 2019-03-24 2019-03-24 17 1