PEN Magazine #08

Pharmacy Education Newsletter

2017- 2018

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Table of Contents Study Abroad in London A comparison of healthcare systems

Public Health 24

Make Pharmacy an Adventure Go Abroad Now

The 6th Eastern Mediterranean Pharmaceutical Symposium in Kuwait

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From Pharmacy Counters to Lab Benches Challenges and rewards

Indian Health Service: A Unique Practice Opportunity

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Pharmacy Entrepreneurship in A Glimpse into Advanced Pharmacy America Practise Experience 30 12

Development through Uncertainty

Pharmacy as A Profession: What is needed?

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14 The Power of Next 18 Telepharmacy 20 2

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“From pharmaceutical education until death” 35 Immunity – Induction, Promotion & Disorders (a smart bomb) 36

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PEN editor: Design & Layout :

Kalvin Halimawan Susanto, BEMF USD, Indonesia

Author: Abd El-rahman Nabil, EPSF, Egypt Arsany Makkar, APhA-ASP, USA Carolyn Marg, APhA -ASP, USA James Cong, APhA-ASP, USA Janhavi Punyarthi, APhA-ASP, USA Karen Abboud, LPSA, Lebanon Sonya Park, APhA-ASP, USA Naser Alsharif, USA, Professor of Pharmacy Sciences Rafiq Unnisa, IPA-India Sara Anwar, EPSF, Egypt Tiffany Lee, APhA-ASP, USA Tin Lee, APhA-ASP, USA Yvonne Feghali, LPSA, Lebanon Zahraa Menhem, LPSA, Lebanon

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Study abroad in London

A comparison of Healthcare Systems “By studying abroad in London, I was able to gain a broader perspective on healthcare systems around the world and learn the importance of comparing these systems to further patient care” by: Carolyn Mag, APhA -ASP, USA

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The United States is at the forefront of modern medical technology and continues to be a leader in pharmaceutical research. One of the biggest flaws of the United States’ healthcare system, however, is how much it costs. A big part of this spending includes pharmaceutical medications. In 2013, the United States per capita spending on prescription drugs was $858 USD compared to an average of $400 USD for 19 other developed countries including the United Kingdom. This is an estimated 17% of total healthcare costs per person annually.1 The high cost of prescription drugs is partially due to market exclusivity which allows a drug manufacturer to Growing up in the Midwest and studying pharmacy have monopoly rights where they can set high in Fargo, North Dakota provided me with a limited prices. Physicians also have prescribing choices perspective of how the United States’ healthcare which influence spending even when alternatives system measured up on a global scale. With our are available at lower costs. country currently in the midst of reforming the Patient Protection and Affordable Care Act of 2010, The United Kingdom’s healthcare system operates it is more important than ever to be educated on as a single-payer system where the National Health this subject to be able to impact health and drug System (NHS) is responsible for the universal policy and provide optimal care for our patients. coverage of all UK residents. All employees who work at publicly owned hospitals and healthcare had the unique opportunity to study abroad in London for three weeks this summer with a small group of fellow pharmacy students from North Dakota State University. This experience allowed me to gain a global perspective on the profession of pharmacy and compare two very different health systems: the United Kingdom’s and the United States’. Through guest lectures, classroom discussions and tours of pharmaceutical facilities, as well as Parliament and other historic sites, we could directly contrast their single-payer system with our combination of both public and private sectors.

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facilities, including pharmacists, are employed by the government. They do have several private medical insurance companies and private hospitals available to more wealthy patients. The major concern with their single-payer system is access to care. While everyone is covered by the NHS, wait times to see a provider can be as long as three months to one year. Those with private health insurance can benefit from reduced waiting times for surgery and other procedures.

Healthcare expenditure in the United Kingdom is much lower compared to the United States with 9.9% of the Gross Domestic Product (GDP) spent on healthcare costs.2 It is easy to pick out the flaws in any healthcare system, but it is more important to search for the benefits to see what can be applied globally and may result in the best patient care possible. For the United States, to cut back on its healthcare spending, it is essential to first study other healthcare systems to learn from them and find ways to continually improve.

By studying abroad in London, I was able to gain a broader perspective on healthcare systems around the world and learn the importance of comparing these systems to further patient care. I encourage any pharmacy student to embrace the opportunity to study pharmacy and healthcare globally because it is truly an experience you will never forget.

Resources 1. Kesselheim AS, Avorn J, Sarpatwari A. The High Costs of Prescription Drugs in the United States: Origins and Prospects for Reform. JAMA. 2016 August 23-30;316(8):858-71. doi: 10.1001/ jama.2016.11237.

2. Harding AJE, Pritchard C. UK and Twenty Comparable Countries GDP-Expenditure-on-Health 1980-2013: The Historic and Continued Low Priority of UK Health-Related Expenditure. International Journal of Health Policy and Management.

2016;5(9):519-523. doi:10.15171/ijhpm.2016.93.

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Make pharmacy an adventure!

Go abroad now! by: Janhavi Punyarthi, APhA-ASP, USA

“We should strive to see what we can learn and bring back from exchange programs to make ourselves better student pharmacists”

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he smell of the ocean hung in the air while a gentle breeze tickled the back of your neck. When you walked across the lawn and into the communal kitchen, a familiar scent of warm bread engulfed you. I would help myself to a baguette, smile and mutter, “merci, madame,” to the nice kitchen lady and come back outside to take a deep breath of the salty sea air. This soon became routine - a baguette, a, “merci,” and a deep appreciation for the fresh ocean air – before I left for the pharmacy every morning.

This was Rochefort; a small, sweet beach town in the south of France, bordering the Atlantic Ocean. Here, little shops adorned the town center, small cafes dotted every corner, and it was common to see ice-cream parlors if you wandered around downtown. Part of the city ran parallel to the river, while the other side veered near the ocean. Given the local environment, it was common to see Rochefort’s inhabitants sporting beachy and sunny clothing. The people

here were kind in nature and seemed to have a preference for being outdoors.

Students would bike around town, couples would walk along the river, and sailing was often considered to be the quintessential pastime of the village.

My walk from the hostel to the pharmacy would take about ten minutes. It was during this time that I would quietly remind myself how lucky I was to have received this opportunity. I was given the chance to complete a pharmacy student exchange program (SEP) through IPSF. It was while I was walking to work that I would take a minute, and whisper to myself, “girl, you’re in France!”

Even now, I still smile in awe at the marvelous experience I had in France.

I often reminisce about the pharmacy and how different it was from the U.S. I think about everything I learned during my month abroad and how important it is to have a global take on pharmacy.

There are many people who would question the importance or need for IPSF PEN 08

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this sort of experience. I, for one, would argue that this sort of global experience is exactly what the high-achieving, curious pharmacy student needs in order to develop a sense of well-roundedness and understanding of culture, policies and healthcare around the world.

culture like abroad? What can we learn from others?

How are they different and what can we contribute to possibly enhance pharmacy in a new place?”

Most importantly, we should strive to see what we can learn and bring back from exchange programs to make ourselves better student pharmacists. As future healthcare professionals, we have a duty to

We need to explore questions such as, “what is the pharmaceutical culture like abroad? What can we learn from others? How are they different and what can we contribute to possibly enhance pharmacy in a new place?”

The medical field is expanding rapidly by the minute with new technologies at every corner and novel medicines at every door. To keep up with the swiftness of pharmacy-related expansion, it is important to establish connections globally. We, as pharmacists, are “medication experts” and need to know how to apply our medications on a global scale.

This is achieved by understanding how pharmacy works across the globe. We need to explore questions such as, “what is the pharmaceutical 8

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better the profession of pharmacy and bring our best knowledge to the playing field. I believe at the end of my exchange, I emerged as a stronger, more confident student pharmacist.

I have become a better professional because of my experience with the different systems of patient care, not only within my country, but internationally.

My pharmacy in France, for instance, included two patient care rooms. One was stocked with braces,

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bandage wraps, and so forth, and was designed to help patients who presented with any sort of pain or inflammation. The other room was typically used for pregnant women, or for patients with bloodflow issues to try on compression stockings. We, in the U.S., commonly lack these types of consultation rooms, but on the other hand, we have patient care areas devoted to immunizations, blood pressure readings, and glucose checks.

I additionally learnt about France’s standards for first-line medications, as well as their approach to managing prescriptions (primarily paper rather than electronic) and the dispensing of controlled substances (of which there seemed to be fewer overall). Their over-the-counter inventory included cosmetics, aging creams, shampoos, pregnancy and baby-care products. French pharmacies are typically separate from grocery stores and it is common for these products to be purchased at the pharmacy, where a staff member is often called upon to offer recommendations. Lastly, it was also instructive to gain experience with regards to different types of healthcare policies and insurance plans.

as the rest of the world. Given my experience, I urge my fellow students to partake in exchange programs and international opportunities. Apart from exchanges, IPSF offers a variety of regional and international conferences that student pharmacists from all over the world can attend.

World Congress is the overarching international conference, where students can attend a plethora of patient care workshops, have the opportunity to present research posters and participate in clinical competitions. Moreover, the hosting country usually offers a post-congress tour for students to visit sights and experience the local culture. Apart from World Congress, different regions of IPSF also tend to host a variety of conferences. For example, the Pan American Region hosts the Pan American Regional Symposium (PARS).

I was fortunate enough to broaden my understanding of the profession while combining my love of travel. I learned about pharmacy, I travelled all over Europe, I made amazing friends, and I created memories to last a lifetime. To end, I will say this...you hear that pharmacy is a very small world, and in many professional cases, this is true. In Having this diverse background gives me a broader my case, however, I took one chance and was able perspective on how we can best serve the needs to make my small world just a little bit bigger. of the patient populations in our country, as well

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From pharmacy counters to lab benches: challenges and rewards by: Karen, LPSA, Lebanon

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y virtue of their jobs, pharmacists are generally the first to hear about new medications. Given their solid, comprehensive background in basic and pharmacological science, they are uniquely suited to \ engage in research, leading to the discovery of those medications.

After three summer pharmacy internships, my exposure to patients’ frustrations with their medications due to either serious adverse effects or a lack of efficiency drove me to look beyond conventional pharmacy careers. For this summer, I wanted to stand behind the lab bench rather than the pharmacy counter to contribute to safer, more effective drugs. I applied to the Summer Research Program in Life Sciences and Technology at the Ecole Polytechnique Fédérale de Lausanne (EPFL). The program consisted of two months of intensive, hands-on lab work and weekly seminars and workshops that culminated in a closing symposium showcasing students’ poster presentations. I chose to work in Professor Stewart T. Cole's lab, which is a renowned laboratory dedicated to drug discovery, uncovering the pathogenesis of tuberculosis and studying the phylogeography of leprosy. As tuberculosis remains one of the top ten causes of mortality worldwide, and multi-drug resistant tuberculosis is on the rise threatening to exacerbate this epidemic, the need to find new antimycobacterials with novel targets becomes more imperative than ever. At EPFL, after the lab highlighted a potential target with no human homologue, my project involved developing a highthroughput enzyme assay to screen a chemical library for inhibitors of the enzyme. The experience was quite challenging but highly rewarding and I would like to share what I’ve learned from it.

Before embarking on a new research project, you should expect to spend a significant amount of time reading the existing literature. It is essential in experiment design and will spare you a lot of confusion as you proceed in your project. Moreover, you will eventually become the expert in this particular area and people will question you on several aspects of your own project, as well as published literature related to it. Therefore, the more you read, the more people will come to regard you as a knowledgeable scientist and trust your project results. Get in the habit of critically reading scientific articles and journals on a regular basis so it won’t be too daunting when you start the research project. Once you’ve finished your literature review, create a preliminary plan. Don’t be discouraged if you don’t adhere to your plan as not everything can be anticipated in science and you may need to adjust your plan as you go.

If you are a novice in the lab, don’t hesitate to ask for assistance in performing unfamiliar laboratory techniques. Your supervisor will realize that you’re just a beginner and will be more than happy to help you. Moreover, your supervisor will appreciate that you are acknowledging your weaknesses and trying to improve yourself. The

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age-old piece of wisdom still holds true in this case; practice makes perfect. Invest time into mastering the techniques you will be using in your project before you actually begin to avoid wasting possibly precious or scarce reagents on failed experiments.

Moreover, don’t just become a pipetting monkey or simply apply the research protocols given to you by your supervisor without understanding the theory behind it. Engage in insightful discussions with your supervisor, show that you’re passionate about the subject, share your ideas concerning the procedure, and ask for additional resources to read if you find that your knowledge is insufficient in a particular area. Eventually, you will enjoy your experience more, and your supervisor will come to regard you as more of a colleague than a student or intern.

Participating in a research project requires serious commitment. Expect to stay long hours at the lab to finish your experiments. Sometimes, after several time-consuming experiments, you realize that you need to abandon the direction in which your project was heading and reassess the situation. If any problems are encountered, you need to troubleshoot and consider any errors that may have occurred. You may need to repeat your experiments to validate your results and ensure that they are reproducible.

While I was developing the enzyme assay, I had to repeat the same experiment multiple times with varying concentrations of the enzyme, substrate, cofactors, and salt concentration in the medium to precisely measure the kinetic parameters and define the concentration of each substance to use in the high-throughput screening. The work is often timeconsuming but is necessary. Finally obtaining the desired results will make all your efforts worthwhile.

As pharmacy students, by engaging more in research projects, we have the opportunity to apply theoretical concepts, enhance our critical thinking and explore academic or industrial scientific research as a career pathway after graduating. More importantly, we can contribute to findings that can be translated into medical practice to improve clinical outcomes and help the patients that we encounter every day.

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A Glimpse into Advanced Pharmacy Practice Experience By: Sonya Park, APhA-ASP, USA

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uring their final year, pharmacy students in the United States have a built-in program in their curriculum called Advanced Pharmacy Practice Experience (APPE). APPEs are the last learning component of the Doctor of Pharmacy curriculum and are also commonly known as “rotations”.

APPEs are designed to allow students to apply their didactic knowledge to real world pharmacy practice. This experience lasts for a year, typically from May to April. Rotations are in blocks of four to six weeks depending on the pharmacy school program. Students are assigned a preceptor for each block who serves as a mentor throughout the rotation.

Most pharmacy students will get to experience a variety of pharmacy environments ranging from community practice, hospital practice, management and leadership practice, pharmaceutical research, academia and more.

Before APPEs

I found myself both excited and nervous about becoming a fourth-year student midway through May as we were soon to leave the safe confines of school. Towards the end of my third year of school, I was unsure about what kind of pharmacy work I wanted to pursue after graduation. I decided against pursuing a clinical track of rotations, which is an APPE focused on inpatient pharmacy, located usually at a hospital. Clinical track APPEs educate and prepare students for residency programs and are usually geared for students who want to pursue this avenue after graduation. A clinical track, however, is not necessarily a requirement for all students who are intent on completing a residency. I was fortunate to have a 12

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highly supportive faculty, mentors and family members who encouraged me throughout pharmacy school to broaden my interests and experience a variety of settings before making a commitment regarding the direction I wanted to go. I picked a wide-ranging APPE rotation schedule allowing me to experience different pharmacy environments.

Community pharmacy experience

My first rotation was in community practice at a large chain pharmacy. During the five weeks that I spent here, my day-today activities involved calling physicians or other healthcare providers to make medication adjustments on prescriptions, receiving verbal prescriptions, troubleshooting insurance issues, educating patients on their medication and fielding daily questions from patients. I really enjoyed the face-to-face interactions with patients and getting to know people from the community. After building rapport with patients from the community, I observed how patients’ attitudes changed over time. As time went by, patients felt more comfortable with having me involved in their care which allowed them to ask disease state-related or medication-related questions freely. I was rather sad at the end of my rotation, however, I knew there were more pharmacy environments I needed to experience.

Hospital pharmacy experience

My second rotation was in a hospital systems practice in a 500 bed hospital. This rotation was a mixture of clinical and management practice experiences. Most mornings, I participated in the rounds with an interdisciplinary group

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comprised of an attending physician, medical residents, medical interns, pharmacists, nurses, social workers, dieticians and therapists. I went on rounds with my preceptor on the cardiology unit and towards the end of five weeks, I was making my own recommendations and answering questions from my interdisciplinary group with some help from my preceptor. In the afternoons after clinical rounds, I followed my preceptor to hospital meetings varying from drug shortage reviews, drug formulary reviews, antimicrobial stewardship meetings, clinical inpatient practice group meetings, pharmacy services meetings and many more. During my five weeks, my preceptor helped me build a strong foundation in the hospital environment and inpatient pharmacy. I was also able to build a strong relationship with my preceptor and I believe I grew tremendously as a person, and as a future practitioner, during this rotation.

Keeping an open mind while embracing challenges

Keeping an open mind while embracing challenges

APPEs enable one to face his or her fears and embrace various challenges while keeping an open mind. For both rotations I have completed, my preceptors challenged me with projects that fit the need of their respective pharmacy institutions.

Some projects were easy and other projects required some further self-education. With each project or question from my preceptors, I realized that I gradually became more independent and found enjoyment in learning from these challenges. Moreover, I have not always been a strong public speaker and both preceptors challenged me to make presentations during the respective five week blocks. At first, it was an uncomfortable experience, however, I embraced the challenge and continue to further my self-improvement in this area.

Keeping an open mind is key for APPEs because without it, I would not have been able to experience so many new opportunities and glimpses into real world pharmacy. For example, during the community rotation, I was able to give presentations on diabetes, participate in immunization clinics, and build relationships with patients whose first language was not English. During the hospital rotation, I was able to experience a small portion of pharmacy informatics by learning new software and implementing teaching sessions to the clinical pharmacists at the hospital.

Self reflection

I have enjoyed both my community and hospital pharmacy rotations although I am still undecided regarding my pharmacy career path. Upon completing these two rotation blocks so far, I realize that five weeks is a short amount of time, but enough to get positive experiences if you embrace new challenges and keep an open mind. I hope to stay positive and remain proactive throughout my six remaining blocks of APPEs and hope to also create new networks with others and find more mentors throughout this process. I am excited about the opportunities that lie ahead in my future APPE blocks. In the upcoming APPE blocks, I hope to have not only found my calling regarding my career path post-graduation, but to have also developed into a well-rounded individual and practitioner who will further the profession of pharmacy.

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Naser Z. Alsharif, Pharm.D, USA, Professor of Pharmacy Sciences

Pharmacy as a Profession: What is Needed?

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hese are exciting times for pharmacy, globally. Over the years, pharmacy has evolved from the apprenticeship model to a career that requires formal, specialized and advanced training with an emphasis on key knowledge, skills and attitudes. There has been the introduction of new curricula with a shift in clinical focus from the product to the patient as well as new educational outcomes such as critical thinking and evidence-based medicine. There has also been more emphasis on a code of ethics with specific obligations towards society. We have witnessed significant efforts to establish local, national and international organizations to promote the profession as well as the implementation of local and international accreditation and licensure standards. It is now recognised that pharmacy requires continuing professional education and there have been further efforts to establish residencies, board certifications and research that contribute to the body of work in pharmacy. Most of the above is what defines a profession. Yet for many countries, including the United States, pharmacy educators, students, practitioners and professional organizations surrendered control of the profession to others and were complacent about highlighting the important services we, as pharmacists, can deliver to improve patient care and the health of the society. Despite all of the measures above, pharmacy was recognized by many stakeholders as an auxiliary service rather than a profession.

Thus, the role of the profession was devalued and many stakeholders around the world were looking at pharmacy through that lens. While progress has been made in some regional countries to counter this image of the pharmacy profession, much work still needs to be done on all fronts to establish a more accurate representation of the profession.

To accomplish this, pharmacy has to address both internal and external factors which influence the image. Within the profession, whether as educators, students, practitioners or regulators, we need to establish accountability in everything that we do. We must ensure that we hold ourselves and our colleagues accountable to the highest level of quality and integrity in all aspects of pharmacy. Key aspects of that include: 1) ensuring academic excellence by making strategic plans to meet the demands of pharmacy education and practice in the future at a local and global level; 2) ensuring current educators, practitioners and preceptors who are serving as

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role models are partnering with students to deliver education; 3) developing admission criteria for students which emphasize altruism, self-awareness, critical thinking, communication skills, cultural competency, advocacy and leadership; 4) establishing local, regional and international accreditation standards which are strictly enforced; 5) enforcing wellthought-out licensure regulations and stringent requirements for continuing professional education; and, 6) developing culturally sensitive and purposeful national and international standards of practice. The above strategies are critical to ensure there is credibility and authenticity in our efforts to improve the profession’s image. This should not be compromised by anyone or be subject to political influence.

Intraprofessional sensitivity1 is also a major aspect of accountability. This requires that while we, as pharmacists, always seek to have the highest confidence in our professional judgement, we should also be aware of the important role each member of our profession plays to serve our patients. We should be exhibiting cultural humility2,3 by recognizing that we are working as a team, in our respective settings, to improve on all aspects of pharmacy education and practice. To err is human, thus acknowledging our limitations and respecting the knowledge and expertise of others within our profession (and other healthcare professionals) is an extremely important skill to possess.

Equally important, pharmacy administrators in all settings and professional pharmacy organizations at all levels, should work collaboratively and strategically to advance the profession on a local and global level. This requires a consolidated effort to advocate in hospital settings, ambulatory care settings, ministries of education, health and labor, insurance companies, as well as developing strategies to reach out to the public and other healthcare professionals and organizations.

This demands a clear consensus on what distinguishes the pharmacist’s role as a member of the healthcare team in our respective regions of the world, and how we advocate for it among all stakeholders. It also requires tackling and addressing current negative stereotypes head on. To ensure the pharmacist’s place as an integral member of the healthcare team, it is important to consolidate relationships with physicians and nurses while reaching out to the public

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simultaneously. It is particularly important to establish a relationship built on trustworthiness, respect, caring and competence as drug experts to ensure that the demand for pharmacists to be at the table is second nature to regulators, politicians, physicians. This is especially important when healthcare issues are discussed or when patient’s needs are addressed.

Another essential aspect to the success of the profession is that key members in all pharmacy settings and in each country must recognize the predominant image and perceptions of pharmacy and pharmacists by all stakeholders.. It is important to proactively speak up and to develop a strategic plan to address any misconceptions or negative stereotypes. The easiest way of addressing this issue is by providing high quality and exemplary professional services and public campaigns in community pharmacies, hospitals and other settings to clearly explain and demonstrate to the public the extensive knowledge and training of pharmacists, what pharmacists do in different settings and how pharmacists contribute as part of the healthcare system in collaboration with other healthcare professionals. Social media and other media outlets should be utilized to counter any negative perceptions. This may

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require professional pharmacy organizations to hire and work with graphic designers to raise the visibility of pharmacists in the public domain and shape their professional image. In the U.S., for example, most TV shows with health professionals as characters rarely, if at all, focus on pharmacists as one of the main characters. In fact, pharmacists are often shown to be counting pills. The efforts outlined above to address the image of pharmacy are in line with established impression management strategies which require demonstrative acts to manage perceived or undesired professional images.4 Also, as with cultural competency models which require that we question our own biases and the misconceptions of others, to start a continuous journey towards cultural competence, we have to also challenge our own misconceptions regarding pharmacy, pharmacy practice and pharmacy practitioners.

We must believe in our trusted status as professionals who are accountable for providing a vital service to society. This is critical in order for our profession to reach higher levels of professional practice and standards. We must challenge those amongst us who are not willing to live up to such high standards and, in the process, erase any misconceptions or negative stereotypes which currently exist. Thus, the continuous journey to improve on pharmacy as a profession becomes a genuine goal for all members of our profession.

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Establishing an image of pharmacy as a profession is a multifaceted approach but it all starts at an individual level in academia, practice, pharmacy regulators and professional pharmacy organizations. We are all part of this beloved and honorable profession and we should consider ourselves to be role models in all that we do. We must continue to honor our oaths and responsibilities towards society in general, and our patients. The vision and mission of our profession on a local scale, as well as around the globe, should be clear to us in what we say and what we do. By taking ownership of our failings over the years, by strategically countering any misconceptions or negative stereotypes and by emphasizing what pharmacists bring to the table we can ensure that our desired image for pharmacy as a profession will become reality.

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The Power of Next By: Sara Anwar, EPSF, Egypt.

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he Power of Next is the name of an event that was hosted by the Egyptian Pharmacy Students’ Federation (EPSF) at Kafrelsheikh University. The event was held during Egyptian Science Week, an initiative which aims to raise awareness of science and technology across Egypt for all ages and categories of society. We chose topics that our society would benefit from, and they ranged across a wide variety of fields, from medical topics including gene therapy, obesity, antimicrobial resistance and medical analysis to massive open online courses (MOOCs), freelancer and professional management projects.

The name of the event, “the power of next,” promised an exciting week. I must say that it proved to be not just a title for me. Instead, it is a lifestyle. Over the course of the event, I began to understand what, “the power of next,” really means...I realized how to be myself and I realized that it was extremely important who I surrounded myself with. When you find people who believe in you and encourage you to follow your dreams, you will find yourself full of hope again. You will have the power to face the next, whatever that may be, and the ability to achieve what you are seeking. I really felt all of it, all those emotions, in that event. I was depressed and

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feeling down, but I was forced to stay positive and I was shown how to achieve this over and over again.

I’ve always heard the saying, “birds of a feather, flock together,” but the people at this event really showed me the true meaning of this saying. If you are surrounded by dreamers, you will become one of them.

After this event, I started being myself, I learned that every moment is important. That moment will not come back again so you must make the most of it.

Finally, the most valuable thing I learnt, was that if I do anything in life, I should do it because I love it and not for any other reason.

I just want to say that I am thankful for everyone in my association because they helped me get myself back. I am so grateful to have them in my life and I owe a special thanks to the creators of this Egyptian Science Week event. They made society better by spreading the joys of science, and I can see this around me. I am hoping to implement a similar event in the Middle East and North African region to help us pass on these important messages that can be learnt from science and innovation. This can happen easily, by the initiatives of student activities and governments in these countries. So finally, thank you all.

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by: Tin Le, APhA-ASP, USA

TELEPHARMACY “the provision of health care services remotely, using telecommunications tools such as smart phones, telephones, and mobile wireless devices”

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“... telepharmacy is the provision of pharmacist care from a distance to a patient through the use of telecommunications and other technologies.”

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edicine has conventionally been limited to treating a patient in person. In the United States, healthcare practitioners have been mandated by law to care for patients in their place of practice. Now, in the modern age where access to information is expected, another method of treating patients has come to light that is far less limiting than traditional doctors’ visits.

Dorsey defines telemedicine as, “the provision of health care services remotely, using telecommunications tools such as smart phones, telephones, and mobile wireless devices.”1 Within this umbrella of telemedicine, falls telepharmacy, a service specific to pharmacists. As defined by the National Association of Boards of Pharmacy (NABP) in the United States, “telepharmacy is the provision of pharmacist care from a distance to a patient through the use of telecommunications and other technologies.”2 The current uses of telepharmacy include mail order, patient counselling by telephone, medication therapy management, collaborative drug management, central processing and remote order entry, remote supervision of technician dispensing, automated dispensing systems and medication kiosks with 24/7 counselling with a registered pharmacist.2 America is a union of states with independent laws bound together by the Constitution. Despite the wide range of applications and benefits, the growth of telepharmacy has been piecemeal due to the legislative process in the United States. The first state to pass telepharmacy legislation was North Dakota. In the late 1990s and early 2000s, significant numbers of rural pharmacies were forced to shut down due to financial hardship in the state, contributing to the growing number of medically underserved in the area. In order to combat this, North Dakota passed legislation in favor of telepharmacy. As a result of this pilot program, nearly 80,000 residents of North Dakota had their pharmacy services restored, retained and established.3 Due to this success, North Dakota enacted legislation that authorized the usage of telepharmacy throughout the state. Ever since, telepharmacy services have been highly successful in rural communities.

Currently, 23 out of the 50 states have passed legislation in favor of telepharmacy, with another 11 states that provide

opportunities to trial and initiate it.4 Although these 34 states allow for the practice of telepharmacy, each individual state also carries with it rules, regulations and restrictions. These limitations can be based on geography, facilities, permitted providers, staffing requirements and inter-state accessibility, depending on the needs of the state.4 On the other hand, 16 states have not yet passed telepharmacy legislation. The barriers to the spread of telepharmacy include payment issues, licensure, online prescribing and security concerns.2 Payment can be challenging with both governmental and private payers. Licensure can impede the ability to offer these services, specifically when practicing across state lines since it is required by law that a medical professional be licensed in the state in which they are practicing. Encryption and security is a primary concern for legislators because health records must be treated with the utmost care to protect patients.2 In order to capitalize on the potential of these services, these issues need to be addressed and resolved before the states which are hesitant to even pilot telepharmacy practices can authorize their usage.

Despite many challenges associated with the practice, telepharmacy is gaining national acclaim. The NABP has noticed the growth of telepharmacy in recent years and have created standard guidelines for telepharmacy practice in the States. The Task Force on the Regulation of Telepharmacy, a subsect of the NABP, recommends amending the language in The Model State Pharmacy Act and collaborating with the individual state boards of pharmacies in order to standardize pharmacy practice and foster the appropriate environment for the expansion of telepharmacy practice.4 As more states successfully adopt telepharmacy legislation, it will become more likely that Congress will introduce its own form of telehealth legislation. Coinciding with this is a standard practice for telepharmacy across all 50 of the United States of America.

Once telepharmacy is authorized and proven successful on a national level, it can continue to expand on the international level. Many of the telepharmacy initiatives that have been successful in the states may also be successful around the world. In Scotland, many rural patients do not have access IPSF PEN 08

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to medicine or pharmacist consultations, much like in North Dakota. A Telepharmacy Robotic Supply Service (TPRSS), a kiosk capable of dispensing over-the-counter and prescription medications and providing consultations through an audiovisual link, was piloted in a rural post office for patients to utilize.5 It was found that this kiosk is feasible and could address healthcare inequalities in remote areas.5 These kiosks have the potential to be an economically viable option in developing countries where there is a shortage of pharmacists to give patients access to medicine. A major concern of implementing this service in developing countries is the people’s level of health and technological literacy. Although in America and Scotland, the people may be accustomed to using technology in their daily lives and that may not be the same in many other countries around the world. As such, implementing a TPRSS machine would also require a pharmacist to be cognizant of the possible lingual and technological barriers of their patient population. With modern innovation, however, these barriers can be easily overcome by creating intuitive technology and educating the patient population on how to use the device.

Telehealth legislation has not yet caught up to the rapidly advancing telecommunications technology and the many benefits that come along with that. Regardless, once legislators start seeing how utilizing these services on a population level will work to reduce healthcare costs and expand healthcare accessibility to different populations, it will only be a matter of time before national telehealth legislation is proposed and authorized. Until then, it is crucial for us, as consumers, patients and pharmacists, to serve as a voice that will propagate the use of these services. Once we overcome these problems, telepharmacy and telehealth are both services that have the potential to spread around the world and benefit patients across international and socioeconomic lines.

 

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Public Health by: Yvonne, LPSA, Lebanon

P

ublic health is a very broad term that embraces many different career pathways. For example, a person holding a Master in Public Health (MPH) may become an assistant professor, teaching epidemiology to university students. Another person with the same degree may be found working within the United Nations, designing and supervising a vaccination program against polio virus for Syrian refugees. Someone else holding an MPH may be consulted by the CIA to collect and review potential bioterrorism agents. All three of these positions, although completely different in many ways, have one aspect in common: their aim is to improve the health of people worldwide, which is what public health is all about.

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potential problems. This type of skill is, for example, what led global health experts to believe that using mosquito nets in Africa, a main component of the malaria prevention program, has turned out to have damaging consequences rather than benefiting the local communities.

Public health professionals are most often concerned with designing, implementing and evaluating policies that improve health on a large scale. For this reason, most public health careers will require a familiarity with numbers and statistics used for the gathering, filtering and analysis of collected data.

Such mathematical skills are important for the interpretation of the collected results and are what public health experts use to raise interesting questions such as, ‘why is it that people in Greece and other parts of the Mediterranean region enjoy a low rate of heart disease despite a high-fat diet?’

Another essential skill that public health experts apply in many of their professions is problem solving. Identifying solutions and taking action is what health experts working in international and national organizations are expected to do. So, for instance, a public health expert in the Food Safety and Applied Nutrition, Food and Drug Administration (FDA) centre, is alarmed by epidemiological data indicating that 600,000 people in the United States die from heart disease every year (which translates into one in four deaths in the U.S.) and wants to try to reduce these numbers. He or she will most probably have read the Seven Countries Study which revealed low rates of heart disease in Greece and other Mediterranean countries despite a high-fat diet. They would have researched more about it and found that the main fat in the Mediterranean diet is olive oil rather than saturated animal fat, common in countries with higher rates of heart disease. The FDA public health expert would subsequently modify the daily nutrition recommendations for the public in accordance to these findings.

Good public experts must also have excellent observational skills. In other words, they must be aware of what is going on around them. Observing people and their behaviours is essential for evaluating policies and detecting

A government official working within the public health sector of the government in Uganda might be concerned after observing that local fishermen are using the antimalarial bed nets as fishing nets. He would know,

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after consulting an ecologist or another public health expert, that this practice is environmentally destructive because the size of the mesh in these nets is too small and catches small fish before they can grow and breed. Additionally, antimalarial nets are treated with insecticides such as permethrin which is highly toxic to fish as claimed by public health experts working at the Environmental Protection Agency (EPA).

Based on these alarming facts he or she would work with other government officials to pass a law banning the use of

“... Public health professionals are most often concerned with designing, implementing and evaluating policies that improve health on a large scale. “

Pharmacy Education Newsletter

mosquito nets for fishing.

As illustrated, public health is a field that touches most aspects of people’s lives including nutrition, environment, ecology, food security, disease prevention and treatment. On the other hand, the role of pharmacy has grown from simply dispensing to clinical care, administrative and public health functions. In fact, the set of responsibilities of a pharmacist now includes public health activities. For example, a community pharmacist who provides hypertension and diabetes screening in their pharmacy is providing public health services on a local level.

A pharmacist who is the drug program administrator of a state Medicaid program is providing services on a national level.

Pharmacists working in public health have an advantage over other public health professionals. They have knowledge to build on and are situated at the very heart of the community in which they provide health services. They work in all sorts of health institutions such as hospitals, community pharmacies and nursing homes. Their position is ideal to provide drug and disease information as well as to collect epidemiological data, all of which can influence health outcomes and our knowledge about them.

Nowadays, schools are cross-training

pharmacists in public health, not only by incorporating public health courses in the pharmacy curriculum, but also by offering PharmD/MPH dual degree programs. In 2004, the American Association of Colleges of Pharmacy (AACP) highlighted the pharmacist's role in, "health improvement, wellness, and disease prevention," and the need for pharmacists to be, “advancing public health policy”.

using a multidisciplinary approach.

Although experts believe that the world economy is declining, it is expected that public health careers will continue to flourish and work for the good of humanity.

In today’s context of international aid, the field of population health is evolving whereby a distinction between public health and global health has recently begun to emerge. It is being stipulated that, while public health focuses on local communities or countries, global health focuses on health issues that transcend national boundaries. If the goal of public

health is to ensure health equity within a community or a nation, the goal of global health is to achieve health equity between nations.

We are currently living in an era where more diseases exist than ever before.

More drugs are available on the market, environmental pollution is threatening our health and food security, wars are employing chemical weapons which cause refugee crises and healthcare professionals are predicting antibiotic resistance in the upcoming generations.

All of these issues carry consequences that will affect populations worldwide and therefore, they must be addressed IPSF PEN 08

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The 6th Eastern Mediterranean Pharmaceutical Symposium in Kuwait by: Zahraa Menzem, LPSA, Lebanon

Words fail me sometimes. To convey your feelings through words about an experience you will cherish forever is much harder than I thought it would be. Everything was utterly perfect... the people, the lectures and the food. It is a must, then, to guide you through my experience during the 6th Eastern Mediterranean Pharmaceutical Symposium (EMPS) this year in Kuwait.

When we arrived, the first thing that the chairperson of the symposium (Ali Al-Shammari) said to us was this: “you come to the symposium with your mind set on attending every single lecture and workshop. I have been there guys. But if I may give you one bit of advice, do not forget the true purpose of coming here. It is not about what workshop you attend, or what competition you participate in, but rather the people you meet here. That is the essence of IPSF.” His words truly resonated with me because he is absolutely right. With IPSF, you make friends for life.

“You come to the symposium with your mind set on attending every single lecture and workshop. But do not forget the true purpose of coming here. It is not about what workshop you attend, or what competition you participate in, but rather the people you meet here. That is the essence of IPSF.” The people you meet make the regional symposium a staggering experience. You think you know people in your region until you discover there is so much more to learn. In the Eastern Mediterranean Regional Office (EMRO), while Arabic is the official spoken language in most countries, it is still entertaining to discover our differences, especially the dialects! With some words, it felt like we were deciphering a code. Yet it made our experience more fun for it. Not only that, but you can also learn about the differences in curriculums between countries and sometimes within the same country. To discover how different and yet the same we are, is incredible. I can now proudly proclaim that I truly know people of my own region and it is a privilege indeed.

This year’s EMPS focused on medication errors. The conference tackled this very serious issue that we, as pharmacists, face in our daily lives and ways to avoid this problem. The program included a set of professionals who never failed to make their lectures interesting and the workshops were perfectly organized. There was also a public health campaign and a patient counseling competition organized. Both were a smashing success.

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Now about the food...you have never eaten mouth-watering food until you have tried Eastern Mediterranean food. This year’s EMPS in Kuwait exceeded our expectations in this regard. The couple of pounds most of us gained throughout the symposium can attest to that. The food was definitely one of the highlights of the symposium. The little chats we had with each other while relaxing at dinner or during coffee breaks were the best moments of the symposium. It was during these moments that we bonded and found friends in everyone.

After attending this year’s EMPS, my understanding of IPSF underwent a fundamental change. Before the symposium, you can say that I only had an inkling of what IPSF truly was. I have heard this a lot after people attended regional symposiums or World Congress. Now we can say that we have seen more clearly the bigger picture of IPSF. These experiences encourage you to give back to this organization. It makes you feel like we can make change happen together if we are united. We can advance the profession of pharmacy and we can alert the world to our presence by our daily contributions in the health field.

I sincerely urge every single member in IPSF to engage more in IPSF’s activities. Attend regional symposiums, attend the World Congress and join the student exchange program. IPSF is a once in a lifetime opportunity, so seize it. With respect to the EMPS, it goes without saying that it is a marvelous experience. I highly recommend attending EMPS whether you are from the EMRO region or from another region as well.

Next year’s EMPS is in Jordan and I can assure you, even now, that it is going to be extraordinary. Join us next year in Jordan for one of the most memorable experiences of your life!

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Indian Health Service: A Unique Practice Opportunity by: Tiffany Lee, APhA-ASP, USA

As a fourth year pharmacy student in the United States, my final year at school is dedicated to what we call our Advanced Pharmacy Practice Experience (APPE), where we complete rotations at different sites to translate our knowledge into practice under the supervision of preceptors. For five weeks, I had the opportunity to have one of my rotations with the Indian Health Service, a federal agency that is responsible for providing comprehensive health services to approximately 2.2 million American Indians and Alaska Natives in 36 states.1 Specifically, I was placed in Gallup, New Mexico at the Gallup Indian Medical Center where we served the Navajo Nation, one of the largest Indian reservations in the U.S.2 Due to the Indian Health Service’s operation as a federal program, pharmacists have a unique opportunity to provide highly focused patientcentered care without concerns such as health insurance. At the Gallup Indian Medical Center, there were a multitude of pharmacist-run clinics, including anticoagulation, diabetes, adherence (HIV/Hep C), asthma, anemia, nephrology and pain clinics. During these clinics, pharmacists would meet with patients to discuss their progress with their condition and help patients meet their health goals.

In one of my favorite clinics, diabetes, we saw a diverse range of patients. There were patients we spoke to who were highly motivated and we discussed detailed methods of carbohydrate counting. There were patients who were frustrated with the fact that their sugar levels were not significantly decreasing, and we spoke with them more about the pathophysiology of

the disease and how the different methods of exercise, diet, and medications work to bring their blood glucose down.

There were also patients who were incredibly anxious about their sugars and often over-treated hypoglycemia and overtested their blood glucose. We discussed with these patients their personal signs and symptoms of hypoglycemia and what entailed a meaningful blood glucose measurement. We spent time with patients to help them better understand diabetes and their medications through diagrams, explaining the timing and onset of insulin, graphics of food portions and graphs detailing their self-monitored blood glucose measurements.

In addition, the pharmacists could adjust insulin therapy as needed. Every patient we met had unique needs and each visit was a meaningful opportunity to connect with them and to collaborate on how to achieve their health goals, whether that was increasing their daily exercise or switching their orange juice to water.

It was incredible to get hands-on experience and be a part of the process of helping patients manage their conditions.

Within the health community, the pharmacists at the Indian Health Service have a truly unique space to provide medication services, develop relationships with patients, and practice to the fullest extent of a pharmacist’s license. By demonstrating our ability to provide valuable care to patients, especially in managing chronic diseases, the pharmacists serving the Indian Health Service have helped to extensively advocate for our profession. In the future, I hope to see this service become a model for pharmacist roles elsewhere.

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Pharmacy Entrepreneurship in America The most obvious opportunity for entrepreneurship in pharmacy comes in the form of the independent pharmacy. “Who, after all, could start a pharmacy business better than a pharmacist? “ by: James Cong, APhA-ASP, USA

The field of pharmacy offers many diverging career paths to those who practice within it. A community pharmacist, an inpatient clinical pharmacist, an ambulatory care pharmacist, a researcher, a professor. These are all positions that often come to mind when wondering about where the pharmacy profession can lead. Another significant route is the path of an entrepreneur. An entrepreneur is someone who takes an idea and transforms it into a business venture. As healthcare professionals, pharmacists are in close contact with the challenges and gaps of care that the field faces and are in the perfect position to create new businesses in order to solve existing issues. The field has undergone tremendous changes in the past several decades and new opportunities arise at every moment.

The most obvious opportunity for entrepreneurship in pharmacy comes in the form of the independent pharmacy.

Who, after all, could start a pharmacy business better than a pharmacist? Despite the presence of retail giants such as Walgreens, CVS, Walmart and RiteAid, there are approximately 22,000 small business community pharmacies in the United States. These businesses often vary in the services that they provide in order to maintain a competitive edge. Many independent pharmacies perform compounding as a service.

These pharmacies often hold expertise in niche market areas such as hormonal drugs, pet medications or sterile intravenous drug compounding. Other pharmacies focus on pairing medication dispensing with alternative services such as medication therapy management, travel vaccinations or whatever the market is missing.

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Kelley-Ross Pharmacy Group which is part of the Polyclinic located in Seattle, Washington. Not only does the Kelley-Ross Pharmacy group offer compounding and vaccinations, they provide education on the use of naloxone, HIV Pre-Exposure Prophylaxis (PrEPTM), HIV Post-Exposure Prophylaxis (PEPTM), a medication synchronization program, in home medication coaching and various other services. The pharmacy accesses different markets such as assisted living and skilled nursing facilities providing long-term care medications. It also offers a mail-order service in order to provide convenient deliveries to its patients. With its great diversity and success, the pharmacy group has been able to expand to many locations across Seattle.

Not all pharmacies offer such a variety of services. For brand new independent pharmacies, the challenges of finding a place in the market are often immense. It can be near impossible to compete with the pricing that retail chain pharmacy giants offer due to their large volumes of prescriptions. Furthermore, many independent pharmacies cannot even afford to accept various patient insurances due to the low reimbursement rates determined by pharmacy benefit managers (PBMs).

As such, a large portion of the market is either turned away or the pharmacy simply takes a profit loss by filling the prescriptions. As another monumental challenge, the United States Pharmacopeia will begin implementing a new set of rules beginning July 1, 2018 known as USP 800. USP 800 will initiate more stringent requirements on regulations and the set-up of pharmacies compounding hazardous drugs. This includes stricter rules on the primary engineering controls to maintain positive and negative airway pressure as well as drug storage space. For the average independent pharmacy

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just starting up, this increases the initial facility costs by tens of thousands of dollars.

Independent pharmacies are not the only entrepreneurial opportunities in the pharmacy field though. As new avenues for revenue spring up, companies that are dedicated to providing singular services on a large scale also begin to appear. SinfonĂ­aRx is a Medication Management Center that began in conjunction with the University of Arizona College of Pharmacy. While the company started as a small service offered by the pharmacy school, it now provides medication therapy management for patients all over the nation via its call centers. Less than a decade after its launch in 2006, SinfonĂ­aRx began providing its own proprietary software to Walmart Pharmacy in order to proactively improve patient medication adherence. The company continues to grow and is a prime example of scaling a pharmacy service to a large population.

As of 2015, the company partnered with AlteaDx to provide drug therapy optimization through genetic testing.

Entrepreneurship is not always a straightforward path though. This can be seen by the history of the Austin startup company RxWiki. RxWiki was a company founded by Lou Scalpati and Donald Hackett in 2009. The company started as an online medium to provide trusted medication and healthcare information to patients and providers. It employed pharmacists to create Wikipedia-like articles in order to generate web page visits and site activity. It further helped patients by providing an independent pharmacy locator as well as prescription discount cards. As the company grew and expanded its services, it found itself in a prime position to offer services to pharmacies themselves. In 2017, RxWiki merged with TeleManager, a communications solutions company, and transformed into Digital Pharmacist Inc. Digital Pharmacist which then went on to acquire PocketRx, a mobile application that allowed patients to manage their prescriptions. Digital Pharmacist then began offering software as a service (SaaS) to independent pharmacies all over the nation in order to provide them with a portal through which their patients can ask for prescription refills and communicate with their pharmacists. The company continues to evolve and aims to help pharmacies increase the medication adherence of their patients. Never one to remain still, founding CEO Donald Hackett has since started a new company named Precision Vaccinations. His new venture focuses on providing the public with factual information reviewed by healthcare professionals on the topic of vaccinations.

As the field rapidly changes, student pharmacists are exposed to the newest services and leading-edge technology. At any point, the concept for a novel billion-dollar company could be conceived in a student’s mind. The road to entrepreneurship is far from the most stable path, but it can be extremely rewarding as new ideas are transformed from dreams= to reality.

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Development through Uncertainty by: Arsany Makkar, APhA-ASP, USA

“Why do you want to do public health?” This was the question I was asked during an interview for a summer program that would eventually lead to my acceptance to Columbia University.

“My goal in life is to help all types of people on a global level and make an impact on them, myself, and the planet,” I replied.

I wanted to make a difference as well as be renowned for it. It is not uncommon to desire distinction in your field of study. But how do you achieve such a level of success and distinction?

My deep appreciation of nature and exploration that sprouted from my childhood fascination of National Geographic seemed to contradict my pursuit of pharmacy and healthcare. Instead of choosing just one path, I attempted to intertwine these two vastly different fields and create a movement towards better health and a better environment. Every corner I turned, however, I was met with a wall of rejection. The questions that I asked of pharmacists met with walls of confusion. It dawned on me then, that maybe I was turning the wrong corners or asking for advice from the wrong people. Then I met Dr. Luigi Brunetti, Pharm.D., MPH, who was able to finally direct me towards the path of public health.

I wanted to learn more about public health. What is it? What do you do? Where can it take me? That summer, I went to the Centers of Disease Control & Prevention (CDC) in Atlanta, Georgia for a week-long orientation. I was accepted into the Columbia University Medical Center Summer Public Health Scholars Program within the CDC Undergraduate Public Health Scholars Program.

It was an opportunity to delve into public health and meet some of the nation’s greatest minds. I met various directors,

US Public Health Service officers, epidemiologists and many other extremely successful people. This was my opportunity to turn the corner and ask them, ‘how did you get here? How did you figure out what you loved to do? How did you choose this profession and lifestyle from a vast world of different professions and lifestyles?’ I was trying to work out how they knew what they wanted to pursue in life, because I had no idea back then and quite frankly, I still don’t.

What I learned was that it was okay. You don’t need to know what you want in life. You will eventually make unexpected choices and end up in unexpected places. In all that you do, however, and everywhere you go, spend time developing yourself as an individual so that when the time comes to apply your skills, you have the confidence and ability to excel, succeed, and distinguish yourself. This isn’t my advice… this is the advice of leaders such as Drs. Anne Schuchat, Hilda Razzaghi, Robert Fullilove, Mary Ann Howland and many others.

When I arrived at the New York City Department of Health and Mental Hygiene (NYC DOHMH) to begin my internship, I was told that my project would encompass educating high school teachers on environmental health. I was pleased about the environmental health aspect, but I was displeased because as a pharmacy student, my role would be limited only to educating instead of researching.

After immaturely complaining about my role to my mentor, I remember asking for guidance from my other mentors Corey Jacinto and Mark Williams. They told me something which drastically changed my summer that I want to share with you.

If you don’t like something, ask whether you can change it – the worst thing that can happen is you get a “no” for an answer.

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I took their advice and asked to work with medications and pharmacovigilance. The next day, I received news that the department was, in fact, looking to research medicationinduced heat illness. It was as if I had drawn a lucky card. Now, I was able to implement both pharmacy and environmental (public) health. For eight weeks, I was tasked with detailing which populations would be most at risk of heat illness depending on the medications they were taking. I also asked if I could outline the mechanism of action of all potential medications. Later, I met with one of the co-authors of Goldfrank’s Toxicological Principles, Dr. Mary Anne Howland, to understand a more clinical toxicological standpoint on heat illness. Now, the NYC DOHMH is using my work to improve medication use and ultimately, the health of at-risk individuals.

Thinking back on last year, I would never have thought that I would be where I am today. I’ve met some amazing leaders, mentors, and peers, learned about environmental (public) health, created medical content and learned that you can develop yourself from every opportunity that’s thrown your way. As long as you don’t waste it, it doesn’t matter if you’re unsure about your career path, just keep developing.

Now I still may not know what I want to do, but at least I have a direction. As a relentless learner, I have a deep desire to work in different environments. My curiosity and desire to explore government, academia, industry and the laboratory is very demanding but the more you develop, the more opportunities you will have. That is what I believe to be the most important advice I have received during my internship. I hope that with this advice, you can begin your own legacy.

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Abd El-rahman Nabil EPSF, Egypt

“From pharmaceutical education until death”

From pharmaceutical education until death...this is a paradoxical topic, but it is also realistic. When we describe the circumstances of pharmaceutical education, we will find the results negative values, but not at all. The Egyptian Pharmaceutical Students’ Federation (EPSF), other volunteering organisations and individuals exert their efforts in an unorganized manner leading to conflicting and unexpected results.

Firstly, we should start with thanking the “soldiers” in Egypt within the Faculty of Pharmacy and Medicine who are fighting and defending the medical profession. These individuals organize volunteering awareness campaigns, spread the ways of learning and also provide education in a structured manner. Their role is extremely important, but right now, they need to revise their methods of teaching in order to to attain the highest quality.

From my point of view, there is a huge gap that exists between the society of learners and academics, and the society of the patient in the real world. Furthermore, not all learners are practising what they have learned. We can see this demonstrated by the uncontrolled dispensing of antibiotics.

There have been enormous efforts by the profession to make the public aware of the dangers of antimicrobial resistance, but there are many physicians who prescribe more than one antibiotic for infants, influenza and mild infections. In addition, there are pharmacists who dispense antibiotics as over-the-counter drugs. Education has no value if it is not informing or influencing our actions. We have an interrelated network that exists between the patient, physician and pharmacist. When we try to solve the problem, we focus on one

or two parts of this network individually. The best solution, however, is often to focus on all three parts of the network (patient, physician and pharmacist) simultaneously.

A solution may exist. It requires, however, collaboration between the International Federation of Medical Students’ Association (IFMSA), EPSF and other specialized groups or individuals. In order to teach medicine and pharmacy students, we must be feeding students strong, scientific, evidence-based information with well-revised data to influence their way of thinking. We should then provide opportunities for them to practice their profession in hospitals and pharmacies and allow them to follow up on specific cases to ensure that trained individuals are given the opportunities to apply what they have learned. In this way, we ensure that individuals graduating are well-trained, with experience in the real world and will not make mistakes that may lead to the deaths of patients.

We are heading towards a dangerous future with confident, quick and spontaneous steps. As we see commonly in practice, how many interacting drugs are dispensed every day?

How many corticosteroids are prescribed every day? How many hormones and antibiotics are administered every day?

We have a serious problem facing us due to the uncontrolled dispensing of drugs. This problem is because of education systems that are not organised well, a dependence and reliance on traditional education forms in universities and practitioners practising without proper education or qualifications.

Pharmacy education should be complementary, relevant and applied in a real-life setting. If it isn’t, we will cause dangerous results possibly leading to death.

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IMMUNITY – INDUCTION, PROMOTION & DISORDERS (A SMART BOMB) by: Rafiq Unissa, IPA-India

“Millions of people around the world still need access to safe drinking Water, Sanitation and Hygiene (WASH)” Abstract: The immune system is an incredible part of our body. It has the task of keeping the body healthy by destroying pathogens and disease-producing organisms, and by neutralizing their toxins. The immune system employs the services of the skin, mucous membranes, hair, cilia, saliva, urine and other natural means of waste disposal to keep the body free of illness and pathogens.

Immunization is widely recognized as one of the most successful and cost-effective health interventions. World Immunization Week 2015 focused on closing the immunization gap and reaching equity in immunization levels as outlined in the Global Vaccine Action Plan (GVAP). Millions of people around the world still need access to safe drinking Water, Sanitation and Hygiene (WASH).

Immunoglobulin’s at birth, environmental hazards affecting immunity, the effects of allergy on asthma, effects of stress, climate control & other factors in spread of infection, and effects of teenage sleep loss issues have been discussed here, along with an emphasis on public health awareness, advocacy & education.

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Introduction: I am a degree collegian, and IPSF is a global, well-known organization. Simply a couple of months ago, I became an actively involved member. The Federation has really modified my life for the high-er, and I would like to do the equivalent for others.

We, being the scholars, can create a distinction and amend the globe by suggesting our thoughts. Pharmacy education offers pharmacists the ele-mental data for their roles and functions for public health.

Professional development portfolios train the scholars in counseling, clinical thinking, project organization, and support so that they can effectively contribute to the general public Health Sector by numerous activities. We have a tendency with our privileged chance to a decent education, and as fu-ture health professionals, to give back to society. This article aims to discuss our knowledge relating to immunity and how it results in prospering public health.

What is the role of the immune system?

It is responsible for keeping the body healthy by destroying pathogens and by neutralizing their tox-ins.For example, should foreign microorganism enter the body, the system employ cells within the body to fight the incursive microorganism, and to forestall their spread

Classification:

Why the immune system is so complex?

Immune activity includes a profit and a price. The negative facet of an immunity is that it produces distressing symptoms of acute and chronic diseases. The term ‘hypersensitivity’ describes a multi-plied, damaging immune response. If we have a tendency to browse a textbook of immunology, we get the impression that immune activity solely happens once an infection threatens or an understandable allergic response occurs. Immune activity is continuous on an everyday basis. We do learn from the immunology text that there are several hypersensitivity diseases. However, it is less common knowledge that nonspecific hypersensitivity states are common and turn out a range of ill-defined illnesses.

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Molecules within some food, particularly proteins, act as antigens. Food additives and contaminants could increase the chances of allergic reactions to food. Immune cells don't recognize the distinction between infective agent, microorganism or food antigens. We have a tendency to expect and often observe similar immune reactions to totally different antigen sources.

What is immunization?

Immunization is known as a cost-efficient health intervention that prevents up to three million deaths each year. Additionally vaccines are available against diseases like pneumonia and rotavirus diar-rhea, which are two of the largest killers of kids below five years old. However, one in five youngsters remains missing out – “In 2013, an estimated 21.8 million infants failed to receive lifesaving vaccines due to inadequate supply of vaccines.” Lack of access to health services, a shortage of accurate in-formation about immunization, shy political and financial support all play a vicinity to this. '' Ensure equity with lifesaving vaccines-Protection throughout life.”

World Immunization Week 2015 “It was from 24-30 Apr 2015, an effort to accelerate action to extend the attention, demand for protec-tion by communities, and improve vaccination delivery services.’’ This year campaign was centered “on closing the immunization gap and reaching equity” in protection levels as made public within the Global Vaccine Action Plan (GVAP), that could be a framework to forestall several “deaths by 2020 through universal access to vaccines.”

The GVAP aims to: •

Strengthen routine protection to satisfy vaccination coverage targets; •

Accelerate management of vaccine-preventable diseases with Poliomyelitis demolition; •

Introduce new and improved vaccines; •

Spur analysis and development for the following generation of vaccines and technologies.

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Pharmacy Education Newsletter

WASH The World Health Organization (WHO) launched a brand new international strategy that aims to extend access to water, sanitation and hygiene (WASH), and support its efforts to combat Neglected Tropical Diseases (NTD’s).

NATURAL IMMUNITY Importance of Immunoglobulin’s at Birth The development of animals (mammals) needs a sterile environment, called a womb. However, after birth the newborn enters a world with several microorganism, which will cause malady or perhaps death. It's necessary that they develop a healthy immune system. Humans receive 90% of immuno-globulin’s, essential proteins that respond and shield the body, via the placenta whereas dogs and cats receive solely 5-10%, and unfortunately, livestock receive no immunoglobulin’s.

“Immunoglobulin’s include 5 totally different varieties of antibodies like IgM, IgD, IgE, IgG, and IgA.” This is why it's necessary for livestock to receive immunoglobulin’s in another approach.

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Pharmacy Pharmacy Education Education Newsletter Newsletter

ENVIRONMENTAL HAZARDS AFFECTING IMMUNITY: • Effects of Allergy and Asthma: Allergy is caused by an response to stimuli or allergens that unharness immunoglobin E (IgE) anti-bodies. To know the effects of Asthma on the physical body we should first examine a primary aller-gic response, represented as a three-step method that involves “initial sensitization to the allergen fol-lowed by activation of mast cells and then prolongation of immune activity.”

The problem is once our immune systems respond to the harmless allergen (Ex: - grass) we'll then develop a pre-disposition to the current substance. Presumably we'll be allergic to grass the rest of our life. Allergy medications and therapy are going to be your sole choice if you have a tendency to commit to go outside.

STRESS AND HOW IT AFFECTS THE BODY? If we are in a very nerve-racking scenario, it's probable that we won't seem to be happy people. Imag-ine that a dangerous animal threatens us, our body pumps in adrenaline, for fight or flight. There's a direct and powerful mood amendment, we do not begin smiling or rant in these circumstances. “Our body is set for an action,” and reacts with the fight emotions of anger, aggression and hostility or the flight emotions of worry, anxiety and nervousness. In a trendy society, the body response is the same, however the environment has been modified. Imagine that there's a secretary in a workplace and her boss comes in.

He's angry, he goes to the secretary and rants and raves at her for no reason. Her body's adrenaline cycle is activated for flight or fight, however due to social circumstances she is re-strained from action.

• Climate Control and Factors in the Spread of Infections: Climate is the entire surroundings encompassing someone. Climate and infections are closely related.2 It has an immense impact on the healing of a wound. An example of this is Gangrene, a standard sort of wound infection that thrives in tropical areas; however it is non-existent in extremely cold temper-atures.4 Another necessary issue is that climate controls physical and mental stress the victim encoun-ters. Increased ultra-violet rays, ensuing from the ozone depletion, additionally suppress the system in both humans and animals.

• Effects of Teenage Sleep Loss Issues: Sleep permits the body to rest and to replenish itself, for a better purpose of living. Schools play an important criterion in a youngster's life in order to receive smart grades and balance a calendar of school events. Several students are going to be up till 3 in the morning typewriting on their comput-ers, then travel to sleep exhausted, and rouse 3 to 4 hours later to start the day once more, myself be-ing one of them. This leads to depression, mood changes, and insomnia, also resulting in suppressing of the immune system.

PUBLIC HEALTH AWARENESS : Public health initiatives facilitate to enhance the standard of life and health promotion. Media and publications portfolios help in increasing the attention of public health by the various digital market-ing platforms, additional to the promotional materials.

• India eliminates maternal and neonatal tetanus: Vaccines work, however our efforts cannot stop here. Unlike small pox and poliomyelitis, tetanus cannot be eradicated as tetanus spores stay mulishly gift within the surroundings worldwide. Because the risk of tetanus persists, we need to continue our efforts to make sure that maternal neonatal tetanus elimination (MNTE) is maintained.

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Pharmacy Education Newsletter

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