Treatment of a periorbital cyst in a dog by creation of a permanent drainage opening

An inflammatory periorbital cyst with secondary pressure atrophy of the maxilla was treated by surgical creation of a drainage opening to the nasal cavity in a 4-year-old Yorkshire Terrier. Following treatment, clinical signs resolved and computed tomography 5 weeks after surgery confirmed the permanence of the drainage opening. Eight months later, the dog showed no clinical abnormalities. Therefore, the procedure described in this report may offer a suitable treatment option in cases where the cyst's size or localization prevents complete excision.

What if continuing education became mandatory? Opinions of Belgian community pharmacists

Objective In July 2003, a survey (n = 1032) was conducted on issues related to continuing education for community pharmacists. This study aims to explore specific results of this survey in-depth. The objectives were to examine how current continuing education courses can be optimised, how much interest pharmacists have in distance learning, and how pharmacists think about mandatory continuing education.

Setting Community pharmacy in the Dutch-speaking part of Belgium.

Method Six focus group discussions were held: two with attenders (n = 14), two with non-attenders (n = 13), and two with the management of the Institute for Permanent Study for Pharmacists (n = 12). A theme plan was used to moderate discussions. Framework analysis was applied to analyse data.

Key findings To optimise live courses, continuing education providers should select good speakers, provide extensive course notes, and focus on issues that are relevant to day-to-day pharmacy practice. The interest in distance learning as a continuing education format was limited. Non-attenders are likely to need a formal obligation to engage in continuing education, with the preferred format being live courses. By increasing patients' awareness and appreciation of pharmacists' capabilities, pharmacists could be more motivated to counsel patients, to engage in continuing education, and to accept a system of mandatory continuing education.

Conclusion Implementation of mandatory continuing education in Belgium might encourage more pharmacists to take part in live continuing education courses than in distance learning. The arguments for and against mandatory continuing education as well as the suggestions for improvement of live continuing education courses should be taken into account when implementing a system of mandatory continuing education.

How do pharmacists manage acute diarrhoea in an 8-month-old baby? A simulated client study

Objectives

Community pharmacists claim a role in health care based on their added value as counsellors and providers of pharmaceutical care. The aim of this study was to assess to what extent they fulfil this role with respect to the management of acute diarrhoea in an 8-month-old baby.

Methods

In February 2008, two female simulated clients of 55 and 35 years old visited 101 Belgian pharmacies. Both entered the pharmacy and said: ‘I'm here for my grandchild/my sister's baby. She has diarrhoea.’ They only provided more information if the pharmacist asked for it. All the questions and the verbal advice provided by the pharmacist were audio-recorded and the suggested medicines were registered.

Key findings

One pharmacist did not ask any questions. All the other pharmacists asked the age of the child, 19% asked how long the symptoms had been on-going, 27% asked whether the baby had a fever and 24% inquired about vomiting. Seventy-five per cent of the pharmacists emphasized the importance of sufficient fluid intake and/or the risk of dehydration, while 4% described how to recognize such dehydration symptoms. Oral rehydration solution was suggested by 30% of the pharmacists, while 86% suggested the yeast probiotic Saccharomyces boulardii. Of the 28% spontaneously giving dietary advice, no-one said that normal feeding should restart ‘as soon as possible’. Thirty-one per cent advised consulting a doctor, either immediately or in the case of the symptoms not improving after a while.

Conclusions

Apart from inquiring about the child's age, the majority of pharmacists asked too few questions to be able to analyse the situation properly. Ample information was provided on the risk of dehydration, but counselling on the suggested medicines was insufficient.

How do pharmacists manage acute diarrhoea in an 8-month-old baby? A simulated client study

OBJECTIVES

Community pharmacists claim a role in health care based on their added value as counsellors and providers of pharmaceutical care. The aim of this study was to assess to what extent they fulfil this role with respect to the management of acute diarrhoea in an 8-month-old baby. METHODS In February 2008, two female simulated clients of 55 and 35 years old visited 101 Belgian pharmacies. Both entered the pharmacy and said: 'I'm here for my grandchild/ my sister's baby. She has diarrhoea.' They only provided more information if the pharmacist asked for it. All the questions and the verbal advice provided by the pharmacist were audio-recorded and the suggested medicines were registered.

KEY FINDINGS

One pharmacist did not ask any questions. All the other pharmacists asked the age of the child, 19% asked how long the symptoms had been on-going, 27% asked whether the baby had a fever and 24% inquired about vomiting. Seventy-five per cent of the pharmacists emphasized the importance of sufficient fluid intake and/or the risk of dehydration, while 4% described how to recognize such dehydration symptoms. Oral rehydration solution was suggested by 30% of the pharmacists, while 86% suggested the yeast probiotic Saccharomyces boulardii. Of the 28% spontaneously giving dietary advice, no-one said that normal feeding should restart 'as soon as possible'. Thirty-one per cent advised consulting a doctor, either immediately or in the case of the symptoms not improving after a while.

CONCLUSIONS

Apart from inquiring about the child's age, the majority of pharmacists asked too few questions to be able to analyse the situation properly. Ample information was provided on the risk of dehydration, but counselling on the suggested medicines was insufficient.

International trends in lifelong learning for pharmacists

Lifelong learning for community pharmacists is shifting from continuing education (CE) towards continuing professional development (CPD) in some countries. The objectives of this report were to compare lifelong learning frameworks for community pharmacists in different countries, and determine to what extent the concept of CPD has been implemented. A literature search was conducted as well as an Internet search on the web sites of professional pharmacy associations and authorities in 8 countries. The results of this review show that the concept of CPD has been implemented primarily in countries that have a long tradition in lifelong learning, such as Great Britain. However, most countries have opted for the CE approach, eg, France, or for a combination of CE and CPD, eg, New Zealand. This approach combines the controllability by regulatory organizations that CE requires with the advantage of sustained behavior change seen in successful CPD programs.

Flemish community pharmacists' motivation and views related to continuing education

OBJECTIVE

IPSA (Institute for Permanent Study for Pharmacists) wanted to assess community pharmacists' opinion on CE-related issues in order to develop more tailored CE programs.

METHOD

A survey for self-administration was sent to 1691 community pharmacists. The method of stratified sampling was used to include pharmacists who do not take up CE courses as well.

MAIN OUTCOME MEASURES

(1) Preferences for course formats, topics of interest and opinion on different CE providers; (2) Facilitators and barriers for participation in CE courses; (3) Opinion on rewarding and participation, obligation and willingness to pay.

RESULTS

A response rate of 62.8% was obtained after three mailings. Lectures remain the most favorite course format. Topics related to pharmaceutical care are the most wanted. The strongest facilitators for attending CE courses are gathering practical knowledge and keeping scientific knowledge up to standard. Social contact with colleagues and receiving a syllabus are perceived as moderately motivating factors. Most frequently mentioned barriers were lack of time, family constraints, distance to the classes and uninteresting subjects. Around 2/3rd of questioned pharmacists are willing to invest more time in CE when participation would be rewarded. When it comes to opinion on mandatory CE, disagreement exists between pharmacists who take up CE courses and those who don't, the latter being less in favor.

CONCLUSION

This survey revealed community pharmacists' opinions, wishes and needs concerning CE. This should enable CE providers to develop more tailored CE programs.

Management of drug interactions with beta-blockers: continuing education has a short-term impact

There is a lack of clear guidelines regarding the management of drug-drug interactions.

OBJECTIVE

To assess the impact of an educational intervention on the management of drug interactions with beta-blockers.

METHODS

The study had a controlled before-and-after design. The intervention group (n=10 pharmacies) received a continuing education course and guidelines on the management of drug interactions with beta-blockers. The control group (n=10 pharmacies) received no intervention. Pharmacy students and staff of internship pharmacies participated in this study. Before and after the intervention, students registered interactions with beta-blockers during two weeks. Information was obtained on drug information of the beta-blocker and the interacting drug, patient's demographics, and the mode of transaction.

RESULTS

A total number of 288 interactions were detected during both study periods. Most beta-blockers causing an interaction were prescribed for hypertension, and interacted with hypoglycemic agents, NSAIDs, or beta2-agonists. Pharmacists' intervention rate was low (14% in the pre-test compared to 39% in the post-test), but increased significantly in the post-test in the intervention group. Reasons for overriding the interaction included limited clinical relevance, refill prescriptions, not being aware of the interaction, and communication problems with the prescriber.

CONCLUSION

An interactive continuing education course, during which practice-oriented guidelines were offered, affected pharmacists' short-term behavior at the counter in dealing with interactions of beta-blockers. Continuing education plays a role in raising pharmacists' awareness and responsibility towards the detection and management of drug interactions in the pharmacy.