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GMP Compliant Synthesis of Canagliflozin, a Novel PET Tracer for the Sodium−Glucose Cotransporter 2

Inhibition of the sodium−glucose cotransporter 2 (SGLT2) by canagliflozin in type 2 diabetes mellitus results in large between-patient variability in clinical response. To better understand this variability, the positron emission tomography (PET) tracer [18F]canagliflozin was developed via a Cu-mediated 18F-fluorination of its boronic ester precursor with a radiochemical yield of 2.0 ± 1.9% and a purity of >95%. The GMP automated synthesis originated [18F]canagliflozin with a yield of 0.5−3% (n = 4) and a purity of >95%. Autoradiography showed [18F]canagliflozin binding in human kidney sections containing SGLT2. Since [18F]canagliflozin is the isotopologue of the extensively characterized drug canagliflozin and thus shares its toxicological and pharmacological characteristics, it enables its immediate use in patients.

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GMP Compliant Synthesis of Canagliflozin, a Novel PET Tracer for the Sodium−Glucose Cotransporter 2

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Algemene Handleiding 1+1=3 ’t PASST Samen

Voor leerlingen met een autismespectrumstoornis (ASS) die substantiële ondersteuning nodig hebben, is passend onderwijs lastig te realiseren. Deze leerlingen kunnen problemen laten zien in hun betrokkenheid bij de leertaak, wat gerelateerd is aan lage schoolprestaties en voortijdige uitval. Ze hebben baat bij een goede gezamenlijke ondersteuning van de leerkracht én de jeugdhulpverlener. Echter, leerkrachten hebben vaak weinig onvoldoende kennis en ervaring met ASS om de juiste ondersteuning te kunnen bieden en jeugdhulpverleners die op school ingezet worden, zijn meestal onvoldoende op de hoogte van wat er vanuit het onderwijs moet gebeuren. Leerkrachten en jeugdhulpverleners kunnen elkaar versterken, maar er is nog te vaak sprake van figuurlijke afstand en gebrek aan verbondenheid. Gezamenlijk professionaliseren kan ervoor zorgen dat het handelen van leerkrachten en jeugdhulpverleners en hun interprofessionele samenwerking worden versterkt, zodat deze professionals een integraal aanbod op maat kunnen maken en op een talentgerichte wijze de betrokkenheid van leerlingen met ASS kunnen ondersteunen. In ’t PASST Samen werken leerkrachten en jeugdhulpverleners (professionals) aan het versterken van hun handelen en hun interprofessionele samenwerkingsvaardigheden. Het doel daarvan is dat de betrokkenheid bij het leren van kinderen met een autismespectrumstoornis (ASS) vergroot wordt. Leerkrachten en jeugdhulpverleners ontwikkelen nieuwe kennis en vaardigheden die ze direct kunnen toepassen in hun werk. Hierdoor wordt hun handelingskracht om een integrale aanpak vorm te geven versterkt. Dit levert uiteindelijk tijdwinst op, omdat er preventief gewerkt wordt aanproblemen die samenhangen met een verlaagde betrokkenheid (bijv. interactieproblemen). Hierdoor worden de kansen voor kinderen met ASS vergroot.

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Algemene Handleiding 1+1=3 ’t PASST Samen

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Barriers and facilitators with medication use during the transition from hospital to home

BACKGROUND: During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home.METHODS: A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram.RESULTS: In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers).CONCLUSIONS: During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.

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Barriers and facilitators with medication use during the transition from hospital to home

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Implementation of an animated medication information tool in community pharmacies, with a special focus on patients with limited health literacy

Objectives: The animated medication information tool ‘Watchyourmeds’ provides information in an accessible manner through animated videos and therefore appears to be especially suitable for people with limited health literacy. This study aimed to assess the implementation of this animated medication information tool in Dutch community pharmacies, with a special focus on patients with limited health literacy. Methods: A cross-sectional survey based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was sent to approximately 75% of the ±1900 community pharmacies in the Netherlands through email newsletters of pharmacy networks. Key findings: 140 pharmacists (⁓10%) completed the survey and 125 of them (89%) indicated that they offered the animated medication information tool to their patients. 108 pharmacists indicated that the tool was offered to all patients, not only to patients with limited health literacy. The distribution method was primarily passive (patients were given a leaflet and were not explicitly pointed to or informed about the tool). Two frequently cited motivations for offering the tool were that it complemented other sources of information and that the health insurer provided a financial incentive. The main reasons patients refused to use the tool were that they had no access to or no affinity for the required technology. Conclusions: This study demonstrated that the tool is used in community pharmacies and that it is offered to all patients, regardless of their presumed health literacy level. A more active method of offering the tool may be warranted to better reach patients with limited health literacy.

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The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescriptionchanges over a 3-month period. A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient.We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start.

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The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

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Problems with continuity of care identified by community pharmacists post-discharge

from Narcis: "What is known and objective Medication discrepancies are common at hospital discharge, and medication reconciliation is widely endorsed as a preventive strategy. However, implementation is difficult for instance due to the unreliability of patients medication histories. In the Netherlands, community pharmacies are well-informed about their patients’ pre-admission medication status which enables thorough post-discharge reconciliation. Our aim was to study the frequency and nature of medication discrepancies, missing patient's knowledge and administrative problems at admission to primary care. Methods A cross-sectional study was conducted in pharmacies belonging to the Utrecht Pharmacy Practice network for Education and Research in the Netherlands. Structured checklists were used to evaluate all discharge prescriptions presented by adult patients discharged from the hospital to their own home during the study period. The primary outcome was all possible problems with continuity of care, defined as (i) the number and type of medication discrepancies, (ii) administrative problems and (iii) the necessity for patient education. Results and discussion In forty-four pharmacies, checklists were completed for 403 patients. Most discharge prescriptions (92%) led to one or more problems with continuity of care (n = 1154, mean 2·9 ± 2·0), divided into medication discrepancies (31%), administrative problems (34%) and necessity for further education (35%). Medication discrepancies (n = 356) resulted mainly from missing pre-admission medication (n = 106) and dose regimen changes (n = 55) on the discharge prescription. Administrative problems (n = 392) originated mainly from administrative incompleteness (n = 177), for example missing reimbursement authorization forms, or supply issues (n = 150), for example insufficient pharmacy stock. The patients’ lack of medication knowledge post-discharge was illustrated by the high need for patient education (n = 406). What is new and conclusion Community pharmacists are still confronted with problems due to inadequate documentation at discharge which can inflict harm to patients if not properly addressed. To reduce these problems, a rigorous implementation of the medication reconciliation process at all transition points, standardized electronic transfer of all medication-related information and interdisciplinary collaboration are crucial."

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Patient–provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands

Objective To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed based on an observation protocol for the following information: content of encounter, initiator of a theme and pharmacy staff's communication style. Results In total, 119 encounters were recorded which concerned 42 first prescriptions, 16 first refill prescriptions and 61 follow-up refill prescriptions. During all encounters, discussion was mostly initiated by pharmacy staff (85%). In first prescription encounters topics most frequently discussed included instructions for use (83%) and dosage instructions (95%). In first refill encounters, patient experiences such as adverse effects (44%) and beneficial effects (38%) were regularly discussed in contrast to follow-up refills (7% and 5%). Patients’ opinion on medication was hardly discussed. Conclusion Pharmacy staff in outpatient pharmacies generally provide practical information, less frequently they discuss patients’ experiences and seldom discuss patients’ perceptions and preferences about prescribed medication. Practice implications This study shows there is room for improvement, as communication is still not according to professional guidelines. To implement professional guidelines successfully, it is necessary to identify underlying reasons for not following the guidelines.

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The effect of a pharmacy-led transitional care program on medication-related problems post-discharge

BACKGROUND: Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge.METHODS: A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data.RESULTS: We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79).CONCLUSIONS: A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.

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The effect of a pharmacy-led transitional care program on medication-related problems post-discharge

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Communication between Patients and Pharmacy Staff on Patient Information Leaflets

Objective: Product Information Leaflets (PILs) are an important source of information for patients on their medication, but may cause confusion and questions. Patients then may seek clarification, for instance from pharmacy technicians. The aim of this study was to explore which questions pharmacy technicians get about PIL-related issues, why and when, and how they handle such questions. Methods: an online survey in a panel of 785 Dutch pharmacy technicians. Key results: Net response rate was 37%. PIL-related questions frequently concerned drug actions, problems with use, side effects, intolerances and pregnancy and lactation. Patients who received generic alternatives instead of the branded product they had received previously, also came more often to pharmacy staff with PIL-related questions. The requested information could not always be found in the PIL itself, not even by the pharmacy technicians themselves. They mentioned that the PIL is not easy to read, understand or recall. Conclusions: Pharmacy staff is often approached by patients having difficulties in understanding PILs. Even pharmacy technicians find PILs difficult to read and often use other sources of information. PIL layout and contents should become more standardized and easier to read and understand.

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GMP Compliant Synthesis of Canagliflozin, a Novel PET Tracer for the Sodium−Glucose Cotransporter 2

Algemene Handleiding 1+1=3 ’t PASST Samen

Barriers and facilitators with medication use during the transition from hospital to home

Implementation of an animated medication information tool in community pharmacies, with a special focus on patients with limited health literacy

The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

Problems with continuity of care identified by community pharmacists post-discharge

Patient–provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands

The effect of a pharmacy-led transitional care program on medication-related problems post-discharge

Communication between Patients and Pharmacy Staff on Patient Information Leaflets

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Piet Berkers

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