Posts

What is a Referral (Medicine)?

Published on by Andrew MarshallLeave a comment

Introduction

In medicine, referral is the transfer of care for a patient from one clinician or clinic to another by request.

Refer to Classification of Pharmaco-Therapeutic Referrals and International Classification of Primary Care.

Other Examples

  • Tertiary care is usually done by referral from primary or secondary medical care personnel.
  • In the field of sexually transmitted diseases (STDs), referral also means the informing of a partner of a patient diagnosed STD of the potential exposure.
  • Patient referral is where patients directly inform their partners of their exposure to infection.
  • An alternative is provider referral, where trained health department personnel locate partners on the basis of the names, descriptions, and addresses provided by the patient to inform the partner.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Referral_(medicine) >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What are Drug Therapy Problems?

Published on by Andrew MarshallLeave a comment

Introduction

Drug therapy problems (DTPs) (or drug related problems, DRPs) represent the categorisation and definition of clinical problems related to the use of medications or “drugs” in the field of pharmaceutical care. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by pharmacists in the course of medication therapy management, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs.

A drug-therapy (related) problem can be defined as an event or circumstance involving drug treatment (pharmacotherapy) that interferes with the optimal provision of medical care. In 1990, Strand and colleagues (based on previous work of Mikeal et al. (1975) and Brodie et al. (1980)) classified the DTPs into eight different categories. According to these categories, pharmacists generated a list of the DTPs for each patient. As a result, pharmacists had a cleaner picture of the patient’s drug therapy and medical conditions. A second publication of Cipolle et al. (1998; 2004; 2012) changed the eight categories into seven, grouped in four Pharmacotherapy needs: indication, effectiveness, safety and adherence.

Examples

Patients who have chronic pain that are prescribed opioid painkillers (such as morphine) may build up a tolerance to the effect of the painkillers, requiring higher doses to achieve the same pain reducing effect. This risky practice of dose escalation can lead to drug overdoses.
Some drugs reduce the body’s absorption of essential nutrients from food, which could lead to nutritional deficiencies.

The Original Eight Problems

According to page 73 in Introduction to Health Care Delivery: A Primer for Pharmacists, drug therapy problems (DTP) originated from Strand et al. (1990) who defined eight problems that could result in poorer health outcomes in an attempt to categorise DTP. Helper and Strand later in 1990 stated the mission statement or raison d’être of pharmacists should be to correct these drug therapy problems.

The original eight problems have now been condensed into seven categories of problems. As given by Shargel, they are:

  1. Unnecessary drug therapy: This could occur when the patient has been placed on too many medications for their condition and the drug is simply not needed.
  2. Wrong drug: This could occur when a patient is given medication that does not treat the patient’s condition, e.g. heart medication to treat an infection.
  3. Dose too low: This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects.
  4. Dose too high: This could occur when a patient is given medication that is too strong and is causing detrimental effects or is simply not necessary.
  5. Adverse drug reaction: This could occur when a patient has an allergic response to a medication.
  6. Inappropriate adherence: This could occur when a patient chooses not to or forgets to take a medication.
  7. Needs additional drug therapy: This could occur when a patient needs more medication to treat their condition.

Further Breakdown of Categories

DRPs can be broken down further into the following categories (or four pharmacotherapy needs):

Indication

  • Requires Additional Drug Therapy:
    • Untreated condition.
    • Preventative / prophylactic.
    • Synergistic / potentiating.
  • Unnecessary Drug Therapy:
    • No medical indication.
    • Duplicate therapy.
    • Non-drug therapy indicated.
    • Treating avoidable ADR.

Effectiveness

Requires Different Drug Product

  • More effective drug available:
    • Condition refractory to drug.
    • Dosage form inappropriate.
    • Not effective for condition.
  • Dosage Too Low:
    • Wrong dose.
    • Frequency inappropriate.
    • Duration inappropriate.
    • Drug interaction.

Safety

Adverse Drug Reaction

  • Undesirable effect:
    • Unsafe drug for patient.
    • Dose changed too quickly.
    • Allergic reaction.
    • Contraindications present.
  • Dosage Too High:
    • Wrong dose.
    • Frequency inappropriate.
    • Incorrect administration.
    • Drug interaction.

Adherence

  • Non-adherence:
    • Directions not understood.
    • Patient prefers not to take.
    • Patient forgets to take.
    • Drug product too expensive.
    • Cannot swallow/administer.
    • Drug product not available.

Reference

Brodie, D.C., Parish, P.A. & Poston, J.W. (1980) Societal Needs for Drugs and Drug-Related Services. American Journal of Pharmaceutical Education. 44(3): pp.276-278.

Cipolle, R.J, Strand, L.M. & Morley, P.C. (1998) Pharmaceutical Care Practice. Illustrated Edition. New York: McGraw Hill.

Cipolle, R.J., Strand, L.M. & Morley, P.C. (2012) Pharmaceutical Care Practice: The Patient-Centred Approach to Medication Management Services. Third Edition. New York: McGraw Hill.

Cipolle, R.J., Strand, L.M. & Morley, P.C. (2004) Pharmaceutical Care Practice: The Patient-Centred Approach to Medication Management Services. Second Edition. New York: McGraw Hill.

Mikeal, R.L., Brown, T.R., Lazarus, H.L. & Vinson, M.C. (1975) Quality of Pharmaceutical Care in Hospitals. American Journal of Hospital Pharmacy. 32(6), pp.567-574.

Strand, L.M., Morley, P.C., Cipolle, R.J., Ramsey, R. & Lamsam, G.D. (1990) Drug-Related Problems: Their Structure and Function. DICP. 24(11), pp.1093-1097. doi:10.1177/106002809002401114.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Drug_therapy_problems >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 02 September [2022]

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1901 – Andreas Embirikos, Greek psychoanalyst and poet (d. 1975).

People (Deaths)

  • 1997 – Viktor Frankl, Austrian neurologist and psychiatrist (b. 1905).

Andreas Embirikos

Andreas Embirikos (Greek: Ανδρέας Εμπειρίκος; 02 September 1901 to 03 August 1975 in Kifissia, Attica) was a Greek surrealist poet and one of the first Greek psychoanalysts.

Embirikos came from a wealthy family as his father Leonidas Embirikos was an important ship-owner and politician. He was born in Brăila, Romania, but his family soon moved to Ermoupolis in Syros, one of the Greek islands in the Aegean Sea. When Embirikos was only seven years old they moved to Athens. While he was still a teenager his parents divorced; he started studying at the School of Philosophy of the National and Capodistrian University of Athens, but he decided to move to Lausanne to stay with his mother without graduating from the university.

The following years Embirikos studied a variety of subjects both in France and in the United Kingdom where he studied at King’s College London; however it was in Paris where he decided to study psychanalysis together with René Laforgue and joined the International Psychoanalytical Association.

Viktor Frankl

Viktor Emil Frankl (26 March 1905 to 02 September 1997) was an Austrian neurologist, psychiatrist, philosopher, writer, and Holocaust survivor.

He was the founder of logotherapy, a school of psychotherapy that describes a search for a life’s meaning as the central human motivational force. Logotherapy is part of existential and humanistic psychology theories.

Logotherapy was recognised as the third school of Viennese Psychotherapy, after those established by Sigmund Freud, and Alfred Adler.

Frankl published 39 books. The autobiographical Man’s Search for Meaning, a best-selling book, is based on his experiences in various Nazi concentration camps.

What is a Pharmacist?

Published on by Andrew Marshall1 Comment

Introduction

Pharmacists, also known as chemists (Commonwealth English) or druggists (North American and, archaically, Commonwealth English), are health professionals who deal with the preparation, properties, effects and proper use of medicines. Pharmacists provide pharmaceutical care to patients and promote public health by serving as health advisors and care providers in the community. Pharmacists undergo university or graduate-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialised knowledge to patients, physicians, and other health care providers.

Among other licensing requirements, different countries require pharmacists to hold either a Bachelor of Pharmacy, Master of Pharmacy, or Doctor of Pharmacy degree.

The most common pharmacist positions are that of a community pharmacist (also referred to as a retail pharmacist, first-line pharmacist or dispensing chemist), or a hospital pharmacist, where they instruct and counsel on the proper use and adverse effects of medically prescribed drugs and medicines. In most countries, the profession is subject to professional regulation. Depending on the legal scope of practice, pharmacists may contribute to prescribing (also referred to as “pharmacist prescriber”) and administering certain medications (e.g., immunisations) in some jurisdictions. Pharmacists may also practice in a variety of other settings, including industry, wholesaling, research, academia, formulary management, military, and government.

Nature of Work

Historically, the fundamental role of pharmacists as a healthcare practitioner was to check and distribute drugs to doctors for medication that had been prescribed to patients. In more modern times, pharmacists advise patients and health care providers on the selection, dosages, interactions, and side effects of medications, and act as a learned intermediary between a prescriber and a patient. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Pharmacists may practice compounding; however, many medicines are now produced by pharmaceutical companies in a standard dosage and drug delivery form. In some jurisdictions, pharmacists have prescriptive authority to either independently prescribe under their own authority or in collaboration with a primary care physician through an agreed upon protocol called a collaborative practice agreement.

Increased numbers of drug therapies, aging but more knowledgeable and demanding populations, and deficiencies in other areas of the health care system seem to be driving increased demand for the clinical counselling skills of the pharmacist. One of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and management of each to improve outcomes. Pharmaceutical care has many benefits that may include but are not limited to: decreased medication errors; increased patient compliance in medication regimen; better chronic disease state management, including hypertension and other cardiovascular disease risk factors; strong pharmacist–patient relationship; and decreased long-term costs of medical care.

Pharmacists are often the first point-of-contact for patients with health inquiries. Thus pharmacists have a significant role in assessing medication management in patients, and in referring patients to physicians. These roles may include, but are not limited to:

  • Clinical medication management, including reviewing and monitoring of medication regimens.
  • Assessment of patients with undiagnosed or diagnosed conditions, and ascertaining clinical medication management needs.
  • Specialised monitoring of disease states, such as dosing drugs in kidney and liver failure
  • Compounding medicines.
  • Providing pharmaceutical information.
  • Providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states.
  • Supervising pharmacy technicians and other staff.
  • Oversight of dispensing medicines on prescription.
  • Provision of and counselling about non-prescription or over-the-counter drugs.
  • Education and counselling for patients and other health care providers on optimal use of medicines (e.g., proper use, avoidance of overmedication).
  • Referrals to other health professionals if necessary.
  • Pharmacokinetic evaluation.
  • Promoting public health by administering immunisations.
  • Constructing drug formularies.
  • Designing clinical trials for drug development.
  • Working with federal, state, or local regulatory agencies to develop safe drug policies.
  • Ensuring correctness of all medication labels including auxiliary labels.
  • Member of inter-professional care team for critical care patients.
  • Symptom assessment leading to medication provision and lifestyle advice for community-based health concerns (e.g. head colds, or smoking cessation).
  • Staged dosing supply (e.g. opioid substitution therapy).

Education and Credentialing

The role of pharmacy education, pharmacist licensing, and continuing education vary from country to country and between regions/localities within countries. In most countries, pharmacists must obtain a university degree at a pharmacy school or related institution, and/or satisfy other national/local credentialing requirements. In many contexts, students must first complete pre-professional (undergraduate) coursework, followed by about four years of professional academic studies to obtain a degree in pharmacy (such as Doctorate of Pharmacy). In the European Union (EU), pharmacists are required to hold a Masters of Pharmacy, which allows them to practice in any other EU country, pending professional examinations and language tests in the country in which they want to practice. Pharmacists are educated in pharmacology, pharmacognosy, chemistry, organic chemistry, biochemistry, pharmaceutical chemistry, microbiology, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, pathophysiology, physiology, anatomy, pharmacokinetics, pharmacodynamics, drug delivery, pharmaceutical care, nephrology, hepatology, and compounding of medications. Additional curriculum may cover diagnosis with emphasis on laboratory tests, disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).

Upon graduation, pharmacists are licensed, either nationally or regionally, to dispense medication of various types in the areas they have trained for.

Some may undergo further specialized training, such as in cardiology or oncology. Specialties include:[citation needed]

  • Academic pharmacist.
  • Clinical pharmacy specialist.
  • Community pharmacist.
  • Compounding pharmacist.
  • Consultant pharmacist.
  • Drug information pharmacist.
  • Home health pharmacist.
  • Hospital pharmacist.
  • Industrial pharmacist.
  • Informatics pharmacist.
  • Managed care pharmacist.
  • Military pharmacist.
  • Nuclear pharmacist.
  • Oncology pharmacist.
  • Regulatory-affairs pharmacist.
  • Veterinary pharmacist.
  • Pharmacist clinical pathologist.
  • Pharmacist clinical toxicologist.

Training and Practice by Country

Armenia

The Ministry of Education and Ministry of Health oversee pharmacy school accreditation in Armenia. Pharmacists are expected to have competency in the WHO Model List of Essential Medicines (EML), the use of Standard Treatment Guidelines, drug information, clinical pharmacy, and medicine supply management. There are currently no laws requiring pharmacists to be registered, but all pharmacies must have a license to conduct business. According to a World Health Organisation (WHO) report from 2010, there are 0.53 licensed pharmacists and 7.82 licensed pharmacies per 10,000 people in Armenia. Pharmacists are able to substitute for generic equivalents at point of dispensing.

Australia

The Australian Pharmacy Council is the independent accreditation agency for Australian pharmacists. The accreditation standards for Australian pharmacy degrees include compulsory clinical placements. with an emphasis on encouraging rural experiences to develop a rural workforce. It conducts examinations on behalf of the Pharmacy Board of Australia towards eligibility for registration. The Australian College of Pharmacy provides continuing education programmes for pharmacists. The number of full-time equivalent pharmacists working in Australia over the past decade has remained stable. Pharmacy practice is described by the practice standards and guidelines including those from the Pharmaceutical Society of Australia.

Wages for pharmacists in Australia appear to have stagnated, and even gone backwards. As of 2007, the award wages for a pharmacist is $812 a week. Pharmacist graduates are the lowest paid university graduates most years. Most pharmacists do earn above the award wage; the average male pharmacist earns $65,000, a female pharmacist averages $56,500. There are more graduates expected in the next few years making it even harder to get a job. Job security and increase in wages with regards to CPI could be unlikely. This is due to the large numbers of pharmacy graduates in recent years, and government desire to lower PBS costs. Contract and casual work is becoming more common. A contract pharmacist is self-employed and often called a locum; these pharmacists may be hired for one shift or for a longer period of time. There are accounts of underemployment and unemployment emerging recently.

Canada

The Canadian Pharmacists Association (CPhA) is the national professional organization for pharmacists in Canada. Specific requirements for practice vary across provinces, but generally include a bachelor’s (BSc Pharm) or Doctor of Pharmacy (PharmD) degree from one of 10 Canadian universities offering a pharmacy program, successful completion of a national board examination through the Pharmacy Examining Board of Canada (PEBC) (Quebec being the exception), practical experience through an apprenticeship/internship program, and fluency in French or English. International pharmacy graduates can begin their journey of becoming licensed to practice in Canada by enrolling with the National Association of Pharmacy Regulatory Authorities (NAPRA) Pharmacists’ Gateway Canada. The vast majority (~70%) of Canada’s licensed pharmacists work in community pharmacies, another 15% work in hospital, and the remainder work in other settings such as industry, government, or universities. Pharmacists’ scope of practice varies widely among the 13 provinces and territories and continues to evolve with time. As a result of pharmacists’ expanding scope and knowledge application, there has been a purposeful effort to transition the professional programmes in Canadian pharmacy schools to offer doctors of pharmacy over baccalaureate curriculums to ensure graduates have the most up to date level of training to match the increasing practice requirements.

Germany

In Germany, the education and training is divided into three sections, each ending with a state examination:

  • University: Basic studies (at least four semesters).
  • University: Main studies (at least four semesters).
  • Community Pharmacy / Hospital Pharmacy / Industry: Practical training (12 months; 6 months in a Community Pharmacy).

After the third state examination a person must become licensed as an RPh (“registered pharmacist”) for a licence to practice pharmacy. Today, many pharmacists work as employees in public pharmacies. They will be paid according to the labour agreement of Adexa and employer associations.

Japan

Historical

In ancient Japan, the men who fulfilled roles similar to pharmacists were respected. The place of pharmacists in society was settled in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists – and even pharmacist assistants – were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.

Contemporary

As of 1997, 46 universities of pharmacy in Japan graduated about 8000 students annually. Contemporary practice of clinical pharmacists in Japan (as evaluated in September 2000) focuses on dispensing of drugs, consultation with patients, supplying drug information, advising on prescription changes and amending prescriptions. These practices have been linked to decreases in the average number of drugs in prescriptions, drug costs and incidence of adverse drug events.

Nigeria

Training to become a registered pharmacist in Nigeria involves a five-year course after six years of secondary/high school or four years after eight years of secondary/high school (i.e. after 2 years of Advanced-level studies in accredited Universities). The degree awarded by most pharmacy schools is a Bachelor of Pharmacy Degree (B.Pharm.) However, in the near future, all schools will offer a 6-year first Degree course leading to the award of a Pharm.D (Doctor of Pharmacy Degree). The University of Benin has started the Pharm.D programme with other pharmacy schools planning to start soon. The Pharmacy Degree in Nigeria is unclassified i.e. awarded without first class, second class upper, etc., however graduates could be awarded Pass with Distinctions in specific fields such as Pharmaceutics, Pharmacology, medicinal chemistry etc. Pharmacy Graduates are required to undergo 1 year of Tutelage under the supervision of an already Registered Pharmacist(a preceptor) in a recognised and designated Institution before they can become Registered Pharmacists. The Profession is Regulated by a Government Statutory body called the Pharmacists Council of Nigeria. The West African Post Graduate College of Pharmacy runs post-registration courses on advanced-level practice in various fields of pharmacy. It is a college jointly funded by a number of Countries in the West Africa sub-region. There are thousands of Nigerian-trained pharmacists registered and practicing in countries such as the US, the UK, Canada etc., due to the relatively poor public sector salaries in Nigeria

Pakistan

In Pakistan, the Pharm.D. (Doctor of Pharmacy) degree is a graduate-level professional doctorate degree. Twenty-one universities are registered with the Pharmacy Council of Pakistan for imparting Pharmacy courses. In 2004 the Higher Education Commission of Pakistan and the Pharmacy Council of Pakistan revised the syllabus and changed the 4-year B.Pharmacy (Bachelor of Pharmacy) Program to a 5-year Pharm.D. (Doctor of Pharmacy) programme. All 21 universities have started the 5-year Pharm.D Programme. In 2011 the Pharmacy Council of Pakistan approved the awarding of a Doctor of Pharmacy degree, a five-year programme at the Department of Pharmacy, University of Peshawar.

Poland

Polish pharmacists have to complete a 5+1⁄2-year Master of Pharmacy Programme at medical university and obtain the right to practice as a pharmacist in Poland from District Pharmaceutical Council. The Programme includes 6 months of pharmacy training. The Polish name for the Master of Pharmacy Degree (M.Pharm.) is magister farmacji (mgr farm). Not only pharmacists, but also pharmaceutical technicians are allowed to dispense prescription medicines, except for narcotics, psychotropics and very potent medicines. Pharmacists approve prescriptions fulfilled by pharmaceutical technicians subsequently. Pharmaceutical technicians have to complete 2 years of post-secondary occupational school and 2 years of pharmacy training afterwards. Pharmacists are eligible to prescribe medicines in exceptional circumstances. All Polish pharmacies are obliged to produce compound medicines. Most pharmacists in Poland are pharmacy managers and are responsible for pharmacy marketing in addition to traditional activities. To become a pharmacy manager in Poland, a pharmacist is expected to have at least 5 years of professional experience. All pharmacists in Poland have to maintain an adequate knowledge level by participating in various university- and industry-based courses and arrangements or by undergoing postgraduate specialisation.

Sweden

In Sweden, the national board of health and welfare regulates the practice of all legislated health care professionals, and is also responsible for registration of pharmacists in the country. The education to become a licensed pharmacist is regulated by the European Union, and states that minimum educational requirements are five years of university studies in a pharmacy programme, of which six months must be a pharmacy internship. To be admitted to pharmacy studies, students must complete a minimum of three years of gymnasium, similar to high school (school for about 15–20-year-old students) programme in natural science after elementary school (6-16-year-olds). Only three universities in the whole of Sweden offer a pharmacy education, Uppsala University, where the Faculty of Pharmacy is located, the University of Gothenburg, and Umeå University. In Sweden, pharmacists are called Apotekare. At pharmacies in Sweden, pharmacists work together with another class of legislated health care professionals called Receptarier, in English so-called prescriptionists, who have completed studies equal to a Bachelor of Science in pharmacy, i.e., three years of university. Prescriptionists also have dispensing rights in Sweden, Norway, Finland and Iceland. The majority of the staff in a pharmacy are Apotekstekniker or “pharmacy technicians” with a three -semester education at a vocational college. Pharmacy technicians do not have dispensing rights in Sweden but are allowed to advise on and sell over-the-counter medicines.

Switzerland

In Switzerland, the federal office of public health regulates pharmacy practice. Four Swiss universities offer a major in pharmaceutical studies, the University of Basel, the University of Geneva, the University of Lausanne and the ETH Zurich. To major in pharmaceutical studies takes at least five years. Students spend their last year as interns in a pharmacy combined with courses at the university, with focus on the validation of prescriptions and the manufacturing of pharmaceutical formulations. Since all public health professions are regulated by the government it is also necessary to acquire a federal diploma in order to work in a pharmacy. It is not unusual for pharmaceutical studies majors to work in other fields such as the pharmaceutical industry or in hospitals. Pharmacists work alongside pharma assistants, an apprenticeship that takes three years to complete. Pharmacists can further specialise in various fields; this is organised by PharmaSuisse, the pharmacists’ association of Switzerland.

Tanzania

In Tanzania, pharmacy practice is regulated by the national Pharmacy Board, which is also responsible for registration of pharmacists in the country. By international standards, the density of pharmacists is very low, with a mean of 0.18 per 10,000 population. The majority of pharmacists are found in urban areas, with some underserved regions having only 2 pharmacists per region. According to 2007-2009 data, the largest group of pharmacists was employed in the public sector (44%). Those working in private retail pharmacies were 23%, and the rest were mostly working for private wholesalers, pharmaceutical manufacturers, in academia/teaching, or with faith-based or non-governmental facilities. The salaries of pharmacists varied significantly depending on the place of work. Those who worked in the academia were the highest paid followed by those who worked in the multilateral non-governmental organisations. The public sector including public retail pharmacies and faith based organisations paid much less. The Ministry of Health salary scale for medical doctors was considerably higher than that of pharmacists despite having a difference of only one year of training

Trinidad and Tobago

In Trinidad and Tobago, pharmacy practice is regulated by the Pharmacy Board of Trinidad and Tobago, which is responsible for the registration of pharmacists in the twin islands. The University of the West Indies in St. Augustine offers a 4-year Bachelor of Science in Pharmacy as the sole practicing degree of pharmacy. Graduates undertake a 6-month internship, known as pre-registration, under the supervision of a registered pharmacist, at a pharmacy of their choosing, whether community or institutional. After completion of the required pre-registration period, the graduate can then apply to the Pharmacy Board to become a registered pharmacist. After working 1 calendar year as a registered pharmacist, the individual can become a registered, responsible pharmacist. Being a registered, responsible pharmacist allows the individual to license a pharmacy and be a pharmacist-in-charge.

United Kingdom

In British English (and to some extent Australian English), the professional title known as “pharmacist” is also known as “dispensing chemist” or, more commonly, “chemist”. A dispensing chemist usually operates from a pharmacy or chemist’s shop, and is allowed to fulfil medical prescriptions and sell over-the-counter drugs and other health-related goods. Pharmacists can undertake additional training to allow them to prescribe medicines for specific conditions.

Practices

In the United Kingdom, most pharmacists working in the National Health Service practice in hospital pharmacy or community pharmacy. The Royal Commission on the National Health Service in 1979 reported that there were nearly 3,000 pharmacists employed in the hospital and community health service in the UK at that time. They were enthusiastic about the idea that pharmacists might develop their role of giving advice to the public.

The new professional role for pharmacist as prescriber has been recognized in the UK since May 2006, called the “Pharmacist Independent Prescriber”. Once qualified, a pharmacist independent prescriber can prescribe any licensed medicine for any medical condition within their competence. This includes controlled drugs except schedule 1 and prescribing certain drugs for the treatment of addiction (cocaine, diamorphine and dipipanone).

Education and Registration

Pharmacists, pharmacy technicians and pharmacy premises in the United Kingdom are regulated by the General Pharmaceutical Council (GPhC) for England, Scotland and Wales and by the Pharmaceutical Society of Northern Ireland for Northern Ireland. The role of regulatory and professional body on the mainland was previously carried out by the Royal Pharmaceutical Society of Great Britain, which remained as a professional body after handing over the regulatory role to the GPhC in 2010.

The following criteria must be met for qualification as a pharmacist in the United Kingdom (the Northern Irish body and the GPhC operate separately but have broadly similar registration requirements):

  • Successful completion of a 4-year Master of Pharmacy degree at a GPhC accredited university. Pharmacists holding degrees in Pharmacy from overseas institutions are able to fulfil this stage by undertaking the Overseas Pharmacist Assessment Programme (OSPAP), which is a one-year postgraduate diploma. On completion of the OSPAP, the candidate would proceed with the other stages of the registration process in the same manner as a UK student.
  • Completion of a 52-week preregistration training period. This is a period of paid or unpaid employment, in an approved hospital or community pharmacy under the supervision of a pharmacist tutor. During this time the student must collect evidence of having met certain competency standards set by the GPhC.
  • A pass mark in the GPhC registration assessment (formally an exam). This includes a closed-book paper and an open-book/mental calculations paper (using the British National Formulary and the GPhC’s “Standards of Conduct, Ethics and Performance” document as reference sources). The student must achieve an overall mark of 70%, which must include at least 70% in the calculations section of the open-book paper. From June 2016, the assessment will involve two papers, as before but the use of a calculator will now be allowed. However, reference sources will no longer be allowed in the assessment. Instead, relevant extracts of the British National Formulary will be provided within the assessment paper.
  • Satisfactorily meeting the GPhC’s Fitness to Practice Standards.

United States

In 2014 the United States Bureau of Labour Statistics revealed that there were 297,100 American pharmacist jobs. By 2024 that number is projected to grow by 3%. The majority (65%) of those pharmacists work in retail settings, mostly as salaried employees but some as self-employed owners. About 22% work in hospitals, and the rest mainly in mail-order or Internet pharmacies, pharmaceutical wholesalers, practices of physicians, and the Federal Government.

All graduating pharmacists must now obtain the Doctor of Pharmacy (Pharm.D.) degree before they are eligible to sit for the North American Pharmacist Licensure Examination (NAPLEX) to enter into pharmacy practice. In addition, pharmacists are subject to state-level jurisprudence exams in order to practice from state to state.

Pharmacy School Accreditation

The Accreditation Council for Pharmacy Education (ACPE) has operated since 1932 as the accrediting body for schools of pharmacy in the United States. The mission of ACPE is “To assure and advance excellence in education for the profession of pharmacy”. ACPE is recognised for the accreditation of professional degree programs by the United States Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). Since 1975, ACPE has also been the accrediting body for continuing pharmacy education. The ACPE board of directors are appointed by the American Association of Colleges of Pharmacy (AACP), the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP) (three appointments each), and the American Council on Education (one appointment). To obtain licensure in the United States, applicants for the North American Pharmacist Licensure Examination (NAPLEX) must graduate from an ACPE accredited school of pharmacy. ACPE publishes standards that schools of pharmacy must comply with to gain accreditation.

A Pharmacy school pursuing accreditation must first apply and be granted Pre-candidate status. These schools have met all the requirements for accreditation, but have not yet enrolled any students. This status indicates that the school of pharmacy has developed its programme in accordance with the ACPE standards and guidelines. Once a school has enrolled students, but has not yet had a graduating class, they may be granted Candidate status. The expectations of a Candidate programme are that they continue to mature in accordance with stated plans. The graduates of a Candidate program are the same as those of fully accredited programmes. Full accreditation is granted to a programme once they have demonstrated they comply with the standards set forth by ACPE.

The customary review cycle for established accredited programmes is six years, whereas for programmes achieving their initial accreditation this cycle is two years. These are comprehensive on-site evaluations of the programmes. Additional evaluations may be conducted at the discretion of ACPE in the interim between comprehensive evaluations.

Education

Acceptance into a doctorate of pharmacy program depends upon completing specific prerequisites or obtaining a transferable bachelor’s degree. Pharmacy school is four years of graduate school (accelerated Pharmacy Schools go January to January and are only 3 years), which include at least one year of practical experience. Graduates receive a Doctorate of Pharmacy (PharmD) upon graduation. Most schools require students to take a Pharmacy College Admissions Test PCAT and complete 90 credit hours of university coursework in the sciences, mathematics, composition, and humanities before entry into the PharmD programme. Due to the large admittance requirements and highly competitive nature of the field, most pharmacy students complete a bachelor’s degree before entry to pharmacy school.

Possible prerequisites:

  • Anatomy.
  • Physiology.
  • Biochemistry.
  • Biology.
  • Immunology.
  • Chemical engineering.
  • Economics.
  • Pathophysiology.
  • Physics.
  • Humanities.
  • Microbiology.
  • Molecular biology.
  • Organic chemistry.
  • Physical chemistry.
  • Statistics.
  • Calculus.

Besides taking classes, additional requirements before graduating may include a certain number of hours for community service, e.g., working in hospitals, clinics, and retail.

Estimated timeline: 4 years undergraduate + 4 years doctorate + 1–2 years residency + 1–3 years fellowship = 8-13 years.

A doctorate of pharmacy (except non-traditional, i.e. transferring a license from another country) is the only degree accepted by the National Associate of Boards of Pharmacy NABP to be eligible to “sit” for the North American Pharmacist Licensure Examination (NAPLEX). Previously the United States had a 5-year bachelor’s degree in pharmacy. For BS Pharmacy graduates currently licensed in US, there are 10 Universities offering non-traditional doctorate degree programmes via part-time, weekend or on-line programmes. These are programmes fully accredited by Accreditation Council for Pharmacy Education (ACPE) but only available to current BS Pharmacy graduates with a license to practice pharmacy. Some institutions still offer 6 year accelerated PharmD programmes.

The current Pharm.D. degree curriculum is considerably different from that of the prior BS in pharmacy. It now includes extensive didactic clinical preparation, a full year of hands-on practice experience in a wider array of healthcare settings, and a greater emphasis on clinical pharmacy practice pertaining to pharmacotherapy optimisation. Legal requirements in the US to becoming a pharmacist include: graduating from an accredited PharmD programme, conducting a specified number of internship hours under a licensed pharmacist (i.e. 1800 hours in some states), passing the NAPLEX, and passing a Multi-state Pharmacy Jurisprudence Exam MPJE. Arkansas, California, and Virginia have their own exams instead of the MPJE; in those states, pharmacists must pass the Arkansas Jurisprudence Exam, the California Jurisprudence Exam, or the Virginia Pharmacy Law Exam.

Residency is an option for post-graduates that is typically 1-2 years in length. A residency gives licensed pharmacists decades of clinical experience in an extremely condensed timeframe of only a few short years. In order for new graduates to remain competitive, employers generally favour residency trained applicants for clinical positions. The profession is moving toward resident-trained pharmacists who wish to provide direct patient care clinical services. In 1990, the American Association of Colleges of Pharmacy (AACP) required the new professional degree. Graduates from a PharmD program may also elect to do a fellowship that is geared toward research. Fellowships can varying in length but last 1-3 years depending on the programme and usually require 1 year of residency at minimum.

Specialisation and Credentialing

American pharmacists can become certified in recognised specialty practice areas by passing an examination administered by one of several credentialing boards.

  • The Board of Pharmacy Specialties certifies pharmacists in thirteen specialties:
    • Ambulatory care pharmacy.
    • Cardiology pharmacy.
    • Compounded sterile preparations pharmacy.
    • Critical care pharmacy.
    • Geriatric pharmacy.
    • Infectious diseases pharmacy.
    • Nuclear pharmacy.
    • Nutrition support pharmacy.
    • Oncology pharmacy.
    • Paediatric pharmacy.
    • Pharmacotherapy.
    • Psychiatric pharmacy.
    • Solid organ transplant pharmacy.
  • The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Expanding Scope of Practice

Vaccinations

As of 2016, all 50 states and the District of Columbia permit pharmacists to provide vaccination services, but specific protocols vary between states.

California

All licensed California pharmacists can perform the following:

  • Order and interpret drug therapy related tests.
  • Furnish smoking cessation aids (such as nicotine replacement therapy).
  • Furnish oral self-administered contraception (birth control pills).
  • Furnish travel medications recommended by the CDC.
  • Administer vaccinations pursuant to the latest CDC standards for anyone ages 3+.

The passage of Assembly Bill 1535 (2014) authorises pharmacists in California to furnish naloxone without a physician’s prescription.

With the passage of Senate Bill 159 in 2019, pharmacists in California are authorized to furnish pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to patients without a physician’s prescription. In order to be eligible to dispense, a pharmacists must first “complete a training programme approved by the” California State Board of Pharmacy.

California pharmacists can apply for Advanced Practice Pharmacist (APh) licenses from the California State Board of Pharmacy. Senate Bill 493, written by Senator Ed Hernandez, established a section on the Advanced Practice Pharmacist and outlines the definition, scope of practice, qualifications, and regulations of those holding this license. An APh can:

  • Perform patient assessments.
  • Refer patients to other healthcare providers.
  • Participate in the evaluation and management of diseases and health conditions in collaboration with other health care providers.
  • Initiate, adjust, or discontinue therapy pursuant to the regulations outlined in the bill.

To qualify for an advanced practice pharmacist license in California, the applicant must be in good standing with the State Board of pharmacy, have an active pharmacist license, and fulfil two of three requirements, including certification in their area clinical practice. The license must be renewed every 2 years, and the APh applying for renewal must complete 10 hours of continuing education in at least one area relevant to their clinical practice.

Vietnam

School students must take a national exam to enter a university of pharmacy or the pharmacy department of a university of medicine and pharmacy. About 5-7% of students can pass the exam. There are 3 aspects to the exam. These are on math, chemistry, and physics or biology. After being trained at the university for 5 years, successful students receive a bachelor’s degree in pharmacy. Or they are university pharmacists (university pharmacist to discriminate between college pharmacist or vocational pharmacist in some countries of the world these trainee pharmacists are called pharmacist assistants). An alternative method of obtaining a bachelor’s degree is as follows. School pupils study at a college of pharmacy or a vocational school of pharmacy. After attending the school or college they go to work in a pharmacy, and with two years of practice they could take an exam to enter university of pharmacy or the pharmacy department of a university of medicine and pharmacy. This exam is easier than the national one. Passing the exam they continue studying to gain 3-year bachelor’s degrees or 4-year bachelor’s degrees. This degree is considered equivalent to a 5-year bachelor’s degree.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Pharmacist >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 01 September [2022]

Published on by Andrew MarshallLeave a comment

Events

People (Births)

  • 1848 – Auguste Forel, Swiss myrmecologist, neuroanatomist, and psychiatrist (d. 1931).
  • 1902 – Kazimierz Dąbrowski, Polish psychiatrist and psychologist (d. 1980).
  • 1950 – Phil McGraw, American psychologist, author, and talk show host.

Auguste Forel

Auguste-Henri Forel (01 September 1848 to 27 July 1931) was a Swiss myrmecologist, neuroanatomist, psychiatrist and eugenicist, notable for his investigations into the structure of the human brain and that of ants. For example, he is considered a co-founder of the neuron theory. Forel is also known for his early contributions to sexology and psychology. From 1978 until 2000 Forel’s image appeared on the 1000 Swiss franc banknote.

Kazimierz Dabrowski

Kazimierz Dąbrowski (01 September 1902 to 26 November 1980 in Warsaw) was a Polish psychologist, psychiatrist, and physician. He is best known for his theory of “positive disintegration” as a mechanism in personality development. He was also a poet who used the pen name “Paul Cienin, Paweł Cienin”.

Phil McGraw

Phillip Calvin McGraw (born 01 September 1950), better known as Dr. Phil, is an American television personality and author best known for hosting the talk show Dr. Phil. He holds a doctorate in clinical psychology, though he ceased renewing his license to practice psychology in 2006.

McGraw rose to fame with appearances on The Oprah Winfrey Show in the late 1990s. Oprah Winfrey then helped McGraw launch his own programme, Dr. Phil, in September 2002. The show is formatted as an advice show.

What is the International Classification of Functioning, Disability and Health?

Published on by Andrew MarshallLeave a comment

Introduction

The International Classification of Functioning, Disability and Health (ICF) is a classification of the health components of functioning and disability.

The ICF received approval from all 191 World Health Organisation (WHO) member states on May 22, 2001, during the 54th World Health Assembly. Its approval followed nine years of international revision efforts coordinated by WHO. WHO’s initial classification for the effects of diseases, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), was created in 1980.

The ICF classification complements WHO’s International Classification of Diseases-10th Revision (ICD), which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC).

Overview

The ICF is structured around the following broad components:

  • Body functions and structure.
  • Activities (related to tasks and actions by an individual) and participation (involvement in a life situation).
  • Additional information on severity and environmental factors.

Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by this combination of factors and dimensions is of “the person in his or her world”. The classification treats these dimensions as interactive and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a measurement instrument. It is applicable to all people, whatever their health condition. The language of the ICF is neutral as to aetiology, placing the emphasis on function rather than condition or disease. It also is carefully designed to be relevant across cultures as well as age groups and genders, making it highly appropriate for heterogeneous populations.

Benefits

There are benefits of using the ICF for both the patient and the health professional. A major advantage for the patient is the integration of the physical, mental, and social aspects of his or her health condition. All aspects of a person’s life (development, participation and environment) are incorporated into the ICF instead of solely focusing on his or her diagnosis. A diagnosis reveals little about one’s functional abilities. Diagnoses are important for defining the cause and prognosis, but identifying the limitations of function is often the information used to plan and implement interventions. Once a rehabilitation team is aware of the daily activities a client is required to participate in, the problem solving sequence set up by the ICF can be utilised. An occupational therapist, for example, would observe a patient performing his or her daily activities and note the patient’s functional abilities. This information would then be used to determine the extent to which the individual’s abilities can be improved through therapy and to what extent the environment can be changed to facilitate the individual’s performance. Intervention at one level (current abilities) has the potential to prevent or modify events at a succeeding level (participation). For example, teaching a deaf child manual signs will foster effective interaction and increase one’s participation with his or her family.

Rehabilitation therapists will be empowered with the ICF not only in their daily work with their patients, but also when working with other medical disciplines; hospitals and other health care administrations; health authorities and policy makers. All items are operationally defined with clear descriptions that can be applied to real life evaluations with clarity and ease. The language used in the ICF helps facilitate better communication between these groups of people.

Clinical Relevance

Knowing how a disease affects one’s functioning enables better planning of services, treatment, and rehabilitation for persons with long-term disabilities or chronic conditions. The current ICF creates a more integrative understanding of health forming a comprehensive profile of an individual instead of focusing on one’s disease, illness, or disability. The implications of using the ICF include an emphasis on the strengths of individuals, assisting individuals in participating more extensively in society by the use of interventions aimed at enhancing their abilities, and taking into consideration the environmental and personal factors that might hamper their participation.

Qualifiers

The ICF qualifiers “may be best translated clinically as the levels of functioning seen in a standardised or clinic setting and in everyday environments”. Qualifiers support standardisation and the understanding of functioning in a multidisciplinary assessment. They enable all team members to quantify the extent of problems, even in areas of functioning where one is not a specialist. Without qualifiers codes have no inherent meaning. An impairment, limitation or restriction is qualified from:

  • 0 (No problem; 0-4%);
  • 1 (Mild problem: 5-24%);
  • 2 (Moderate problem: 25-49%);
  • 3 (Severe problem: 50-95%); to
  • 4 (Complete problem: 96-100%).

Environmental factors are quantified with a negative and positive scale denoting the extent to which the environment acts as a barrier or facilitator.

For insurance purposes, the qualifiers can describe the effectiveness of treatment. One can interpret the decreasing of a qualifier score to be an increase in the functional ability of a patient.

Core Sets

An ICF Core Set can serve as a reference framework and a practical tool to classify and describe patient functioning in a more time efficient way. ICF Core Sets can be used along the continuum of care and over the course of a health condition. The ICF classification includes more than 1,400 categories limiting its use in clinical practice. It is time-consuming for a clinician to utilize the main volume of the ICF with his or her patients. Only a fraction of the categories is needed. As a general rule, 20% of the codes will explain 80% of the variance observed in practice. ICF Core Sets contain as few as possible, but as many ICF categories as necessary, to describe a patient’s level of functioning. It is hypothesized that using an ICF Core Set will increase the inter-rater reliability when coding clinical cases as only the relevant categories for a particular patient will be utilised. Since all of the relevant categories are listed in an ICF Core Set, its use in multidisciplinary assessments protects health professionals from missing important aspects of functioning.

Paediatric Use

As clinicians and researchers used the ICF, they became more aware of its limitations. The ICF lacks the ability to classify the functional characteristics of a developing child. Different ICF codes are needed across the first years of a child’s life to capture the growth and development of a disability even when the child’s diagnosis does not change. The coding system can provide essential information about the severity of a health condition in terms of its impact on functioning. This can serve a significant role for providers caring for children with spectrum disorders such as autism or cerebral palsy. Children with these conditions may have the same diagnoses, but their abilities and levels of functioning widely vary across and within individuals over time. The first draft of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) was completed in year 2003 and published in 2007. The ICF-CY was developed to be structurally consistent with the ICF for adults. A major difference between the ICF-CY and ICF is that the generic qualifiers from the adult ICF now include developmental aspects for children and youth in the ICF-CY. Descriptions of codes in the ICF-CY were revised and expanded and new content was added to previously unused codes. Codes were added to document characteristics as adaptability, responsivity, predictability, persistence, and approachability. “Sensing” and “exploration of objects” codes were expanded as well as the “importance of learning”. Since a child’s main occupation is playing, it is also important to include more codes in this area. Different levels of play have separate codes in the ICF-CY (solitary, onlooker, parallel). This contrasts with the adult ICF as only one code existed in regards to leisure or recreation.

Changes in ICF-CY codes over time reflect developmental effects attributable to the child’s interaction with the environment. Environmental factors influence functioning and development and can be documented as barriers or facilitators using the ICF-CY. The key environments of children and adolescents include their homes, day care centres, schools and recreation settings of playground, parks, and ball fields. Children will transition between different environments many times as they grow. For example, a child will transition into elementary or high school or from one service setting or agency to another. Attention to these transitions of children with disabilities has been identified as an important role for health care providers. A transition requires preparation and planning to find an appropriate and accommodating setting for a child’s needs. With a coding system such as the ICF-CY, the transition will be smoother and interventions can start where the previous health provider left off.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/International_Classification_of_Functioning,_Disability_and_Health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 31 August [2022]

Published on by Andrew MarshallLeave a comment

People (Deaths)

  • 1920 – Wilhelm Wundt, German physician, psychologist, and philosopher (b. 1832).

Wilhelm Wundt

Wilhelm Maximilian Wundt (16 August 1832 to 31 August 1920) was a German physiologist, philosopher, and professor, known today as one of the fathers of modern psychology.

Wundt, who distinguished psychology as a science from philosophy and biology, was the first person ever to call himself a psychologist. He is widely regarded as the “father of experimental psychology”. In 1879, at the University of Leipzig, Wundt founded the first formal laboratory for psychological research. This marked psychology as an independent field of study. By creating this laboratory he was able to establish psychology as a separate science from other disciplines. He also formed the first academic journal for psychological research, Philosophische Studien (from 1881 to 1902), set up to publish the institute’s research.

A survey published in American Psychologist in 1991 ranked Wundt’s reputation as first for “all-time eminence” based on ratings provided by 29 American historians of psychology. William James and Sigmund Freud were ranked a distant second and third.

On This Day … 30 August [2022]

Published on by Andrew MarshallLeave a comment

People (Births)

Viktor Skumin

Victor Andreevich Skumin (Russian: Ви́ктор Андре́евич Ску́мин, born 30 August 1948) is a Russian and Soviet scientist, psychiatrist, philosopher and writer.

After graduating from the Kharkiv National Medical University in 1973, he became a psychotherapist in Kiev Institute of Cardiovascular Surgery. In 1978, he described a new disease, the Skumin syndrome. He introduced a method of psychotherapy and self-improvement based on optimistic autosuggestion for psychological rehabilitation of cardiosurgical patients (1979).

From 1980 to 1990, he was professor of psychotherapy at the Kharkiv Medical Academy of Post-graduate Education. The main result of his scientific activity was the discovery of the “syndrome of the neurotic phantom of somatic disease” and a “concept of the mental constituent of a chronic somatic disease”.

From 1990 to 1994, Skumin held positions as chaired professor of psychology and pedagogy, and of physical education and Health life at the Kharkiv State Academy of Culture. In 1994, he was elected to the post of the President-founder of the World Organisation of Culture of Health (Moscow). In 1995, Skumin became the first editor-in-chief of the journal To Health via Culture. He is known for inventing a popular term “Culture of Health” (1968).

Besides psychiatry and psychology, Skumin writes on healthy lifestyle, yoga, and philosophy. He co-authored series of illustrated books and articles on Agni Yoga, Roerichism, Russian cosmism, transhumanism, and New Age. He wrote books of fiction and lyrics for several songs.

What is Random Acts of Kindness Day?

Published on by Andrew Marshall1 Comment

Introduction

Random Acts of Kindness Day is a day to celebrate and encourage random acts of kindness. “It’s just a day to celebrate kindness and the whole pay it forward mentality”, said Tracy Van Kalsbeek, executive director of the Stratford Perth Community Foundation, in 2016, where the day is celebrated on 04 November. It is celebrated on 01 September in New Zealand and on 17 February in the US.

Background

The Random Acts of Kindness Foundation (RAK) was founded in 1995 in the US. It is a non-profit headquartered in Denver, Colorado. The founder of the group is Will Glennon. Glennon is currently the Chairman of World Kindness, USA.

Random Acts of Kindness (RAK) day began in 2004 in New Zealand. Promoters of the day suggest paying for another person’s meal in drive-through’s, letting someone go ahead in line, buying extra at the grocery store and donating it to a food pantry, buying flowers for someone, helping someone change a flat tire, posting anonymous sticky notes with validating or uplifting messages around for people to find, complimenting a colleague on their work, sending an encouraging text to someone, taking muffins to work, letting a car into the traffic ahead of you, washing someone else’s car, taking a gift to new neighbours, or paying the bus fare for another passenger.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Random_Acts_of_Kindness_Day >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.