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
BASIC
RESEARCH:
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
Xia
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
Pharmaceutical Sciences,
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.
Maryvonne Le
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.
CLINICAL
RESEARCH:
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.
Background
& 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.
Lalitha
Raman-Wilms, Leslie Dan Faculty
of Pharmacy,
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
Anne
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
Authority.
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
16-19, 2005,
SOCIAL AND
ADMINISTRATIVE RESEARCH:
SocAdminRes. No. 1: The health care team: what role do
community pharmacists see for themselves?
1.
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.