J Pharm Pharmaceut Sci (www.cspscanada.org) 8(3):483-493, 2005
ASSOCIATION OF FACULTIES OF PHARMACY OF
ANNUAL CONFERENCE AND MEETINGS
AFPC Poster Session
Saturday, June 25, 2005
7:30 am – 5:00 pm
William Pascoe Room
Delta Bessborough Hotel
BasicRes No. 1: Combination therapy preventing the emergence of antibiotic-resistant Enterobacter cloacae
Harris Iacovides1, Robert Ariano1,2, Godfrey Harding1,2, Sheryl Zelenitsky1,2, University of Manitoba 1 and St. Boniface General Hospital2, Winnipeg, MB
Background: Clear indications for combination antibiotic therapy in the treatment of nosocomial infections remain to be defined. Enterobacter continues to rate among the most common Gram-negative pathogens in hospitalized patients, with resistance to broad-spectrum cephalosporins approaching 35%. The objectives of this study were to (1) simulate the emergence of cephalosporin-resistant E. cloacae during ceftazidime therapy in an in vitro pharmacodynamic model (IPDM), and (2) characterize the ability of combination therapy with ciprofloxacin or gentamicin to prevent resistance. Methods: A one-compartment IPDM of E. cloacae bacteremia was established using three clinical blood isolates. Each isolate was initially susceptible to all antibiotics tested, with minimum inhibitory concentrations (MICs) for ceftazidime of 0.5 mcg/ml. Ceftazidime alone and in combination with ciprofloxacin or gentamicin were tested using concentration profiles simulating those observed with standard clinical doses (q12h x 72h) in humans. Resistance was detected through MIC determinations after 24, 48 and 72h of therapy. Resistant isolates were further classified as stably derepressed or reversibly induced by re-plating on antibiotic-free media five times and re-determining MICs. Results: Despite optimal dosing, monotherapy with ceftazidime selected high-level resistance in 90% of exposures for all isolates. Ceftazidime MICs increased to values > 256 mcg/ml during therapy. Of the resistant isolates, 100% of isolate #1, 78% of isolate #2 and 33% of isolate #3 were stably derepressed mutants. Alternatively, combination therapy with either ciprofloxacin or gentamicin was 100% effective at suppressing the emergence of ceftazidime-resistant isolates. Conclusions: This pre-clinical data strengthen the argument for combination antibiotic therapy in the prevention of antibiotic-resistant E. cloacae infection, and support further investigation in animal models and humans.
BasicRes No. 2: The anti-atherosclerotic effects of the Growth Hormone-Releasing Peptides are CD36 dependent
Diala Harb1, Kim Bujold1, Maria Febbraio2, Martin G Sirois3, Andre Tremblay4, Huy Ong1,3 and Sylvie Marleau1, 1Faculty of Pharmacy, Departments of 3Pharmacology, 4Obstetrics & Gynecology, Faculty of Medicine, Université de Montréal, Montréal, Québec, 2Department of Cell Biology, Lerner Research Institute, Cleveland, OH, USA
Our recent studies have shown that long-term (12 weeks) treatment with growth hormone-releasing peptides (GHRPs), as ligands of the CD36 type B scavenger receptor, show striking anti-atherosclerotic and hypocholesterolemic effects in apoE-deficient mice (apoE-/-) fed a high fat, high cholesterol (HFHC) diet. Synthetic GHRP analogs such as hexarelin (HEX), in addition to binding CD36 on macrophages, also bind to the ghrelin receptor (GHS-R1a). In order to assess the relative contribution of these receptors to macrophage accumulation and fatty streak formation at lesion-proned sites, apoE-/- mice have been treated with either ghrelin (320 µg/kg), the endogenous GHS-R1a ligand, HEX (100 µg/kg) a ligand of both CD36 and GHS-R1a, and EP 80317 (300 µg/kg) a selective CD36 ligand, for a period of 12 weeks. At 18 weeks of age, treated mice received 111In-labelled peritoneal macrophages from donors apoE-/- mice. Aortic accumulation of labeled macrophages was assessed by densitometric analysis 48 hours later. Chronic treatment with EP 80317 was associated with a reduction of 111In-labelled peritoneal macrophages accumulation by 40% compared to 0.9% NaCl-treated mice, suggesting a potential role of EP 80317 in modulating the inflammatory component of atherosclerosis. In agreement, long-term treatment with EP 80317 was associated with a 51% reduction of oil red-O-stained lesion after 12 (from 6-18) weeks of treatment. In contrast, chronic treatment with ghrelin failed to modulate the development of aortic lesions whereas HEX modestly reduced aortic lesions by 28%. Our results support a role for CD36 in mediating the anti-atherosclerotic effects of GHRPs.
BasicRes No. 3: Hexarelin modulates left ventricular apoptotic signaling pathways in cardiomyopathic hamsters.
Mukandila Mulumba, Huy Ong and Sylvie Marleau, Faculty of Pharmacy, Université de Montréal, POB 6128, Station Downtown, Montréal, QC, H3C 3J7
Recent studies have shown that programmed cell death (apoptosis) greatly contributes to the development of heart failure in patients with dilated cardiomyopathy. Novel therapeutic strategies to reduce cardiac apoptosis include administration of growth hormone-releasing peptides (GHRPs), initially designed as growth hormone sécrétagogues acting through the GHS-R1a receptor. Hexarelin (Hex), a synthetic hexapeptide GHRP analog, has been shown to inhibit cardiomyocyte apoptosis in vitro. The aim of this study was to assess the effects of Hex on the development of apoptosis in cardiomyopathic hamsters (CMH). CMH were treated with Hex (100 μg/kg/day, s.c) or 0.9% NaCl for 30 days starting either at the age of 30 days (early phase of the disease) or 160 days (late phase). Golden Syrian hamsters (GSH) were used as controls. Apoptotic nuclei of early-treated CMH were assessed by immunohistochemistry and the expression of apoptotic mediators by RT-PCR. Vehicle-treated show an elevated percentage of apoptotic nuclei (8.50 ±0.50%) compared to GSH (3.33 ± 0.60%). Hexarelin significantly reduced the number of nuclei by 30% (p<0.05). In agreement, the mRNA levels of the anti-apoptotic markers Bcl-2 and Bcl-Xl were increased by 53 and 72%, respectively in left ventricle. Similar results were observed following late treatment with Hex, with Bcl-2 and Bcl-Xl mRNA levels increased by 46% and 88%, respectively. In contrast, Hex reduced the expression of Bax, a pro-apoptotic protein, by 60% and 69%, respectively, when the treatment was initiated in the early or late phase of the disease. These results suggest that Hex may exert its cardioprotective effects by modulating the apoptotic pathways in both the early and late phase of cardiomyopathy development in CMH.
BasicRes No. 4: Determining the role of Hoxa2 gene in palate development using a retroviral gene delivery system
Wang and Adil J. Nazarali,
Hoxa2-/- mice exhibit craniofacial abnormalities including a cleft palate. Valproic acid (VPA) can induce a cleft plate in humans exposed in utero. The effect of VPA on palatal fusion rates was measured in treated mouse palate cultures. The fusion rates were 91.7%, 68.2%, 55.0%, 21.1% and 0% with 0, 12.5, 25.0, 50.0 and 100 mg/ml of VPA, respectively (N=19-24 palates/dose, p≤ 0.05). RT-PCR results revealed wild-type palatal cultures exposed to VPA resulted in a dose dependent decrease in Hoxa2 expression and a delay in palatal growth. It has not been determined what role Hoxa2 gene plays in palate development. A retroviral expression system has been developed to study the function of Hoxa2 in the developing palate. Transduction of palatal shelves with Hoxa2 antisense retrovirus resulted in a pronounced inhibition of palatal fusion. The fusion rates were 45%, 33% and 28% with titers at 0.08 ×106, 1.80 ×106 and 3.60 ×106 cfu/ml, respectively (N=18-25 palates/titer). These are comparable to palatal cultures from Hoxa2-/- mouse (44.4%) (p≤0.05). Interestingly, retroviral particles expressing Hoxa2 sense transcripts did not impact palatal development to the same extent as their antisense counterparts. The palatal fusion rates were relatively high (73%) with lower viral titers (N=19-22 palates/titer), while higher viral titers induced palatal fusion to a lesser extent (50-61%) (N=16-20 palates/titer). The expression of Hoxa2 in the wild-type palates at different embryonic stages was quantified with real-time RT-PCR. Confocal microscopy has revealed Hoxa2 retroviral expression in the palate. Our results have demonstrated for the first time that direct inhibition of Hoxa2 transcripts in the developing palate induces a delay in palatal growth. (Supported by NSERC)
BasicRes No. 5: Heavy metals modulate Aryl hydrocarbon Receptor (AhR)-regulated genes at transcriptional and posttranscriptional levels by oxidative mechanisms.
Reem H. Elbekai and Ayman O.S El-Kadi,, Faculty of Pharmacy and
Recently, we demonstrated the ability of heavy metals (As3+, Cd2+, and Cr6+) to alter the capacity of AhR ligands to induce the bioactivating Cyp1a1 and the detoxifying NQO1 and GST Ya xenobiotic metabolizing enzymes. Since heavy metals have been shown to exert their toxicity, at least in part, by the generation of reactive oxygen species (ROS), we evaluated the role of metal-induced ROS on the expression of these enzymes. Hepa 1c1c7 cells were treated with 5 mM of As3+, Cd2+, or Cr6+ in the presence or absence of TCDD (1 nM), an AhR ligand. Cd2+ and Cr6+ increased the production of ROS, while As3+ caused perturbations in glutathione redox status. Although all three metals inhibited the induction of Cyp1a1 activity by TCDD, Cyp1a1 mRNA levels were potentiated. Pre-treatment with the antioxidant N-acetylcysteine (NAC) did not alter Cyp1a1 mRNA expression but completely abrogated the inhibition of Cyp1a1 activity induction by the metals. In parallel, when cellular GSH was depleted with the pro-oxidant, L-buthionine-[S,R]-sulfoximine (BSO), Cyp1a1 mRNA expression was further potentiated whereas Cyp1a1 activity was further inhibited, compared to treatment with metals and TCDD alone. Metals alone induced Cyp1a1 mRNA expression, which was superinduced in the presence of the protein synthesis inhibitor, cycloheximide. On the other hand, all three metals, alone or in the presence of TCDD, enhanced NQO1 and GST Ya activities and mRNA levels, an effect that was completely abrogated with NAC and markedly potentiated by BSO. Pretreatment with the DNA transcription suppressor, actinomycin-D, abolished the induction of NQO1 and GST Ya mRNA levels by the metals. Our data clearly show that heavy metal-induced ROS modulate Cyp1a1 activity posttranscriptionally but induce NQO1 and GST Ya activities at the transcriptional level.
BasicRes No. 6: Novel implantable delivery system increases maximum tolerable doses of paclitaxel in mice
Vessela Vassileva, Christine Allen, Micheline Piquette-Miller, Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 2S2
Purpose: To compare the safety, toxicity and biocompatibility of a novel chitosan-egg phophatidylcholine (chotosan-ePC) implantable delivery system that provides controlled and sustained release of paclitaxel (PTX) versus the conventional Taxol ® formulation in healthy CD-1 mice. Methods: Animals were surgically implanted intraperitoneally (IP) with drug-free or PTX-chitosan-ePC formulation. In parallel, to compare tolerable doses, bolus IP Taxol® injections were administered to mice in various amounts every other day or weekly, with Cremophor EL (CrEL) and anhydrous ethanol as control. Following sacrifice, animals were visually inspected for signs of infection, inflammation and capsid formation (around implants). Tissues were collected, fixed, paraffinized, sectioned and stained with hematoxylin and eosin (H&E). Toxicity was assessed as number of deaths, weight loss, general appearance and histopathological changes. Results: Mice implanted with the drug-free or PTX-chitosan-ePC formulations appeared healthy, without any weight loss. There were no observable signs of infection, inflammation, local irritation or fibrous encapsulation. In contrast, mice receiving bolus IP PTX injections every other day, displayed significant weight loss and deaths with signs of inflammation and irritation within the peritoneal cavity. The maximum tolerable PTX dose was 20 mg/kg/week as bolus IP administration, whereas PTX doses of more than 154 mg/kg/week were well tolerated when administered with the implants. Interestingly, the majority of deaths occurred in the CrEL treated controls. Conclusions: The novel chitosan-ePC delivery system is non-toxic, biocompatible and a safer method of PTX administration, providing higher dosages without adverse effects with possible clinical significance in the treatment of solid tumors.
BasicRes No. 7: The effect of heat-treatment on Fungizone-induced renal toxicity in human kidney proximal tubule cells and fungal toxicity in Aspergillus fumigatus; the role of phospholipases.
Ross Taylor1, Carlos Leon1, Karen Bartlett2, and Kishor M. Wasan1, 1 Faculty of Pharmaceutical Sciences, University of British Columbia and 2 School of Occupational and Environmental Hygiene, University of British Columbia
Purpose: To determine the effects of heat-treatment (70 °C for 20 minutes) on Fungizone (FZ)-induced nephrotoxicity in human kidney (HK-2) cells, on fungal toxicity in Aspergillus fumigatus, and to determine the role of phospholipase A2 (PLA2). Methods: HK-2 cells grown in T75 flasks were seeded in 96 well plates (20,000 cells/well). FZ/heat-treated Fungizone (HFZ) concentrations of 10, 25, and 50 μg/ml of Amphotericin B (AmpB) were prepared. Snake venom PLA2 (2.15 U/ml) was pre-incubated with HFZ one hour prior to addition to the cells. After 18-hour incubations, 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H- tetrazolium (MTS) assays were performed, assessing cell viability through mitochondrial respiration. Aspergillus fumigatus spore suspensions were prepared and seeded in 96-well plates at 500,000 spores/well. HFZ/FZ were prepared as above and incubated with the fungi. Minimum inhibitory concentrations (MIC) were determined after 72 hours. Results: FZ-induced cytotoxicity was significantly greater than HFZ in HK-2 cells (40.4 ± 2.8% vs. 11.0 ± 1.1%) for 25 µg AmpB/ml (n=4, p<0.05). HFZ/FZ were found to have similar MIC ranges for Aspergillus fumigatus (0.225 – 0.25) μg AmpB/ml (n=4). Independently, PLA2 had no apparent effect on HK-2 cells; however, the addition of 2.15 U/ml of PLA2 to 50 µg heated-AmpB/ml significantly enhanced cytotoxicity (42.71 ± 2.85% vs. 25.22 ± 1.48%); (n=4, p< 0.05). Conclusions: Results suggest HFZ is significantly less toxic than FZ towards HK-2 cells. The efficacy of HFZ against A. fumigatus was equivalent to FZ. PLA2 is not independently cytotoxic, but increases HFZ-associated cytotoxicity. Acknowledgements: This project was funded by CIHR.
BasicRes No. 8: Estrogenic drugs modulation of the striatal rat dopamine transporter.
Saux, and Thérèse Di Paolo, Molecular
The membrane dopamine transporter (DAT) is the main mediator of dopamine uptake from synapses. Estrogens were reported to increase rat and human striatal DAT. The first study investigated if the selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene could reproduce the estradiol effect on DAT in long term ovariectomized rats, a model of hormonal withdrawal as occurs in menopause. Tamoxifen is currently used for breast cancer treatment while raloxifene is given to women to treat osteoporosis. In the middle striatum, ovariectomy decreased DAT specific binding, which was corrected by estradiol, tamoxifen and raloxifene. The effect was specific to this subregion since neither the anterior nor the posterior parts responded to hormonal withdrawal and treatments. The second study sought the possible involvement of the estrogen receptors ERa and ERb in the estradiol modulation of striatal DAT. Ovariectomized rats were treated for 2 weeks with estradiol, a specific ligand for the estrogen receptor a (ERa 4,4’,4’’-(4-Propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT) or estrogen receptor b (ERb 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN). Ovariectomy decreased DAT specific binding in the middle striatum compared to intact rat values and estradiol corrected this decrease. DPN, but not PPT, mimicked the estradiol increase. Neither ovariectomy nor treatments modulated DAT specific binding in the anterior and posterior striatum. These results show a new effect of tamoxifen and raloxifene in the brain and suggest for the first time that ERb mediates the estradiol increase of DAT in striatum. Supported by a CIHR grant to TDP. MLS was supported by a studentship from La Fondation de l’Université Laval.
BasicRes No. 9: Nrf2 deficiency does not alter susceptibility to hypoxic ischemic brain injury in the neonatal mouse
Derek J. Roberts1,2,3, Gregory J. Anger3, Robert W. Gilbert3, George S. Robertson2,3 , 1College of Pharmacy, 2Department of Psychiatry, and 3Department of Pharmacology, Dalhousie University, Halifax, NS.
Cerebral ischemia results in the excessive generation of reactive oxygen species (ROS) in the brain that leads to oxidative stress and possible neuronal cell death. To combat this induced oxidative stress, protective cellular mechanisms are activated that promote neuronal survival. Activation of the nuclear transcription factor NF-E2-Related-Factor-2 (Nrf2) is one such endogenous protective mechanism that forms a coordinated defense against ROS. Treatments that induce the activation of Nrf2 may represent a novel therapeutic strategy for stroke. The objective of this study was to determine whether Nrf2 deficiency alters brain damage (infarct volume) in a neonatal mouse model of hypoxic-ischemic brain injury. In wild type (WT), Nrf2 heterozygous (Nrf2 +/-), and Nrf2 homozygous (Nrf2 -/-) knockout mice (PO7) the left common carotid artery was isolated and cauterized. Following a 2 hour recovery period, all mice were placed in a low oxygen atmosphere environment (8% oxygen) for 60 minutes. Seven days later, animals were sacrificed; brains fixed and sectioned at a thickness of 50 µm. Sections were stained with cresyl violet and for the neuron specific marker NeuN. Infarct volume of all stained brain sections was determined using the Scion Image software package. WT, Nrf2 +/-, and Nrf2 -/- animals composed of 8-14 animals each displayed comparable infarct volumes in the ipsilateral hemisphere, neocortex, hippocampus, and striatum. Loss of NeuN-positive cells also appeared similar in all groups. The results of the present study indicate that Nrf2 deficiency does not influence the susceptibility of the neonatal brain to the injurious effects of hypoxia-ischemia. Given that adult Nrf2 null mice have been reported to be more susceptible to brain injury caused by transient focal ischemia, we will determine whether susceptibility to hypoxic-ischemic brain injury is increased in older animals. Our findings also suggest that in this model, oxidative stress is not a major contributing factor to injury in the neonatal brain; however, measurement of ROS generated in the neonatal brain of Nrf2 null and WT mice following hypoxia ischemia is required to test this hypothesis.
ClinicalRes No. 1: Long-term survival and late effects of
central nervous system tumors in children of
Kaiser Ali, Betty C. Riddell, Edward Leung, Christopher Mpofu, Saskatoon Cancer Centre, Saskatchewan Cancer Agency, and Colleges of Medicine, and Pharmacy & Nutrition, University of Saskatchewan, Canada.
& Objectives: Central
nervous system (CNS) tumors comprise the largest group of pediatric tumors in
developed countries. A 30 year review of children with primary CNS tumors was
conducted to determine their outcome with regard to long-term survival and late
effects. Materials & Methods:
Diagnostic categories were identified from a computerised Pediatric Oncology
Data Base derived from the Saskatchewan Cancer Registry. Data items from
individual patients were captured on standardized forms, and then transferred
to a software program for statistical analyses. Results: Of a total of 1606 cancers diagnosed < 19 years
of age, 316 [20%] had CNS tumors; 297/316 [94%] brain tumors (BT) and 19/316
(16%) tumors of the spinal cord. The three commonest modalities of treatments
were surgery (Sx) + radiation therapy (XRT) [35%], Sx alone [29%], and Sx+XRT+
chemotherapy [20%]. Percentage ten-year disease-free survival off therapy for
the first three cohorts in 5-year blocks commencing with patients diagnosed in
1970 were 36%, 30%, and 33% respectively. For those patients surviving disease
free 5 years post therapy, systemic late effects were noted in 69%. Conclusions: Prospective, longitudinal
long-term cohort studies will allow for earlier detection and intervention with
strategies designed to mitigate the high rate of multiple CNS and other
systemic morbidities recorded in these survivors. Note: This Abstract has been accepted as a poster
presentation at the North American Association of Central Cancer Registries
(NAACCR), June 7 – 9, 2005, in
EDUCATIONAL AND TEACHING RESEARCH:
Richard Braha Assessment Consultants Incorporated, Halifax, Nova Scotia andLesley Lavack, Leslie Dan Faculty of Pharmacy, University of Toronto
What to assess. The content domain was determined through compilation of data drawn from key pharmacy professional and academic documents. An extensive list of characteristics was collapsed into nine positive and nine negative broad non-academic characteristics domains. A validation survey of key stakeholders was undertaken. Results re-affirmed the relevance of the characteristics and assisted in determining relative importance. Development. A pool of items was generated for each of the identified positive and negative non-academic characteristics. Validity scales were developed for use in a multiple-choice format questionnaire. Sequential field tests investigated the psychometric performance and qualities of the items and this instrument. Refinements were made until acceptable psychometric performance standards were met. The instrument achieved or exceeded all relevant psychometric standards in field tests and was used in the Spring 2003 admissions cycle. Validity and standard setting. Extensive analyses were completed to ensure the instrument and cut-scores were reliable and valid for the purpose of selecting applicants for consideration. After confirming internal validity of the instrument, a combination cut-score was determined and a subset with the most positive and least negative characteristics was identified. Conclusions. The instrument displayed strong psychometric properties: excellent item characteristics, reliability, difficulty and discrimination. It displayed ease of administration, scoring, and the ability to select applicants who displayed desirable non-academic characteristics in the absence of undesirable characteristics. The new instrument is improving the reliability with which the Faculty assesses applicants’ non-academic characteristics. Endnote: The instrument was/is being used in the 2004 and 2005 admissions cycles at U of T and one other Canadian Faculty of Pharmacy.
Edu/Teach-Res No. 2: Number of direct observation forms requested of preceptors during final year pharmacy experiential rotations
Andrea J. Cameron, Lesley A. Lavack, Annie WM Lee, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto
Objective: To determine perceptions, and related factors, of both preceptors and students, related to a reduction in number of required direct observation forms (OBS) used for student feedback. Methods: An online survey was designed to elicit feedback from preceptors and students, related to a reduction in OBS required during 8-week rotations. Prior to 2005 one OBS per day, (40 per rotation), was required. In 2005, preceptors were asked to complete one form daily in the first 4 weeks, followed by one every other day for remaining weeks. Variables measured in the survey include: number of rotations supervised, practice type, shared preceptoring, and impact on verbal feedback. Routine program evaluation feedback and unsolicited comments were also collected. Results: The survey will be emailed during the final 2 weeks of the second rotation, ending April 29. From preliminary feedback students and preceptors have commented: ‘OBS forms are an excellent tool for developing counseling skills and gauging improvement’; ‘OBS are irrelevant in the second half of rotation’; ‘prefer to keep one OBS daily to provide critical evidence for summative evaluations’; ‘student perceived the reduced OBS number meant a reduced effort was appropriate’. Conclusions: Results of the survey and other feedback will guide further modifications to the documentation process. The simplicity and consistency of one OBS throughout a rotation may be supported, with a view to converting other documentation to on-line. Reinforcement of the purpose and importance of OBS can be provided to students and preceptors in pre-rotation communications. Frequent direct observations of student performance in a clinical setting are a key component of effective experiential learning.
Edu/Teach-Res No. 3: Interprofessional
rural program in
Author: Interprofessional Rural Program of BC Working group. Presenter:
Rosemin Kassam, Faculty of Pharmaceutical Sciences, The University of
Objective An Interprofessional Rural Program of British
Columbia (IRPbc) was established to expose students in the health professions
to rural communities and to provide them with the opportunity to learn how to
work effectively within an interprofessional setting. Methods: A program development
approach was used to implement the IRPbc. The IRPbc is a provincial program,
developed through funding from the British Columbia Ministry of Health and coordinated
through the British Columbia Academic Health Council. The program was initiated
as a broad-based collaborative initiative bringing together partners from
government, the academic context and health services in rural communities; this
was an important first step for
Edu/Teach-Res No. 4: Pharmacy
students’ experiences with the interprofessional rural program in
Rosemin Kassam, Faculty of Pharmaceutical Sciences, The University of British Columbia, 2146 East Mall, Vancouver, BC V6T 1Z3
Background: In January 2003, the British Columbia Ministry of Health funded the development of an Interprofessional Rural Program of British Columbia (IRPbc) to prepare students for interprofessional collaborative practice and to promote rural recruitment of health professionals. To-date, 60 students representing 11 health professionals have participated. Objective: To present pharmacy students’ experiences with the IRPbc. Methods: Recruitment of rural communities as clerkship sites for pharmacy students was influenced by the availability of local preceptors to supervise students. Senior year students with an interest in rural practice and interprofessional education were recruited through an interview process and offered a two-day orientation session. Students were provided with shared accommodation and funding for travel. In addition to completing the requirements of their own professional education, each student had to meet expectations set by the IRPbc. Individual interviews with students, along with review of their learning log were used to evaluate their experiences. Results: To-date four pharmacy students have had the opportunity to partake in the IRPbc. For the first three placement cycles, these experiences took place primarily in two communities, Bella Coola and Trail, and occurred in teams ranging from three to seven interprofessional students. Students identified a number of benefits they received through this experience. Some of the benefits included the opportunity to interact with an interprofessional team, gain a stronger sense of their own identity, develop an increased appreciation of other professions they worked with and, last but not least, experience life in a small community. Conclusion: IRPbc has provided a model for implementation of interprofessional education.
Edu/Teach-Res No. 5: Development of an on-line, foundations course for students in a part-time Doctor of Pharmacy Program.
Raman-Wilms, Leslie Dan Faculty
Background: A part-time on-line program was developed for a post-baccalaureate Doctor of Pharmacy Program. One of the earlier courses students take is Foundations for Advanced Practice Pharmacy, which enables students to develop the required knowledge and skills for the Advanced Therapeutics courses. Objectives: The development, implementation and evaluation of the on-line foundations course taught in a problem-based format for a post-baccalaureate Doctor of Pharmacy Program is presented. Methods: A literature search was done to identify existing on-line programs that emphasize problem-based learning. Based on the literature review, consultations with individuals working with on-line courses and from reviewing the existing face-to-face foundations course, an on-line course was developed and implemented for nine part-time Doctor of Pharmacy Students. At the completion of the course, students were surveyed on the benefits and challenges with the on-line learning. This survey was compared to a similar survey given to learners in the face-to-face program for the same course. Results: Overall, the on-line course was successful in helping students meet the required course objectives. Compared to the face-to-face program, students taking the on-line course expressed additional challenges to their learning. Conclusions: An on-line course was successful in helping part-time students meet the objectives of a foundations, problem-based, Doctor of Pharmacy course. Based on students’ feedback, this on-line course will be further revised and modified to improve the student’s learning experience.
PHARMACY PRACTICE RESEARCH:
PPR No. 1: Natural health products in the management of osteoporosis
M Whelan1,2, Tannis M Jurgens1, Susan K
Bowles1,3, 1 College of Pharmacy, Dalhousie University, 2
Department of Family Medicine, Dalhousie University, 3 Division of
Geriatric Medicine and Department of Pharmacy, Capital District Health
Objective: To identify natural health products (NHPs) recommended for the management of osteoporosis and to review the evidence for their effect on bone mineral density (BMD)/fracture rate in women. Methods: Medline, Natural Medicines Comprehensive Database, and the Internet were initially searched to identify any NHPs advocated for use in osteoporosis. These sources, along with IPA, The Cochrane Library, IBIDS, CINAHL, and HerbMed, were searched again to locate randomized controlled trials (RCTs) in English, published between 1966 and October 2004. Additional references were obtained from the bibliographies of those articles. RCTs were selected if the NHP was evaluated in osteoporosis in women using BMD/fracture rate as the outcome measure. RCTs were excluded if the NHP was examined in secondary osteoporosis. NHPs examined in well-conducted systematic reviews were excluded. Data was extracted using predetermined criteria and studies appraised using the Jadad scale. Results: Forty-six NHPs were identified that claimed to be of benefit in osteoporosis. Of these 46, 15 had some clinical trial evidence to support their claim. Calcium, Vitamin D, and fluoride were excluded from the list of 15 as they were reviewed elsewhere. Strontium was also excluded as strontium ranelate, a drug under development, was used in the published studies. For the remaining 11 NHPs, RCTs that fit the inclusion criteria of the study were found for only DHEA, phytoestrogens and Vitamin K. Conclusion: Identified data is insufficient to support the use of phytoestrogens, DHEA or Vitamin K for the management of osteoporosis in women. Acknowledgment: Funding provided by Merck Frosst Canada & Co.
PPR No. 2: Impact of a pharmacist telephone follow-up intervention on patients receiving antibiotic treatment in community: MICROBE study
Thanh-Thao Ngo, Hélène Lachance-Demers, Cynthia Vachon, Krystel Beaucage, Faculty of Pharmacy, University of Montreal, Montreal, Quebec.
Purpose: To evaluate the impact of a community-pharmacist telephone follow-up intervention (PTFI) on clinical outcomes, pharmaceutical care, and cost for patients undergoing antibiotic treatment. Method: In a multicenter, randomized, controlled trial, patients in the usual pharmacist intervention (UPI) were compared to PTFI patients. Results: Compared to the UPI (n=129), in the PTFI (n=126), drug-related problems (DRPs) were identified in more patients (PTFI: 53%, UPI: 8%; p<0.001). Verbal recommendations (PTFI: 52%, UPI: 6%; p<0.001) as well as recognized (PTFI: 10%, UPI: 2%; p=0.015) and study-specific pharmaceutical advices (PTFI: 5%, UPI: 1%; p=0.064) were issued for more patients. The mean difference in the change in the number of infectious symptoms across the two groups (-0.24 symptom; 95% confidence interval (95% CI): -1.22 to 0.74) and the change in the infection-severity score (mean difference: -0.05 unit, 95% CI: -0.35 to 0.25) were small and not statistically significant. The adherence to treatment and patient satisfaction did not differ across the two intervention groups. The incremental direct costs of the PTFI vary from $2.65 CAD and $5.11 CAD per patient depending on whether cognitive services are reimbursed. Conclusion: A PTFI provides an excellent opportunity to detect and manage DRPs. No improvement in clinical outcomes was detected. This may be attributable to the difficulty of measuring clinical outcomes without laboratory culture, to the high level of pharmaceutical care offered to all study patients, and to the relatively small number of patients.
Financial support for this
study was provided by Pro Doc Ltée. The results of this study were presented at
the Canadian Association for Population Therapeutics annual conference, April
SOCIAL AND ADMINISTRATIVE RESEARCH:
SocAdminRes. No. 1: The health care team: what role do community pharmacists see for themselves?
Background: This study reports on
support among community pharmacists for multidisciplinary health care teams and
greater clinical responsibility, as well as the extent they perceive a
leadership role for themselves within the health care team. Methods: A mail-in questionnaire (English or French)
was sent to community pharmacists across
Published by the Canadian Society for Pharmaceutical Sciences.
Copyright © 1998 by the Canadian Society for Pharmaceutical Sciences.