Post Apotheke

Addressing the complexities of health care quality improvement (QI) requires understanding the multifactorial aspects that contribute to capacity building in hospital settings. With escalating demands on health care systems, identifying factors that enhance QI capacity is crucial. This study aims to elucidate these factors and explore how they can be leveraged to improve QI initiatives in hospitals. We conducted a comprehensive literature review, searching databases including CINAHL, Embase, Medline, PubMed, and the Cochrane Library to identify key factors influencing QI capacity development. The Joanna Briggs Institute critical appraisal tool was used to assess the methodological quality of studies. NVivo software facilitated the coding and thematic analysis of extracted data, enabling the identification of key themes. Analysis of 21 studies identified key factors for hospital QI capacity: (1) Accountability and priority setting, emphasizing clear responsibilities and strategic focus; (2) strategic management, aligning frameworks with QI objectives; (3) collaboration, highlighting the importance of synergistic efforts among stakeholders; (4) enhancing QI knowledge and experience, stressing continuous learning and experience sharing; and (5) QI project support, detailing the need for adequate resources and backing. These themes collectively provide a blueprint for advancing QI capacity in hospitals. This review highlights critical themes for enhancing QI capacity in hospitals, particularly the integration of accountability, strategic management, collaboration, knowledge enhancement, and project support. Recognizing the interconnected nature of these themes is vital for sustained improvements in health care outcomes. Future research should explore the role of organizational culture in optimizing QI initiatives.

Abstract The number of pharmacies in Germany has been declining for years. This means that a significant portion of the population can barely reach the nearest pharmacy on foot. While the nearest pharmacy is generally easily accessible by car, the distances to the next but one can be considerable. When evaluating these findings, it must be noted that the legislator has not formulated any tangible definitions regarding the proper supply of medicinal products to the population by pharmacies, which is mandated in the public interest. Applying the provisions of the Postal Services Act as a guide to pharmacy provision, it becomes clear that approximately 900 municipalities that are entitled to a post office branch do not have a local pharmacy. This corresponds to approximately 8% of all municipalities in Germany.

This thesis focused on treatment refinement and enhancing the use of gold-standard immunosuppressive therapies in children with immune diseases and in paediatric haematopoietic cell transplantation (HCT). Chapter 1 gave an overview of the current evidence on the pharmacokinetic (PK) and pharmacodynamic (PD) relationships of systemic corticosteroids in paediatric and adult patients with autoimmune and inflammatory diseases. Evidence for a PK-efficacy relationship was inconclusive and limited, but there was some evidence for PK-toxicity relationship regarding the severity of Cushingoid features. This overview revealed the existing knowledge gap and that prospective research is still highly needed. Chapter 2 described the development and validation of a liquid chromatography–tandem mass spectrometry (LC-MS/MS) assay for the quantification of prednisolone serum concentrations in patient samples. Protein-unbound prednisolone was obtained with equilibrium dialysis. Prednisolone protein binding showed no significant degradation after 30 months of storage at -80°C and was not influenced by multiple cycles of freezing and thawing. Chapter 3 described the two-compartment population PK model of total and unbound prednisolone. The model included the linear and saturable binding of prednisolone to albumin and corticosteroid binding globulin (CBG), respectively, and the circadian rhythm of CBG. Allometric scaling of prednisolone PK adequately described the relationship with body size. It was recommended to address the clinical implications of the current BW-based dosing regimen in future PK-PD studies, as younger children are relatively underdosed. In chapter 4 (interim analysis), the associations between prednisolone PK and presence of corticosteroid-related neuropsychiatric adverse effects (AEs) were explored in children with immune diseases, in addition to the development of behavioural changes over time and the perceptional differences in AEs between patients and their parents. There was a substantial presence of neuropsychiatric AEs, although the current analysis did not demonstrate associations with the PK of prednisolone. In chapter 5 (interim analysis), the associations between prednisolone PK and the response to prednisolone as either prophylactic treatment or therapy of graft-versus-host disease (GvHD) in children post-HCT were explored. High variability in prednisolone exposure was observed, and a trend towards a lower exposure in patients diagnosed with GvHD. These patients tended to have a lower age, and consequently a lower BW. It was recommended to consider a different allometric-based dosing strategy in younger children, such as body surface area (BSA)-based dosing. In chapter 6, the adherence to low-dose methotrexate (MTX) in patients with juvenile idiopathic arthritis (JIA) was addressed. With an ultrasensitive LC-MS/MS assay, plasma samples from JIA patients were analysed to assess adherence to MTX. Adherence in this JIA population was 88% shortly after initiation of MTX therapy and decreased to 77% after one year of treatment. Teenagers were more at risk for non-adherence. Chapter 7 revealed the relative overdosing of fludarabine in young children undergoing HCT. Overexposure to fludarabine was observed in 50% to 80% of infant HCT patient, indicating that the BSA-based dosing strategy may be inappropriate in infants and young children and dose reductions in children <1 year of age could improve achievement of a fludarabine exposure within the optimal target range.

Since knowledge about customers' attitudes towards medication reviews in community pharmacies is limited, the objective of this study was to gain insight into customers' perceived facilitators and barriers to participate in this service, with the aim of identifying areas to facilitate the implementation process. In spring 2024, we conducted a prospective, questionnaire-based survey for a total of 58 days. All customers (≥18 years) in 3 pharmacies in Germany, regardless of whether they were eligible for medication reviews or not, were approached during their pharmacy visit in person and invited to complete the tablet-based questionnaire on-site. The pilot-tested, multilingual questionnaire covered socio-demographic-data and customers' attitudes towards medication reviews. Potential benefits of medication reviews were rated regarding their perceived importance on a 3-point-Likert-scale (0 = not important, 1 = important, 2 = very important). A mean score was calculated for each benefit. Data were analyzed descriptively and binary logistic regression analyses were applied to explore associations of selected predictors with awareness of medication reviews or expected benefits. A total of 1561 pharmacy customers participated, with 59.2% (interquartile range (IQR): 17.9%) of patients being approached daily. Awareness of medication reviews was low (18.0%, n = 281/1561), whereby female participants (odds ratio (OR): 1.211 (0.914-1.603)) and those who request pharmacies' consultation services (OR: 1.020 (1.012-1.029) were more likely to know it. Key expectations towards benefits included better knowledge of medicines (mean score: 1.4 ± 0.7), fewer side-effects (1.4 ± 0.7) and fewer problems with their medication (e.g. interactions; 1.3 ± 0.7). No difference was found for prior awareness of medication reviews in terms of benefit expectations. Gaining knowledge and improving medication safety through a medication review is most valuable to customers. By clearly explaining the purpose and expected benefits of medication reviews, the outreach and impact could be increased.Trial registration: German Clinical Trials Register identifier: DRKS00032446.

The 2013 amending directive on the recognition of professional qualifications (2005/36/EC) calls on European countries to implement concepts for the continuing professional development of healthcare professionals. This article examines the development of continuing education and training of pharmacists in Germany and compares it with Austria, France, Switzerland and the UK.The development of avoluntary training certificate for pharmacists in Germany began in the early 2000s. The certificate requires proof of 150 continuing education points, which can be earned by attending lectures, seminars and other educational activities, to be submitted to the responsible chamber of pharmacists. With the introduction of pharmaceutical services and vaccinations in 2022, proof of specific qualification measures will be linked to the authorisation to provide certain services.Specialisation developed differently in the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG). In the GDR, specialisation was possible from 1974 and in the FRG from 1979. Today, further training to become aspecialist pharmacist is offered in 10areas, and additional designations can be acquired in 8areas. Many EU countries have mandatory continuing education requirements, which are usually monitored by a professional association. Austria introduced mandatory continuing education in 2024. In Switzerland, in addition to specialisation, regular proof of continuing education is also required to manage acommunity pharmacy. France and the UK have mandatory revalidation systems that go beyond this, with the UK having implemented continuous professional (competence) development most comprehensively. Germany has the opportunity to utilise the experience of other European countries in order to further develop its continuing education and specialisation in line with EU standards.

Background and ImportanceLeachables are chemical compounds that migrate from packaging materials into pharmaceutical formulations during regular use and can cause potential health risks alone or in interaction with other compounds of the pharmaceutical formulation. We expect a higher risk in solvents such as complex emulsions. Especially in new formulations such as mRNA vaccines, leachables may cause unknown interactions and are present in higher amounts. Identifying and quantifying these compounds is crucial to ensure product safety. As the stability of the vaccine in syringes is 12 hours after filling into the syringes, knowledge about the leachable situation in syringes is of interest.Aim and ObjectivesOur aim is to quantify the concentration of leachables during the official shelf life of Comirnaty Vaccine (12 hours, room temperature 15–25).Material and MethodsEmulsions of Comirnaty, Propofol and ethanol were stored at room temperature in plastic syringes for 2 weeks. Leachables were quantified at 3, 5, 12 hours and 14 days after filling. The samples were analysed by HPLC (Ultimate 3000, ThermoScientific) coupled with massspectrometry (4000 qTrap, Sciex), GC-MS (8890GC System, Agilent) and UV-Spectrometry (DrugLog, Pharmacolog).ResultsUsing GC-MS, Vulkanox BKF could be identified, which was also confirmed and quantified by HPLC-MS on a Raptor Biphenyl column. UV-Vis (Druglog) provided more general confirmation of leachables but lacked the specificity required for precise quantification. The concentration of leachables increased over time in all three solvents. The concentration of Vulkanox BKF in the Comirnaty vaccine and Propofol was similar increased. In Ethanol was the concentration ca. 10 times higher compared with the emulsions.Conclusion and RelevanceVulkanox was detected in measurable quantities, but it is not possible to evaluate whether this substance is harmful at these levels due to the lack of available toxicological data. Regulatory guidelines should ensure that the migration of such leachables remains below hazardous levels and possible influence on the stability of the mRNA vaccine is excluded. However, prolonged exposure or higher concentrations of these compounds could increase health risks.References and/or AcknowledgementsConflict of InterestNo conflict of interest