PE Newsletter | January 2013
International Pharmaceutical Students’ Federation
PEN Pharmacy Education Newsletter
education@ipsf.org http://pharmacy-ed.ipsf.org
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PEN editorial Dear IPSFers,
in Canada.
It is a great pleasure for me to present the fourth edition of Pharmacy Education Newsletter to you.
Last but not least we have an event review where Ms. Sevdenur Karataş shares her experience in the 11th National Pharmacy Fair, in Turkey, which is somehow unique because in addition to being an event where pharmaceutical companies promote their firms and latest products; it provides separate programs for final year pharmacy students and also gave pharmacy students’ clubs and associations opportunity to promote their activities.
The highlight of this edition comes from our Chairperson of Pharmacy Education, Mr. Marouen Ben Guebila, himself. He wrote an interesting
Mr. Fahmi Fuady Phuture Co-Ordinator 2012-2013
article about genome sequencing and the latest developments in this field - i especially related to personalized medicine and the controversy this may bring. Ms. Ahlem el-Ghoul shares some information about a common but sometimes overlooked problem pharmacists encounter in their professional work, medication errors. Our experienced IPSF’er, Ms. Shirley Young, provides us some insight on academic detailing, a relatively new practice she is doing in her professional work as a clinical pharmacist
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Ms. Alexandra Marques IPSF Chairperson of Media and Publications
Genome sequencing : a paradigm shift in personalized medicine Mr. Marouen Ben Guebila Page 4
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11th Pharmaceuctical Fair in Turkey & OTC Workshop Ms. Sevdenur Karataş Page 12
Post-event
January 2013
Design & Layout
Enjoy reading, viva la Pharmacie!
content highlight
publication team
As a publication PEN is still a new project and there are much room for improvement. For this reason, don’t hesitate to contact us at phuture@ ipsf.org if you have any comments, suggestions, or even if you want to get your article published here.
Ed innovation Medication Errors: Causes and Prevention Ms. Ahlem el Ghoul
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Academic Detailing – An Expanded Role of a Pharmacist, a Canadian Experience Ms. Shirley Yeung Page10
know IPSF partners StudyPortals Page 14
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PEN highlight
Genome sequencing : a paradigm shift in personalized medicine by Mr. Marouen Ben Guebila, IPSF Chairperson of Pharmacy Education 2012-13 The first human genome was sequenced from 1992 to 2002. It took more than ten years and the involvement of several hundreds of molecular biology labs from different countries in the world. In 2013, sequencing the human genome takes ‌ six hours(figure 1).
tide polymorphism (SNP). Several studies focused on these variations to find a correlation to drug response. Codeine and Warfarin were the first drugs that had a genetic tests developed for patients and the list is still enlarging. The human genome (Ornl, 2003) sequencing allowed moving from pharmacogenetics (studying one gene at a time) to pharmacogenomics, with a whole genome overview to variability.
In terms of financial load, today, sequencing the human genome costs only 1000 dollars while in the beginning , the human genome project cost was around 1 billion dollars.
Genome Wide Associations Studies (GWAS)(Psychiatric GWAS Consortium coordinating comittee, 2009) are the direct income of genome sequencing. The purpose was to find inter-gene interactions that could impact drug efficiency. Today, more variability sources were identified like Copy Number VariThe direct outcome of this study was that there ation (CNV) and epigenetic factors. All these comwas not only one human genome, but several ge- bined together, in meta-analysis helped identifying nomes. We are all different and this difference is causes of non-response to several drugs. coded in our genome. Humans only differ by 1% to the Chimpanzee genome. Inter-individual variabilSince then, an ambitious project was launched; ity concerns only slight parts of the genomes. Sev- 1000 genome project (Siva, 2008)aims to sequence eral studies revealed that these regions are highly the genome from different countries and ethnics to responsible for drug efficacy. understand better the variation in the genome. The big question scientists had at the time is: if we are all different, why should we take the same medicine? The concept of personalized medicine started from this fact.
Transcriptomic studies, started very recently had a lot of interest. In several cases, transcriptomic profiling can give more information than just studying the genome. Several successes have been made in understanding, drug response using transcriptomThe variability in the genome comes in the form ics. ENCODE project with 30 original article (Encode, of mutations (silent or active), called single nucleo- 2012), especially, gave a better understanding of page 4 coding regions in the genome. Maybe a bigger con-
PEN highlight
clusion is that, non-coding regions are as useful as coding regions and can have a great impact on variability between individuals. In 2012, The FDA, was the first drug agency to deliver a marketing authorization for drugs for AfricanAmerican people, based on these genome studies. In conclusion, a lot of question remains without an answer. Genome studies are a new path that adds a new element to the answer. But not without risks, in fact, several countries refuse to segregate people on genome basis, called ethnic studies. Ethically, our genome, can, in the near future, inform about the disease predisposition. Imagine this kind of information falling in the hands of your banker or your employer ‌ Limits need to be set to avoid any misuse of medical data.
is getting higher and higher, with a need of highly trained people, high computational capabilities and last but not least a relevant interpretation. References: Ornl. (2003). Taken from HGP: http://www.ornl. gov/sci/techresources/Human_Genome Encode. (2012). Taken from Nature: http://www. nature.com/encode/ Psychiatric GWAS Consortium coordinating comittee. (2009). Genomewide Association Studies: History, Rationale, and Prospects for Psychiatric Disorders. Am J Psychiatry. Siva, N. (2008). 1000 Genomes project. Nature Biotechnology.
Finally, It is true that human genome sequencing costs almost 1000 dollars nowadays, but analysis cost
Figure 1 – Third generation sequencers (left) and first generation sequencers (right). With more precision, longer reads and higher speed, third generation sequencers are taking New Generation Sequencers (NGS) to the next level. An error rate of 20 % remains their main weakness.
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PEN Ed innovation
Medication Errors: Causes and Prevention by Ms. Ahlem el Ghoul
Although drug therapy is considered as a widely used type of remedy, it is not always the safest path to take, knowing that many errors may occur during its process causing health disorders, which are sometimes lifethreatening.
men can lead to prescribing errors, pharmacists’ lack of attention and concentration (in a busy day for example), lack of patient information about their drugs, self medication, the absence of communication between prescribers and pharmacists, including hospital nurses, and also between pharmacists and patients.
There are other reasons such as: illiteracy, mostly in the third world countries, and the replacement Medication Error is defined of pharmacists by unqualified sales clerks at drug by the American Food and stores. Drug Administration (FDA) as To assure medication safety Institute of Safe Med“any preventable event that may cause or lead to inappropriate medication use ication Practices (ISMP) developed the 10 key eleor patient harm while the medication is in the con- ments of medication use: trol of the health care professional, patient, or con• patient information sumer. Such events may be related to professional • drug information practice, health care products, procedures, and sys• adequate communication tems, including prescribing; order communication; • drug packaging, labeling, and nomenclature product labeling packaging, and nomenclature; • medication storage, stock, standardization, compounding; dispensing; distribution; administra- and distribution tion; education; monitoring; and use” • drug device acquisition, use, and monitoring Studies have been devoted to reveal causes of • environmental factors drug errors that are usually due to negligence of • staff education and competency health care providers or patients themselves, some • patient education of the most common causes are: illegible handwrit• Quality processes and risk management. ten prescriptions, oral transmission of prescriptions -sound-alike names may cause error -, selection of an incorrect drug or dose or a too complex regi-
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Each country implements its own medication vigilance system in order to prevent and reduce drug errors:
PEN Ed innovation
Canada:
To augment the USP MERP and MedWatch programs, USP has launched MedMARx速, an InternetISMP Canada, ensures safe use of medications, accessible method for hospitals to anonymously prevention of medication errors and regulates report and track medication errors in a standard healthcare policies by collaborating with several format. national and international patient safety organizaMeanwhile, many internal institutions are also tions worldwide along with ISMP US. ISMP Canada, Canadian Institute for Health Information (CIHI) developing medication errors reporting programs, and Health Canada have led to the development of which are turned out to be even more effective than Canadian Medication Incident Reporting and Pre- the national programs. vention System (CMIRPS), which is concerned with Algeria: reporting and prevention of medication error incidents all over the nation. The national center of Pharmacovigilance and ISMP Canada and ISMP US have created internet accessible software called Analyze ERR that records, tracks and performs a root cause analysis of medication error.
Europe: The European Foundation for the Advancement of Healthcare Practitioners (EFAHP) introduced the European Medication Error Reporting Program to provide a uniform method to report medication errors. This program is useful in helping healthcare organizations and practitioners across Europe to use medicines more safely. It has also initiated medication safety awareness, which includes meetings and seminars.
Materiovigilance (Centre national de Pharmacovigilance et de Materiovigilance) (CNPM) is a surveillance system established to insure safety. The center set a system of detection, evaluation and risk management in terms of drugs, vaccines and medical devices, as well as dissemination of information on incidents and potential incidents. One of the CNPM objectives is to promote rational use of medication and prevent medication errors. Since pharmacists are the most accessible health care professionals they play a crucial role in preventing and reducing medication errors by delivering correct and accurate information about drugs, permanently actualizing medicines information and improving their patient counseling skills.
United States:
To reach our goal, which is reducing medical erThe United States Pharmacopoeia (USP) Medica- rors, we should all shout out the seriousness of the tion Error Reporting Program (MERP) is run in coop- matter and its risks. eration with the Institute of Safe Medication PracSources: tices. All reports are reviewed and assessed than http://www.ismp.org http://www.fda.gov forwarded to FDA, which also has an adverse event http://www.cnpm.org.dz reporting program called MedWatch.
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PEN Ed innovation
Academic Detailing –
An Expanded Role of a Pharmacist, a Canadian Experience by Ms. Shirley Yeung, from Vancouver, Canada
The pharmacist is often known as the medication expert within the healthcare team. Typically, pharmacists have been placed in a traditional dispensary role, providing medications and counselling to patients as required. Globally, there has been a push, where pharmacists are trying to expand beyond the technical dispensary role and into the more clinical role, where their medication knowledge can be fully utilized. Over the years, it has been noted that prescribing practices are often influenced by the marketing done by various pharmaceutical companies. These companies often send out representatives, with little or no medical knowledge to sell various medications to the doctors. It is common for these representatives to overemphasize the benefits and minimize the risks of the medications to make them more appealing to the physicians. To counteract these influences, in Canada, a relatively newer service, often known as academic detailing or educational outreach, has been implemented. This service utilizes healthcare professionals, mainly pharmacists, to provide evidence‐ informed drug information to the physicians. The goal of the service is to provide the most up‐to‐date drug information to optimize prescribing practices and promote the best possible outcomes for patients. Physicians, especially general practitioners, are extremely busy; therefore, it is important to be mindful of this when speaking to them about drug information. In order to provide the most practical information, a detailed literature review must already be completed on the topic. This may include critically reviewing the latest meta‐analysis, randomized
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controlled trials, observational studies and various national guidelines as necessary. The literature is then summarized and condensed to a format that can used as a reference for the detailing session. During the detailing session, the pharmacist and the physician would have a discussion about the drug information. Given that time is valuable for the physician, not every physician will have the same learning needs, making each and every detailing session unique. In order to fulfil each of the prescriber’s needs, it is important to have effective communication skills. It is especially helpful to be flexible and adapt to questions that the prescriber has and be able to provide practical recommendations that can be applied easily to clinical practice. The trickiest aspect is to convince the physician to adapt and use the information that is provided. In a sense, the pharmacist is trying to “sell” information, and market an idea. This is why it is important to have effective communication skills to persuade the physician to “buy in” on the information, so that his or her prescribing practices would be changed. It is also important to develop a respectful relationship between the pharmacist and prescriber. This will create a non‐threatening learning environment to ensure better delivery of the drug information to improve the overall pharmaceutical care of the patient. Services like this have been implemented in multiple countries including USA, Australia, UK, and Sweden for about 20 years. Multiple studies have also been conducted to assess the effects of academic detailing on prescribing. It is evident that these discussions and educational sessions with the pharmacists will effectively modify prescribing habits to ensure optimal patient care. This is an example where pharmacists can use their expertise in medication knowledge to enhance pharmaceutical care. It is an extremely unique role as the pharmacist can modify patient care at the point of prescribing, rather than at the point of dispensing.
PEN FIPEd corner
FIP-WHO Global Survey of Pharmacy Schools Has your school responded?
FIP Education Initiatives and WHO are implementing a global survey that aims to collect information: To ascertain the educational background of the pharmacy workforce and production capacity; To ascertain quality assurance accreditation mechanisms and processes. The data will be used to identify gaps, shortages and cooperation opportunities, besides providing the evidence-based information needed for investment policies that will reduce existing gaps and increase pharmacy education capacity. The participation of all pharmacy education institutions in this survey is vital to provide a better understanding of current pharmacy education issues, and will assist in the development of global pharmacy education policy recommendations. For these reasons, FIP and WHO have sent an invitation to the Deans of all schools of pharmacy to complete the Global Survey of Pharmacy Schools. Please help us by ensuring that your Dean or School leader has completed the survey for your pharmacy school/faculty/department [www.fip. org/education].
Should you wish to provide data on behalf of your school or your country please contact Andreia Bruno education@fip.org to obtain the information to be able to complete the survey. If you have any comments or questions concerning the project please send them to education@fip.org.
A million thanks in advance for your help! FIPEd Development Team
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PEN post-event
11th Pharmaceuctical Fair in Turkey
&OTC Workshop
by Ms. Sevdenur KarataĹ&#x; , IUPSA International Vice President of Education 2012-2013 11th Pharmaceutical fair and OTC workshop took place on 3rd and 4th November 2012 in Istanbul, Turkey. The event was hosted by Devajans, a company whose main activity is organizing fairs around Turkey. Numerous pharmaceutical companies including recently established ones participated in this fair to promote their companies, products, and most importantly new licensed medications for more than 4.000 visitors. There were also booths for pharmacy faculties and students’ associations, which gave them the opportunity to introduce themselves, their goals and their activities. This also helped to gather students from all over Turkey under one roof. As IUPSA International, we promoted not only our association but also IPSF, its activities and how to get involved.
This year the fair has improved compared to the previous years. In addition to the fair itself, there were a workshop about OTC, a separate conference for final year pharmacy students, an essay competition and a pharmacy technicians meeting. OTC products were chosen as the topic for the workshop because of their rising importance in Turkey. It has been observed that the sales of these products have increased lately which may be a direct result of some changes in laws related to advertising. This also has affected the trend in medication consuming in the population. In the workshop, the speakers informed the pharmacists about the changes in laws, aromatherapy, homeopathy, and staffs management. They also gave practical information which can be used when counseling patients.
During the conference, which held for final year students, the speakers focused on topics such as communication skills, pharmacists’ role in counseling, and career steps for future pharmacists. They The fair was a great opportunity for pharmacists, explained what kind of difficulties we may face earpharmacy students and healthcare professionals to ly in our career and most importantly how we can discuss and acquire the latest knowledge about the overcome them. Two successful pharmacists gave a changes in pharmacy system and our ongoing role presentation about their career in pharmaceutical in it. In recent years, the health care system has de- company and their path to success. veloped very fast in Turkey therefore it is crucial to The essay competition was also organized for keep updated with the changes and be aware of final year pharmacy students and fresh graduates, the challenges that comes along them. who probably have the most expectation about how they are going to practice their professions. page 12
PEN post-event
The topic was ‘the pharmacy of my dream’ and the goal behind this competition was to get some new ideas in that can be implemented in community pharmacy practice in Turkey. Some students wrote their ideas about how to improve pharmaceutical care practice, some described more about crazy designs of a dream pharmacy and some wrote in a more literary way. Although all the essays were well-written and interesting, only the first five es-
says were awarded at the end of the competition. The first prize winner wrote a detailed essay covering many aspect of pharmacy from the pharmacists function in his imaginary pharmacy to the relation with patients and other healthcare practitioners. All things considered 11th Pharmacy Fair & OTC Workshop was a great experience, filled with many educational seminars and stands.
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PEN know IPSF partners
Did you know that there are are more than 150 Master’s programmes related to Pharmacy in Europe? And did you know that there is over 16 billion euro available in scholarships to study in Europe? Now you do. Be surprised by the great study opportunities that Europe has to offer with thanks to StudyPortals – the European study choice platform. The team of StudyPortals does its best to stimulate and inform you on international study choice. On several web portals you can find relevant information about study programmes, including pharmacology and related studies as well as information about funding opportunities. In addition on you have a great chance to learn from others students and experiences they have shared on Student Experience Exchange platform. StudyPortals provides a unique overview of all study programs offered in any European country. Through the search engine you can find study programmes in pharmacy or other disciplines of interest. Each program has a short description, information about the tuition fee, duration and university information. It provides all details related to study programme: application requirements, contents, application deadlines, start dates, mode etc. Check it out and find your Bachelor’s, Master’s, PhD, Short Courses or Online Degree (and Scholarships to finance it).
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International Pharmaceutical Students’ Federation PO BOX 84200 2508 AE Den Haag The Netherlands Tel: +31 70 302 1992 Fax: +31 70 302 1999 Email: ipsf@ipsf.org Website: www.ipsf.org
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