Appropriate training for community pharmacists may improve the quality of medication use. Few studies have reported the impact of such programs on medication management for patients with chronic ...kidney disease (CKD).
Multicenter, cluster-randomized, controlled trial.
Patients with CKD stage 3a, 3b, or 4 from 6 CKD clinics (Quebec, Canada) and their community pharmacies.
Each cluster (a pharmacy and its patients) was randomly assigned to either ProFiL, a training-and-communication network program, or the control group. ProFiL pharmacists completed a 90-minute interactive web-based training program on use of medications in CKD and received a clinical guide, patients’ clinical summaries, and facilitated access to the CKD clinic.
Drug-related problems (primary outcome), pharmacists’ knowledge and clinical skills, and patients’ clinical attributes (eg, blood pressure and glycated hemoglobin concentration).
Drug-related problems were evaluated the year before and after the recruitment of patients using a validated set of significant drug-related problems, the Pharmacotherapy Assessment in Chronic Renal Disease (PAIR) criteria. Pharmacists’ questionnaires were completed at baseline and after 1 year. Clinical attributes were documented at baseline and after 1 year using available information in medical charts.
207 community pharmacies, 494 pharmacists, and 442 patients with CKD participated. After 1 year, the mean number of drug-related problems per patient decreased from 2.16 to 1.60 and from 1.70 to 1.62 in the ProFiL and control groups, respectively. The difference in reduction of drug-related problems per patient between the ProFiL and control groups was −0.32 (95% CI, −0.63 to −0.01). Improvements in knowledge (difference, 4.5%; 95% CI, 1.6%-7.4%) and clinical competencies (difference, 7.4%; 95% CI, 3.5%-11.3%) were observed among ProFiL pharmacists. No significant differences in clinical attributes were observed across the groups.
High proportion of missing data on knowledge and clinical skills questionnaire (34.6%) and clinical attributes (11.1%).
Providing community pharmacists with essential clinical data, appropriate training, and support from hospital pharmacists with expertise in nephrology increases pharmacists’ knowledge and reduces drug-related problems in patients with CKD who are followed up in clinics incorporating a multidisciplinary health care team.
Background Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease (CKD) are lacking. Study Design Quality improvement report. Setting & Participants ...Nephrologists (n = 4), primary care physicians (n = 2), hospital pharmacists with expertise in nephrology (n = 4), and community pharmacists (n = 2). The PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria were applied retrospectively to 90 patients with CKD in a randomized study. Quality Improvement Plan Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems (DRPs). Using a RAND method, experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention. The PAIR criteria include 50 DRPs grouped into 6 categories. Outcomes DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists. Measurements Prevalence of DRPs and reliability, validity, and responsiveness of the PAIR criteria. Results A mean of 2.5 DRPs/patient (95% CI, 2.0-3.1) was identified based on the PAIR criteria compared with 3.9 DRPs/patient (95% CI, 3.4-4.5) based on clinical judgment of nephrology pharmacists. Inter-rater reliability coefficients (κ) by PAIR category varied from 0.80-1.00, with an intraclass correlation coefficient (ICC) of 0.93 (95% CI, 0.89-0.95) for total DRPs per patient. Test-retest reliability coefficients by category varied from 0.74-1.00, with an ICC of 0.91 (95% CI, 0.82-0.96) for total DRPs per patient. During the study, the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment. Limitation The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation. Conclusion The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD. The PAIR criteria are reliable, but their responsiveness remains to be shown.
Introduction:
Chronic kidney disease (CKD) patients are multimorbid elderly at high risk of drug‐related problems. A Web‐based training program was developed based on a list of significant ...drug‐related problems in CKD patients requiring a pharmaceutical intervention. The objectives were to evaluate the impact of the program on community pharmacists' knowledge and skills and their satisfaction with the training.
Methods:
Pharmacists were randomized to the training program or the control group. Training comprised a 60‐minute Web‐based interactive session supported by a clinical guide. Pharmacists completed a questionnaire on knowledge (10 multiple‐choice questions) and skills (2 clinical vignettes) at baseline and a second time within 1 month. Trained pharmacists completed a written satisfaction questionnaire. Semidirected telephone interviews were conducted with 8 trained pharmacists. Changes in knowledge and skills scores were compared between the groups.
Results:
Seventy pharmacists (training: 52; control: 18) were recruited; the majority were women with <15 years' experience. Compared with the control group, an adjusted incremental increase in the knowledge score (22%; 95% confidence interval CI: 16%–27%) and skills score (24%; 95% CI: 16%–33%) was observed in the training group. Most pharmacists (87%–100%) rated each aspect of the program “excellent'' or “very good.” Additional training and adding a discussion forum were suggested to complement the program.
Discussion:
Pharmacists like the Web‐based continuing education program. Over a short time span, the program improved their knowledge and skills. Its impact on their clinical practices and quality of medication use in CKD patients remains to be assessed.
RESULTS: The PAIR criteria include 50 DRPs grouped into 6 categories. A mean of 2.5 DRPs/ patient (95% CI: 2.0 to 3.1) were identified. Interraters reliability coefficients (kappa) by category varied ...from 0.8 to 1.0 with an intra-class correlation coefficient (ICC) of 0.93 (95% CI: 0.89 to 0.95) for the total DRPs/patient. Test-retest reliability coefficients by category varied from 0.74 to 1.00 with an ICC of 0.91 (95% CI: 0.82 to 0.96) for the total DRPs/ patient. A total of 3.5 DRPs/patient were identified by consensual evaluation based on implicit judgments.
The presence of virulent phages is closely monitored during cheese manufacturing, as these bacterial viruses can significantly slow down the milk fermentation process and lead to low-quality cheeses. ...From 2001 to 2020, whey samples from cheddar cheese production in a Canadian factory were monitored for the presence of virulent phages capable of infecting proprietary strains of Lactococcus cremoris and Lactococcus lactis used in starter cultures. Phages were successfully isolated from 932 whey samples using standard plaque assays and several industrial
strains as hosts. A multiplex PCR assay assigned 97% of these phage isolates to the
genus, 2% to the P335 group, and 1% to the
genus. DNA restriction profiles and a multilocus sequence typing (MLST) scheme distinguished at least 241 unique lactococcal phages from these isolates. While most phages were isolated only once, 93 of them (out of 241, 39%) were isolated multiple times. Phage GL7 was isolated 132 times from 2006 to 2020, demonstrating that phages can persist in a cheese factory for long periods of time. Phylogenetic analysis of MLST sequences showed that phages could be clustered based on their bacterial hosts rather than their year of isolation. Host range analysis showed that
phages exhibited a very narrow host range, whereas some
and P335 phages had a broader host range. Overall, the host range information was useful in improving the starter culture rotation by identifying phage-unrelated strains and helped mitigating the risk of fermentation failure due to virulent phages.
Although lactococcal phages have been observed in cheese production settings for almost a century, few longitudinal studies have been performed. This 20-year study describes the close monitoring of dairy lactococcal phages in a cheddar cheese factory. Routine monitoring was conducted by factory staff, and when whey samples were found to inhibit industrial starter cultures under laboratory conditions, they were sent to an academic research laboratory for phage isolation and characterization. This led to a collection of at least 241 unique lactococcal phages, which were characterized through PCR typing and MLST profiling. Phages of the
genus were by far the most dominant. Most phages lysed a small subset of the
strains. These findings guided the industrial partner in adapting the starter culture schedule by using phage-unrelated strains in starter cultures and removing some strains from the starter rotation. This phage control strategy could be adapted for other large-scale bacterial fermentation processes.
L'étendue des expérimentations locales dans le domaine de l'intervention psychosociale auprès des jeunes et de leur famille est largement méconnue. Pourtant, si l'on innove, c'est pour répondre à la ...nécessité souvent criante de s'adapter à l'environnement de travail et à la clientèle. Or, lorsque les pratiques originales restent dans l'ombre, les intervenants courent le risque de passer à côté de trouvailles utiles et de reproduire les erreurs du passé. Ce livre décrit une trentaine d'initiatives en cours dans le réseau des centres jeunesse du Québec. Les auteurs sont des praticiens et des universitaires dont la collaboration a permis de trouver des solutions prometteuses pour offrir aux jeunes en difficulté un soutien individuel et familial adéquat.