N 6. In-patient Department. First Aid. At a Chemist’s. Continuous Tenses:
Active and Passive Voice.
The mortar and pestle,
an internationally recognized symbol to represent the pharmacy profession
Pharmacy (from
the Greek φάρμακον
= drug) is the health profession that links the health sciences
with the chemical sciences,
and it is charged with ensuring the safe use of medication. The scope of pharmacy practice includes more traditional roles such as
compounding and dispensing medications on the orders of physicians, and it also
includes more modern services related to patient care,
including clinical services, reviewing medications for safety and efficacy, and
providing drug information. Pharmacists, therefore, are experts on drug therapy and are
the primary health professionals who optimize medication use to provide
patients with positive health outcomes.
Symbols
The two symbols most
commonly associated with pharmacy are the mortar and pestle
and the ℞ (recipere) character,
which is often written as "rx" in typed text. Pharmacy organisations
often use other symbols, such as the Bowl of Hygieia,
conical measures,
and caduceuses
in their logos.
Other symbols are common in different countries: the green Greek cross
in France
and the United Kingdom, the increasingly-rare Gaper in The Netherlands,
and a red stylized letter A in Germany and Austria (from Apotheke, the German
word for pharmacy, from the same Greek
root as the English word 'apothecary').
|
Bowl of Hygeia |
The green Greek Cross
used in |
Mortar and pestle |
Recipe symbol |
|
The red stylized
"A" used in |
Caduceus |
Rod of Asclepius |
Gaper used historically
in the |
Disciplines
Pharmacy,
tacuinum sanitatis casanatensis (XIV century)
The field of Pharmacy can generally be divided into three main disciplines:
Pharmaceutics is the discipline of pharmacy that deals with the process of
turning a new chemical entity (NCE) into a medication to be used safely and effectively
by patients. It is also called the science of dosage form design. There are
many chemicals with pharmacological properties, but need special measures to
help them achieve therapeutically relevant amounts at their sites of action.
Pharmaceutics helps relate the formulation of drugs to their delivery and
disposition in the body. Pharmaceutics deals with the formulation of a pure
drug substance into a dosage form. Branches of pharmaceutics include:
·
Pharmaceutical formulations
·
Pharmaceutical manufacturing
·
Dispensing Pharmacy
·
Pharmaceutical Technology
·
Physical Pharmacy
·
Pharmaceutical Jurispundence
Pure drug substances are usually white crystalline or amorphous powders.
Historically before the advent of medicine as a science it was common for
pharmacists to dispense drugs as is, most drugs today are administered as parts
of a dosage form. The clinical performance of drugs depends on their form of
presentation to the patient.
·
Medicinal chemistry and Pharmacognosy
Medicinal
chemistry and pharmaceutical chemistry are disciplines at the intersection of
chemistry, especially synthetic organic chemistry, and pharmacology and various
other biological specialties, where they are involved with design, chemical
synthesis and development for market of pharmaceutical agents, or bio-active
molecules (drugs).
Compounds
used as medicines are most often organic compounds, which are often divided
into the broad classes of small organic molecules (e.g., atorvastatin,
fluticasone, clopidogrel) and "biologics" (infliximab,
erythropoietin, insulin glargine), the latter of which are most often medicinal
preparations of proteins (natural and recombinant antibodies, hormones, etc.).
Inorganic and organometallic compounds are also useful as drugs (e.g., lithium
and platinum-based agents such as lithium carbonate and cis-platin.
In
particular, medicinal chemistry in its most common guise—focusing on small
organic molecules—encompasses synthetic organic chemistry and aspects of
natural products and computational chemistry in close combination with chemical
biology, enzymology and structural biology, together aiming at the discovery
and development of new therapeutic agents. Practically speaking, it involves
chemical aspects of identification, and then systematic, thorough synthetic
alteration of new chemical entities to make them suitable for therapeutic use.
It includes synthetic and computational aspects of the study of existing drugs
and agents in development in relation to their bioactivities (biological
activities and properties), i.e., understanding their structure-activity
relationships (SAR). Pharmaceutical chemistry is focused on quality aspects of
medicines and aims to assure fitness for purpose of medicinal products.
At
the biological interface, medicinal chemistry combines to form a set of highly
interdisciplinary sciences, setting its organic, physical, and computational
emphases alongside biological areas such as biochemistry, molecular biology,
pharmacognosy and pharmacology, toxicology and veterinary and human medicine;
these, with project management, statistics, and pharmaceutical business
practices, systematically oversee altering identified chemical agents such that
after pharmaceutical formulation, they are safe and efficacious, and therefore
suitable for use in treatment of disease.
Medicinal
chemistry in the path of drug discovery
Discovery
Discovery
is the identification of novel active chemical compounds, often called
"hits", which are typically found by assay of compounds for a desired
biological activity. Initial hits can come from repurposing existing agents
toward a new pathologic processes, and from observations of biologic effects of
new or existing natural products from bacteria, fungi, plants, etc. In
addition, hits also routinely originate from structural observations of small
molecule "fragments" bound to therapeutic targets (enzymes,
receptors, etc.), where the fragments serve as starting points to develop more
chemically complex forms by synthesis. Finally, hits also regularly originate
from en-masse testing of chemical compounds against biological targets, where
the compounds may be from novel synthetic chemical libraries known to have
particular properties (kinase inhibitory activity, diversity or drug-likeness,
etc.), or from historic chemical compound collections or libraries created
through combinatorial chemistry. While a number of approaches toward the
identification and development of hits exist, the most successful techniques
are based on chemical and biological intuition developed in team environments
through years of rigorous practice aimed solely at discovering new therapeutic
agents.
Hit
to lead and lead optimization
Further
chemistry and analysis is necessary, first to identify and "triage"
compounds that do not provide series displaying suitable SAR and chemical
characteristics associated with long-term potential for development, then to
improve remaining hit series with regard to the desired primary activity, as
well as secondary activities and physiochemical properties such that the agent
will be useful when administered in real patients. In this regard, chemical modifications
can improve the recognition and binding geometries (pharmacophores) of the
candidate compounds, and so their affinities for their targets, as well as
improving the physicochemical properties of the molecule that underlie
necessary pharmacokinetic/pharmacodynamic (PK/PD), and toxicologic profiles
(stability toward metabolic degradation, lack of geno-, hepatic, and cardiac
toxicities, etc.) such that the chemical compound or biologic is suitable for
introduction into animal and human studies.
Process
chemistry and development
The
next through final synthetic chemical stages involve production of lead
compound in suitable quantity and quality to allow large scale animal and
eventual, extensive human clinical trials. This involves the optimization of
the synthetic route for bulk industrial production, and discovery of the most
suitable drug formulation. The former of these is still the bailiwick of
medicinal chemistry, the latter brings in the specialization of formulation
science (with its components of physical and polymer chemistry and materials
science). The synthetic chemistry specialization in medicinal chemistry aimed
at adaptation and optimization of the synthetic route for industrial scale
syntheses of 100's of kilograms or more is termed process synthesis, and
involves thorough knowledge of acceptable synthetic practice in the context of
large scale reactions (reaction thermodynamics, economics, safety, etc.).
Critical at this stage is the transition to more stringent GMP requirements for
material sourcing, handling, and chemistry.
Training
in medicinal chemistry
Medicinal
chemistry is by nature an interdisciplinary science, and practitioners have a
strong background in organic chemistry, which must eventually be coupled with a
broad understanding of biological concepts related to cellular drug targets.
Scientists in medicinal chemistry work are principally industrial scientists
(but see following), working as part of an interdisciplinary team that uses
their chemistry abilities, especially, their synthetic abilities, to use
chemical principles to design effective therapeutic agents. Most training
regimens include a postdoctoral fellowship period of 2 or more years after
receiving a Ph.D. in chemistry. However, employment opportunities at the
Master's level also exist in the pharmaceutical industry, and at that and the
Ph.D. level there are further opportunities for employment in academia and
government. Many medicinal chemists, particularly in academia and research,
also earn a Pharm.D (doctor of pharmacy). Some of these PharmD/PhD researchers
are RPh's (Registered Pharmacists).
Graduate
level programs in medicinal chemistry can be found in traditional medicinal
chemistry or pharmaceutical sciences departments, both of which are
traditionally associated with schools of pharmacy, and in some chemistry
departments. However, the majority of working medicinal chemists have graduate
degrees (MS, but especially Ph.D.) in organic chemistry, rather than medicinal
chemistry, and the preponderance of positions are in discovery, where the net
is necessarily cast widest, and most broad synthetic activity occurs.
In
discovery of small molecule therapeutics, an emphasis on training that provides
for breadth of synthetic experience and "pace" of bench operations is
clearly present (e.g., for individuals with pure synthetic organic and natural
products synthesis in Ph.D. and post-doctoral positions, ibid.). In the
medicinal chemistry specialty areas associated with the design and synthesis of
chemical libraries or the execution of process chemistry aimed at viable
commercial syntheses (areas generally with fewer opportunities), training paths
are often much more varied (e.g., including focused training in physical
organic chemistry, library-related syntheses, etc.).
As
such, most entry-level workers in medicinal chemistry, especially in the U.S.,
do not have formal training in medicinal chemistry but receive the necessary
medicinal chemistry and pharmacologic background after employment—at entry into
their work in a pharmaceutical company, where the company provides its
particular understanding or model of "medichem" training through
active involvement in practical synthesis on therapeutic projects. (The same is
somewhat true of computational medicinal chemistry specialties, but not to the
same degree as in synthetic areas.) Hence, although several graduate programs
offer Ph.D. and postdoctoral training in medicinal chemistry, the broader
education of a top-tier synthetic or physical chemistry graduate program most
frequently provides the entry level skills sought for industrial medicinal
chemistry.
Areas of pharmacy practice include:
·
Disease-state management
·
Clinical interventions
(refusal to dispense a drug, recommendation to change and/or add a drug to a
patient's pharmacotherapy, dosage adjustments, etc.)
·
Professional development.
·
Pharmaceutical care
·
Extemporaneous
pharmaceutical compounding.
·
Communication skills
·
Health psychology
·
Patient care
·
Drug abuse prevention
·
Prevention of drug
interactions, including drug-drug interactions or drug-food interactions
·
Prevention (or minimization)
of adverse events
·
Incompatibility
·
Drug discovery and evaluation
·
Community Pharmacy
·
Detect
pharmacotherapy-related problems, such as:
·
The patient is taking a drug
which he/she does not need.
·
The patient is taking a drug
for a specific disease, other than one afflicting the patient.
·
The patient needs a drug for
a specific disease, but is not receiving it.
·
The patient is taking a drug
underdose.
·
The patient is taking a drug
overdose
·
The patient is having an
adverse effect to a specific drug.
·
The patient is suffering
from a drug-drug interaction, drug-food interaction, drug-ethanol interaction,
or any other interaction.
The boundaries between these
disciplines and with other sciences, such as biochemistry, are not always
clear-cut; and often, collaborative teams from various disciplines research
together.
Pharmacology
is sometimes considered a fourth discipline of pharmacy. Although pharmacology
is essential to the study of pharmacy, it is not specific to pharmacy.
Therefore it is usually considered to be a field of the broader sciences.
There are various
specialties of pharmacy practice. Some specialization is based on the place of
practice including: community, hospital, consultant, locum, drug information,
regulatory affairs, industry, and academia. Other specializations are based on
clinical roles including: nuclear, oncology, cardiovascular, infectious disease, diabetes, nutrition,
geriatric, and psychiatric pharmacy.
Pharmacists
Pharmacists
are highly-trained and skilled healthcare professionals who perform various
roles to ensure optimal health outcomes for their patients. Many pharmacists
are also small-business owners, owning the pharmacy in
which they practice. But
Pharmacists are represented
internationally by the International Pharmaceutical
Federation (FIP). They are represented at the national level by professional
organisations such as the Royal Pharmaceutical Society of Great
Britain (RPSGB), the Pharmacy Guild of Australia (PGA), and the American Pharmacists Association (APhA). See
also: List of pharmacy associations.
In some cases, the
representative body is also the registering body, which is responsible for the ethics of the
profession. Since the Shipman Inquiry, there has
been a move in the UK to separate the two roles.
Pharmacy
technician
Pharmacy
technician, also sometimes known as a pharmaceutical technician, is a health
care worker who performs pharmacy related functions, generally working under
the direct supervision of a licensed pharmacist or other health professional.
Pharmacy technicians work in a variety of locations, usually in
community/retail and hospital pharmacies but also sometimes in long-term care
facilities, pharmaceutical manufacturers, third-party insurance companies,
computer software companies, or in government or teaching. Job duties include
dispensing prescription drugs and other medical devices to patients and
instructing on their use. They may also perform administrative duties in
pharmaceutical practice, such as reviewing prescription requests with doctor's
offices and insurance companies to ensure correct medications are provided and
payment is received. In recent times, they also speak directly with the
patients on the phone to aid in the awareness of taking medications on time.
In
many countries, both developed and developing, the relative importance of
pharmacy technicians within the pharmacy workforce has been amplified in recent
years, largely as a reaction to pharmacist shortages, resulting in an increase
in their numbers and responsibilities.
Alternative
medicine, pharmacotherapeutics, customer care, retail and hospital software
systems, inventory management, and infection control.
Practical
training, such as completing an internship in a pharmacy, is also often
required as part of training for employment as a pharmacy technician.
Many
employers favor pharmacy technicians to be certified with a national/local
pharmacy board, such as by passing a standard exam and/or paying a fee. In the
Allied
health professions are health care professions distinct from dentistry,
nursing, medicine, and pharmacy. One estimate reported allied health
professionals make up 60 percent of the total health workforce. They work in
health care teams to make the health care system function by providing a range
of diagnostic, technical, therapeutic and direct patient care and support
services that are critical to the other health professionals they work with and
the patients they serve.
Professions
Definitions
of allied health professions vary across countries and contexts, but generally
indicate that they are health professions distinct from medicine, dentistry,
optometry and nursing. Some definitions only include health care providers that
require registration by law to practice, but usually all allied health
professions that require a post-secondary degree or higher qualification are
included.
Depending
on the country and local health care system, a limited subset of the following
professions (professional areas) may be represented, and may be
regulated:Anesthesia technician
·
Autotransfusionist
·
Athletic Trainer
·
Audiologist
·
Bioengineer
·
Biomedical scientist
·
Cardiographic technician
·
Environmental health officer
·
Cardiovascular technologist
·
Clinical laboratory scientist
·
Clinical officer
·
Clinical psychologist
·
Dental hygienist
·
Diagnostic medical sonographist
·
Dietitian / Nutritionist
·
Electrocardiogram technician
·
Emergency Medical Technician
·
Epidemiologist/Biostatistician
·
Exercise physiologist
·
Health care administrator Health coach
·
Health Information Administrator
·
Health information technician
·
Health inspector
·
Kinesiotherapist
·
Licensed Practical Nurse
·
Massage therapist
·
Medical assistant
·
Community Health Workers and Officers
·
Medical coder
·
Neurophysiologist
·
Medical dosimetrist
·
Medical physicist
·
Medical laboratory scientist
·
Medical radiation scientist
·
Medical transcriptionist
·
Music therapist
·
Nuclear medicine technologist
·
Occupational therapist
·
Orthotist / Prosthetist Orthoptist
·
Paramedic
·
Pedorthist
·
Perfusionist
·
Personal trainer
·
Pharmacy technician
·
Phlebotomist
·
Physical Therapist
·
Radiation therapist
·
Radiologic Technologist
·
Rehabilitation counsellor
·
Respiratory therapist
·
Speech and language pathologist
·
Surgical technologist
·
Recreational therapist
·
Ultrasound technologist
All
professional areas ascribed before belong to the ever-growing group of allied
health professionals and their subspecialties. The precise titles, roles, and
requisites of the allied health professions may vary considerably from country
to country. For example, the National Council for Homeopathy of Pakistan and
the Central Council of Homeopathy of India recognize as allied health
professionals those who qualify with a four-year university degree in the
discipline, whereas in other countries the practice of homeopathy is not
subject to professional regulation.
Recognized
allied health professions
Allied
health professions in
In
·
Audiology
·
Behavioral health (counseling, marriage
and family therapy)
·
Clinical measurement science
·
Exercise physiology
·
Nuclear medicine technology
·
Medical Laboratory Scientist
·
Dietetics
·
Occupational therapy
·
Optometry
·
Orthotics and prosthetics Paramedic
·
Pharmacy
·
Podiatry
·
Psychology
·
Physiotherapy
·
Radiation therapy
·
Radiography / Medical imaging
·
Respiratory Therapy
·
Sonography
·
Speech pathology
Allied
health professions in the
In
the
·
Chiropody/Podiatry
·
Diagnostic radiography
·
Dietetics
·
Drama therapy
·
Orthoptics
·
(Environmental Health Officers))
·
Orthotics Occupational therapy
·
Physiotherapy
·
Paramedics
·
Prosthetics
·
Speech and language therapy
·
Therapeutic radiography
However,
it is more and more recognized that other professionals have a role to play in
regard to healthcare. These include professionals such as youth workers, social
workers, sexual health workers and school nurses. Not only do these
practitioners have a key role to play due to their interaction with a wide
range of the population but they may also have that opportunistic 'teachable'
moment that allows them to impart health advice in a non-threatening manner.
Health
professions in
In
·
Dental therapy & oral hygiene
·
Dietetics
·
Emergency care
·
Environmental health
·
Medical technology
·
Occupational therapy, medical
orthotics / prosthetics & creative arts therapy Optometry & dispensing
opticians
·
Physiotherapy, podiatry &
biokinetics
·
Psychology
·
Radiography & clinical technology
·
Speech, language & hearing
professions
Training
and education
Some
allied health professions are more specialized, and so must adhere to national
training and education standards and their professional scope of practice.
Often they must prove their skills through degrees, diplomas, certified
credentials, and continuing education. Other allied health professions require
no special training or credentials and are trained for their work by their
employer through on-the-job training (which would then exclude them from
consideration as an Allied Health Profession in a country like
Allied
health professions can include the use of many skills. Depending on the
profession, these may include basic life support; medical terminology, acronyms
and spelling; basics of medical law and ethics; understanding of human
relations; interpersonal communication skills; counseling skills; computer
literacy; ability to document healthcare information; interviewing skills; and
proficiency in word processing; database management and electronic dictation.
History
The
explosion of scientific knowledge that followed World War II brought
increasingly sophisticated and complex medical diagnostic and treatment
procedures. Increasing public demand for medical services combined with higher
health care costs provoked a trend toward expansion of service delivery from
treating patients in hospitals to widespread provision of care in physician's
private and group practices, ambulatory medical and emergency clinics, and
mobile clinics and community-based care. In the developing world, international
development assistance led to numerous initiatives for strengthening health
workforce capacity to deliver essential health care services. What followed has
been an increase in the need for skilled health care delivery personnel
worldwide.
Changes
in the health industry and emphasis on cost-efficient solutions to health care
delivery will continue to encourage expansion of the allied health workforce.
The World Health Organization estimates there is currently a worldwide shortage
of about 2 million allied health professionals (considering all health workers
aside from medical and nursing personnel) needed in order to meet global health
goals.
In
recognition of the growth of the number and diversity of allied health
professionals in recent years, the newly adopted 2008 version of the
International Standard Classification of Occupations has increased the number
of groups dedicated to allied health professions. Depending on the presumed
skill level, they may either be identified as “health professionals” or “health
associate professionals”. For example, new categories have been created for
delineating “paramedical practitioners” — grouping professions such as clinical
officers, clinical associates, physician assistants, Feldshers, and assistant
medical officers — as well as for community health workers; dietitians and
nutritionists; audiologists and speech therapists; and others.
Allied
health employment projections
Projections
in the
Studies
have also pointed to the need for increased diversity in the allied health
workforce to realize a culturally competent health system in the
Workforce
and health care experts anticipate that health services will increasingly be
delivered via ambulatory and nursing care settings rather than in hospitals.
According to the North American Industry Classification System (NAICS), the
health care industry consists of three main sub-sectors, divided by the types
of services provided at each facility:
Hospitals:
Primarily provides inpatient health services and may provide some outpatient
services as a secondary activity.
Ambulatory
health care settings: Primarily provides outpatient services at facilities such
as doctors’ offices, outpatient clinics and clinical laboratories.
Nursing
and residential care facilities: Provides residential care, such as community
care for the elderly or mental health and substance abuse facilities.
In
the
Advancements
in medical technology also allow for more services that formerly required
expensive hospital stays to be delivered via ambulatory care. For example, in
In
developing countries, many national human resources for health strategic plans
and international development initiatives are focusing on scaling up training
of allied health professions, such as HIV/AIDS counsellors, clinical officers
and community health workers, in providing essential preventive and treatment
services in ambulatory and community-based care settings.
With
this growing demand for ambulatory health care, researchers expect to witness a
heavier demand for professions that are employed within the ambulatory sector
and other non-hospital settings — in other words, allied health.
Health
human resources (“HHR”) — also known as “human resources for health” (“HRH”) or
“health workforce” — is defined as “all people engaged in actions whose primary
intent is to enhance health”, according to the World Health Organization's
World Health Report 2006. Human resources for health are identified as one of
the core building blocks of a health system. They include physicians, nurses,
midwives, dentists, allied health professions, community health workers, social
health workers and other health care providers, as well as health management
and support personnel – those who may not deliver services directly but are
essential to effective health system functioning, including health services
managers, medical records and health information technicians, health
economists, health supply chain managers, medical secretaries, and others.
The
field of health human resources deals with issues such as planning,
development, performance, management, retention, information, and research on
human resources for the health care sector. In recent years, raising awareness
of the critical role of HRH in strengthening health system performance and
improving population health outcomes has placed the health workforce high on
the global health agenda.
Global
situation
Nations identified with critical shortages of
health care workers
The
World Health Organization (WHO) estimates a shortage of almost 4.3 million
physicians, midwives, nurses and support workers worldwide.”. The shortage is
most severe in 57 of the poorest countries, especially in sub-Saharan
Shortages
of skilled for health workers are also reported in many specific care areas.
For example, there is an estimated shortage of 1.18 million mental health
professionals, including 55,000 psychiatrists, 628,000 nurses in mental health
settings, and 493,000 psychosocial care providers needed to treat mental
disorders in 144 low- and middle-income countries. Shortages of skilled birth
attendants in many developing countries remains an important barrier to
improving maternal health outcomes. Many countries, both developed and
developing, report maldistribution of skilled health workers leading to
shortages in rural and underserved areas.
Regular
statistical updates on the global HHR situation are collated in the WHO Global
Atlas of the Health Workforce. However the evidence base remains fragmented and
incomplete, largely related to weaknesses in the underlying human resource
information systems (HRIS) within countries.
In
order to learn from best practices in addressing health workforce challenges
and strengthening the evidence base, an increasing number of HHR practitioners
from around the world are focusing on issues such as HHR advocacy, surveillance
and collaborative practice. Some examples of global HRH partnerships include:
Health
Workforce Information Reference Group (HIRG)
Global
Health Workforce
Health
workforce research
Health
workforce research is the investigation of how social, economic,
organizational, political and policy factors affect access to health care
professionals, and how the organization and composition of the workforce itself
can affect health care delivery, quality, equity, and costs.
Many
government health departments, academic institutions and related agencies have
established research programs to identify and quantify the scope and nature of
HHR problems leading to health policy in building an innovative and sustainable
health services workforce in their jurisdiction. Some examples of HRH
information and research dissemination programs include:
Human
Resources for Health journal
HRH
Knowledge Hub,
Center
for Health Workforce Studies,
Canadian
Institute for Health Information: Spending and Health Workforce
Public
Health Foundation of
National
Human Resources for Health Observatory of
OECD
Human Resources for Health Care Study
Health
workforce policy and planning
In
some countries and jurisdictions, health workforce planning is distributed
among labour market participants. In others, there is an explicit policy or
strategy adopted by governments and systems to plan for adequate numbers,
distribution and quality of health workers to meet health care goals. For one,
the International Council of Nurses reports:
The
objective of HHRP [health human resources planning] is to provide the right
number of health care workers with the right knowledge, skills, attitudes and
qualifications, performing the right tasks in the right place at the right time
to achieve the right predetermined health targets.
An
essential component of planned HRH targets is supply and demand modeling, or
the use of appropriate data to link population health needs and/or health care
delivery targets with human resources supply, distribution and productivity.
The results are intended to be used to generate evidence-based policies to
guide workforce sustainability. In resource-limited countries, HRH planning
approaches are often driven by the needs of targeted programmes or projects,
for example those responding to the Millennium Development Goals.
The
WHO Workload Indicators of Staffing Need (WISN) is an HRH planning and
management tool that can be adapted to local circumstances. It provides health
managers a systematic way to make staffing decisions in order to better manage
their human resources, based on a health worker’s workload, with activity
(time) standards applied for each workload component at a given health
facility.
Global
Code of Practice on the International Recruitment of Health Personnel
The
main international policy framework for addressing shortages and maldistribution
of health professionals is the Global Code of Practice on the International
Recruitment of Health Personnel, adopted by the WHO's 63rd World Health
Assembly in 2010. The Code was developed in a context of increasing debate on
international health worker recruitment, especially in some higher income
countries, and its impact on the ability of many developing countries to
deliver primary health care services. Although non-binding on
Types of pharmacy practice settings
[Community pharmacy
19th century Italian pharmacy
Modern pharmacy in Norway
A pharmacy (commonly the chemist in Australia,
New Zealand
and the UK; or drugstore in North America;
or Apothecary,
historically) is the place where most pharmacists practice the profession of
pharmacy. It is the community pharmacy where the dichotomy of the profession
exists—health professionals who are also retailers.
Community pharmacies usually
consist of a retail storefront with a dispensary where medications are stored
and dispensed. The dispensary is subject to pharmacy legislation; with
requirements for storage conditions, compulsory texts, equipment, etc.,
specified in legislation. Where it was once the case that pharmacists stayed
within the dispensary compounding/dispensing medications; there has been an
increasing trend towards the use of trained pharmacy technicians while the pharmacist
spends more time communicating with patients.
All pharmacies are required
to have a pharmacist on-duty at all times when open. In many jurisdictions, it
is also a requirement that the owner of a pharmacy must be a registered
pharmacist (R.Ph.). This latter requirement has been revoked in many
jurisdictions, such that many retailers (including supermarkets
and mass merchandisers) now include a pharmacy as a
department of their store.
Likewise, many pharmacies
are now rather grocery store-like in their design. In addition to medicines and
prescriptions, many now sell a diverse arrangement of additional household
items such as shampoo,
bandages,
office supplies,
candy,
and snack foods.
Hospital pharmacy
Pharmacies within hospitals
differ considerably from community pharmacies. Some pharmacists in hospital
pharmacies may have more complex clinical medication management issues whereas
pharmacists in community pharmacies often have more complex business and
customer relations issues. Because of the complexity of medications including
specific indications, effectiveness of treatment regimens, safety of
medications (i.e., drug interactions) and patient compliance issues ( in the
hospital and at home) many pharmacists practicing in hospitals gain more
education and training after pharmacy school through a pharmacy practice
residency and sometimes followed by another residency in a specific area. Those
pharmacists are often referred to as clinical pharmacists and they often specialize
in various disciplines of pharmacy. For example, there are pharmacists who
specialize in haematology/oncology, HIV/AIDS, infectious disease, critical
care, emergency medicine, toxicology, nuclear
pharmacy, pain management, psychiatry, anticoagulation clinics, herbal medicine,
neurology/epilepsy management, paediatrics, neonatal pharmacists and more.
Hospital pharmacies can
usually be found within the premises of the hospital. Hospital pharmacies
usually stock a larger range of medications, including more specialized
medications, than would be feasible in the community setting. Most hospital
medications are unit-dose, or a single dose of medicine. Hospital pharmacists
and trained pharmacy technicians compound sterile products for patients
including total parenteral nutrition (TPN), and
other medications given intravenously. This is a complex process that requires
adequate training of personnel, quality assurance
of products, and adequate facilities. Some hospital pharmacies have decided to outsource
high risk preparations and some other compounding functions to companies who
specialize in compounding.
Nuclear pharmacy
Nuclear pharmacy focuses on
preparing radioactive materials for diagnostic tests and for treating certain
diseases. Nuclear pharmacists undergo additional training specific to handling radioactive
materials, and unlike in community and hospital pharmacies, nuclear pharmacists
typically do not interact directly with patients.
Compounding pharmacy
Compounding is the practice
of preparing drugs in new forms. For example, if a drug manufacturer only
provides a drug as a tablet, a compounding pharmacist might make a medicated lollipop
that contains the drug. Patients who have difficulty swallowing the tablet may
prefer to suck the medicated lollipop instead.
Compounding pharmacies
specialize in compounding, although many also dispense the same non-compounded
drugs that patients can obtain from community pharmacies.
Consultant pharmacy
Consultant pharmacy practice
focuses more on medication regimen review (i.e. "cognitive services")
than on actual dispensing of drugs. Consultant pharmacists most typically work
in nursing homes,
but are increasingly branching into other institutions and non-institutional
settings. Traditionally consultant pharmacists were usually independent
business owners, though in the
Internet pharmacy
Since about the year
While most Internet
pharmacies sell prescription drugs and require a valid
prescription, some Internet pharmacies sell prescription drugs without
requiring a prescription. Many customers order drugs from such pharmacies to
avoid the "inconvenience" of visiting a doctor or to obtain
medications which their doctors were unwilling to prescribe. However, this
practice has been criticized as potentially dangerous, especially by those who
feel that only doctors can reliably assess contraindications, risk/benefit
ratios, and an individual's overall suitability for use of a medication. There
also have been reports of such pharmacies dispensing substandard products. Of
course as history has shown, substandard products can be dispensed by both
Internet and Community pharmacies, so it is best that the buyer beware.
Canada is home to dozens of licensed
Internet pharmacies, many which sell their lower-cost prescription drugs to
U.S. consumers, who pay the world's highest drug prices. However, there are
Internet pharmacies in many other countries including Israel, Fiji and the UK
that serve customers worldwide.
In the United States,
there has been a push to legalize importation of medications from Canada and other
countries, in order to reduce consumer costs. While in most cases importation
of prescription medications violates Food and Drug Administration (FDA)
regulations and federal laws, enforcement is generally targeted at
international drug suppliers, rather than consumers. There is no known case of
any U.S. citizens buying Canadian drugs for personal use with a prescription,
who has ever been charged by authorities.
Issues in pharmacy
Separation of prescribing from dispensing
In most jurisdictions (such
as the United States), pharmacists
are regulated separately from physicians. Specifically, the legislation stipulates that the
practice of prescribing must be separate from the practice of dispensing. These
jurisdictions also usually specify that only pharmacists may supply
scheduled pharmaceuticals to the public, and that pharmacists cannot
form business partnerships with physicians or give them "kickback"
payments. However, the American Medical Association (AMA) Code of
Ethics provides that physicians may dispense drugs within their office
practices as long as there is no patient exploitation and patients have the
right to a written prescription that can be filled elsewhere. 7 to 10 percent
of American physician practices reportedly dispense drugs on their own.[1]
In other jurisdictions
(particularly in Asian
countries such as China, Hong Kong,
Malaysia,
and Singapore),
doctors
are allowed to dispense drugs themselves and the practice
of pharmacy is sometimes integrated with that of the physician,
particularly in traditional Chinese medicine.
In Canada it is common for a
medical clinic and a pharmacy to be located together and for the ownership in
both enterprises to be common, but licensed separately.
The reason for the majority
rule is the high risk of a conflict of interest. Otherwise, the physician has a
financial self-interest in "diagnosing" as many conditions as
possible, and in exaggerating their seriousness, because he or she can then
sell more medications to the patient. Such self-interest directly conflicts
with the patient's interest in obtaining cost-effective medication and avoiding
the unnecessary use of medication that may have side-effects.
A campaign for separation
has begun in many countries and has already been successful (like in Korea). As many of the
remaining nations move towards separation, resistance and lobbying from
dispensing doctors who have pecuniary interests may prove a major stumbling
block (e.g. in Malaysia).
The future of pharmacy
In the coming decades,
pharmacists are expected to become more integral within the health care system.
Rather than simply dispensing medication, pharmacists expect to be paid for
their cognitive skills.
This paradigm shift has
already commenced in some countries; for instance, pharmacists in Australia
receive remuneration from the Australian Government for conducting comprehensive
Home Medicines Reviews. In the United Kingdom, pharmacists (and nurses) who
undertake additional training are obtaining prescribing rights. In the
are now expanding
into direct consultation with patients, under the banner of "senior care
pharmacy."
The following services are available to patients through IPD:
·
Nursing care-
continuous monitoring, drug administration
·
Preparation for
surgery and post-operative care
·
Diets
·
Sending the
samples to the laboratory & collecting the reports
·
Procuring drugs
for individual patients
·
Call the doctors
to attend patients
·
Arranging diet for
individual patients
·
Shifting the
patients to imaging department or OT
·
Cross referral-
get the opinion of other consultants
·
Get the
pre-anesthetic checkup (PAC) of patients done
·
Procure blood from
blood bank
·
Transfer in/ out
of the patients
Assess the effectiveness and efficiency of inpatient services
Hospital Management Information
System
Pharmacy to submit drug
requisition for individual patients
Dietary section to submit diet requisition for individual patients
Linen and laundry for linen supplies
Laboratory and Radiology for requisition for lab tests and their reports
Billing section for finalization of patient bills
Admission desk for sending information about vacant beds
BOR= Number of patient care days/
number of available bed days * 100
Number of admissions- consultant
wise: In order to compare the performance of different consultants
Number of patients/ admissions-
disease/ diagnosis wise
Average number of tests (imaging & lab) advised per patient –
consultant wise
The following are the quality indicators of indoor care:
Activities related to transfer in of the patient on the floor
Ward nurse receives the information from the concerned area (ward, ICU
etc)
Ward nurse prepares the unit to receive the patient in the ward
Patient is handed over to ward nurse against a checklist.
She then continues the treatment as handed over to her until it is
changed
Ward nurse informs the admission department regarding the transfer
Activities related to transfer out
of the patient
Ward nurse arranges for the transport and fill up the transfer checklist.
Activity flow for ward requisition
for Pharmacy, medical stores and general stores
Department boy comes and delivers the items
Ward nurse checks the requested items and endorses signature on the issue
note
Ward nurse stores the items at proper place and enter in stock register.
ED in-patient wait times among the lowest in the Ontario
In-patient Department
The whole floor of the clinic is
assigned for In-patient Department. There are wards of several types:
·
lux wards (VIP-class),
·
wards for patients with limited
capacities for locomotion or bed patients;
·
wards for 2 patients with
functional beds.
All the wards are equipped with
built-in furniture, conditioner, buttons for nurse call, signalization, TV,
port for internet connection, sanitary arrangement with shower.
Reanimation wards are provided
for serious patients with devices for monitoring of patient’s condition and for
provision of first aid (defibrillator, apparatus of artificial lung
ventilation).
Patients are guaranteed the
complete allowance during treatment: meals 4 times a day (taking into account
all diets, if necessary), medicinal treatment, clothes (hospital gown,
slippers), personal hygienic means (cosmetic and hygienic means)
Some in-patient departments have
a capacity of comfortably accommodating one hundred patients. Our wards have
been divided as per the presenting cases where we have:
* Male and female surgical wards
* Maternity ward
* Gynecological ward
* Nursery
* Ante- natal ward
* Post-natal ward
The above are divide into either
general or private ward depending on the client preferences.
All the patient beds are
standard adjustable hospital beds, comfortable, each with a bedside switch,
bedside alarm bell switch (for requesting attention medical or otherwise),
bedside lamp and partitioning curtains. These beds are spaced as per the
recommended international standards.
The department has the capacity
to handle a wide variety of cases including:
All types of surgeries;
orthopedic, general surgery, urological cases, cardiothoracic cases,
neurological cases, Ear Nose and throat (ENT) cases, gastro-enterology and
acute trauma cases
Medical cases; respiratory
conditions, Hypertension, Diabetes Mellitus and its complications,
cardiovascular conditions, Malaria, Gastroenteritis, Peptic Ulcer disease,
Osteoarthritis among others.
Gynecological and maternal
cases; labor and delivery.
Critical neonatal unit with
incubators available.
Nursing services are provided by
a team of over forty qualified nurses. These provide a high patient nurse ratio
to ensure that the hospital’s vision of provision of quality healthcare is
achieved.
VIDEO
Inpatient Treatment
The Present
Progressive
Present Continuous
|
positive |
negative |
question |
answer |
|
I am
working. I’m
working. |
I am not working. |
Am
I working? |
Yes,
I am. No,
I’m not. |
|
He She is working. It
He’s She’s working. It’s
|
He She is not working. It isn’t |
he Is she working? it |
Yes,
he she
is. it No, he she
isn’t. it |
|
We You are working. They
|
We You are not working. They aren’t |
we Are
you working? they |
Yes,
we you
are. They No,
we you
aren’t. they |
While the simple
present and the present progressive are sometimes used interchangeably, the present progressive
emphasises the continuing nature of an act, event, or condition.
Nora is
looking for the first paperback editions of all of Raymond Chandler's books.
Deirdre is
dusting all the shelves on the second floor of the shop.
The union
members are pacing up and down in front of the factory.
KPLA is
broadcasting the hits of the 70s this evening.
The presses
are printing the first edition of tomorrow's paper.
The doors are
opening in 10 minutes.
The premier
is arriving on Tuesday.
The publisher
is distributing the galley proofs next Wednesday.
The Past Progressive Tense
The past progressive
tense is used to described actions ongoing in the past. These actions often
take place within a specific time frame. While actions referred to in the
present progressive have some connection to the present, actions referred in
the past progressive have no immediate or obvious connection to the present.
The on-going actions took place and were completed at some point well before
the time of speaking or writing.
Each of the
highlighted verbs in the following sentences is in the past progressive tense.
The cat was walking
along the tree branch.
Here the
action "was telling" took place in the past and continued for some
time in the past.
When the
recess bell rang, Jesse was writing a long division problem on the blackboard.
The
archivists were eagerly waiting for the delivery of the former prime minister's
private papers.
Here the
ongoing action of "waiting" occurred at some time unconnected to the
present.
Between 1942
and 1944 the Frank and Van Damm families were hiding in a Amsterdam office
building.
The Future Progressive Tense
The future progressive
tense is used to describe actions ongoing in the future. The future progressive
is used to refer to continuing action that will occur in the future.
The glee club
will be performing at the celebration of the town's centenary.
Ian will be
working on the computer system for the next two weeks.
The selection
committee will be meeting every Wednesday morning.
We will be
writing an exam every afternoon next week.
They will be
ringing the bells for Hypatia next month.
The present progressive tense
9.9 Form of the present
progressive tense
The progressive is formed with the
present of be + the -ing form See under be
for details about form [> 10.6]
|
I am |
waiting writing running beginning lying |
I’m |
waiting writing running beginning lying |
|
You are |
You’re |
||
|
He is |
He’s |
||
|
She is |
She’s |
||
|
It is |
It’s |
||
|
We are |
We’re
|
||
|
You are |
You’re |
||
|
They are |
They’re |
9.10 Spelling: how to add '-ing' to a verb
wait/waiting
We can add -ing to most
verbs without changing the spelling of their
base forms. Other examples: beat/beating, carry/carrying,
catch/catching, drink/drinking, enjoy/enjoying,
hurry/hurrying
write/writing
If a verb ends in -e, omit the -e
and add -ing. Other examples:
come/coming,
have/having, make/making, ride/riding, use/using This
rule does not apply to verbs ending in double e:
agree/agreeing,
see/seeing; or to age/ageing and singe/singeing
run/running
A verb that is spelt with a
single vowel followed by a single consonant
doubles its final consonant. Other examples: hit/hitting,
let/letting
put/putting, run/running, sit/sitting
Compare: e.g. beat/beating which
is not spelt with a single vowel and
which therefore does not double its final
consonant.
begin/beginning
With two-syllable verbs, the
final consonant is normally doubled when
the last syllable is stressed. Other examples: for'get/forgetting,
pre'fer/prefernng, up'set/upsetting Compare: 'benefit/benefiting,
'differ/differing and 'profit/profiting which are stressed on their first
syllables and do not double their final consonants.
Note
'label/labelling 'quarrel/quarrelling, 'signal/signalling and
'travel/travelling (BrE) which are exceptions to this rule. Compare:
labeling, quarreling, signaling, traveling (AmE) [compare > 9.14.2].
-ic at the end of a
verb changes to -ick when we add -ing:
panic/panicking picnic'picnicking
traffic/trafficking
lie/lying
Other examples: die/dying, tie/tying
9.11 Uses of the present progressive tense
9.11.1 Actions in progress at
the moment of speaking
We use the present progressive to describe actions or events which
