Sunday, June 15, 2008
Future of Pharmacy Informatics
Pharmacy informatics will likely continue to grow in its scope and importance for some time. When, in 1999, the Institute of Medicine (IOM) published the report To Err is Human, the pharmacy community was at once called out for allowing unsafe medication management practices to preponderate and called upon to dramatically improve the safety of medication use in the United States. The Institute for Safe Medication Practices (ISMP, [4]), a leading patient safety organization, is well positioned to advance medication safety efforts. ISMP continues to focus on pharmacy informatics and patient information management as key areas of both promise and concern, promise that the application of new information technologies will improve patient safety and concern that the diffusion, adoption and best-practice use of medication management technologies is happening too slowly. Time will tell if pharmacy informatics, as an area of applied information sciences and as a sub-discipline of health informatics, will indeed positively transform medication use so that patients benefit from improved safety and efficacy with respect to the medications they require.
History and Trends in Pharmacy Informatics
The application of computerized information technology to pharmacy practice, including highly specialized software and hardware, is not new. In fact, the term pharmacy informatics is much newer than the domain it specifies. Pharmacists, computer scientists and other specialists brought the first generation of pharmacy-specific computer technology to retail and hospital pharmacies in the 1970s through the 1990s.
A present, major trend in pharmacy informatics is to move from pharmacy-specific systems to larger, fully-integrated information systems that include pharmacy functions as a component of larger clinical information systems, retail prescription management systems and drug supply chain management systems. Another major trend is the accelerating technology diffusion of computerized provider order entry (CPOE) for medication orders in hospitals and electronic prescribing (e-Prescribing) of prescriptions sent via networks from physician offices to retail pharmacies.
Pharmacy informatics professional activity has been growing demonstrably over the past several years. For example, the American Society of Health-System Pharmacists (ASHP) created a new organizational section in 2006, the Section on Pharmacy Informatics and Technology (SOPIT), that is expressly, "dedicated to improving health outcomes through the use and integration of data, information, knowledge, technology, and automation in the medication-use process." Also, the American Medical Informatics Association (AMIA, [1]) has created a pharmacoinformatics working group to, "promote interaction among AMIA members who are interested in the intersection of technology and medication management."
As a profession, pharmacy practice encompasses many different practice venues including retail, community pharmacy, hospital pharmacy practice, long-term care, mail-order and others. This diversity of pharmacy practices is reflected by a like diversity of stakeholder groups interested in pharmacy informatics and the automation of the drug supply chain. One group, the American Society of Automation in Pharmacy (ASAP, [2]) is notable for its retail-oriented mission, "to assist its members in advancing the application of computer technology in the pharmacist's role as caregiver and in the efficient operation and management of a pharmacy."
In the academic sphere, as of July 1, 2007, pharmacy informatics is a required component of professional pharmacy degree programs. The latest standards from the Accreditation Council for Pharmacy Education ([3]) require colleges of pharmacy to address pharmacy informatics within their curricula. ACPE expects Doctor of Pharmacy graduates to be familiar with informatics terminology, justifications for systemic processing of data and the consequences, both advantageous and undesirable, of using technological information and communication innovations in healthcare.
Pharmacy informatics practitioners put their energies toward creating standardized, high-reliability workflows developed through an integral approach that aligns the physical-chemical characteristics of drug products, pharmacy staff needs and requirements, work process expectations and outputs, and available information, machine and robotics technologies. The practice of pharmacy informatics also may involve drug information analysis, project management, customer and vendor relations, communications, system administration, technical troubleshooting, computer programming, contracting and business leadership.
A present, major trend in pharmacy informatics is to move from pharmacy-specific systems to larger, fully-integrated information systems that include pharmacy functions as a component of larger clinical information systems, retail prescription management systems and drug supply chain management systems. Another major trend is the accelerating technology diffusion of computerized provider order entry (CPOE) for medication orders in hospitals and electronic prescribing (e-Prescribing) of prescriptions sent via networks from physician offices to retail pharmacies.
Pharmacy informatics professional activity has been growing demonstrably over the past several years. For example, the American Society of Health-System Pharmacists (ASHP) created a new organizational section in 2006, the Section on Pharmacy Informatics and Technology (SOPIT), that is expressly, "dedicated to improving health outcomes through the use and integration of data, information, knowledge, technology, and automation in the medication-use process." Also, the American Medical Informatics Association (AMIA, [1]) has created a pharmacoinformatics working group to, "promote interaction among AMIA members who are interested in the intersection of technology and medication management."
As a profession, pharmacy practice encompasses many different practice venues including retail, community pharmacy, hospital pharmacy practice, long-term care, mail-order and others. This diversity of pharmacy practices is reflected by a like diversity of stakeholder groups interested in pharmacy informatics and the automation of the drug supply chain. One group, the American Society of Automation in Pharmacy (ASAP, [2]) is notable for its retail-oriented mission, "to assist its members in advancing the application of computer technology in the pharmacist's role as caregiver and in the efficient operation and management of a pharmacy."
In the academic sphere, as of July 1, 2007, pharmacy informatics is a required component of professional pharmacy degree programs. The latest standards from the Accreditation Council for Pharmacy Education ([3]) require colleges of pharmacy to address pharmacy informatics within their curricula. ACPE expects Doctor of Pharmacy graduates to be familiar with informatics terminology, justifications for systemic processing of data and the consequences, both advantageous and undesirable, of using technological information and communication innovations in healthcare.
Pharmacy informatics practitioners put their energies toward creating standardized, high-reliability workflows developed through an integral approach that aligns the physical-chemical characteristics of drug products, pharmacy staff needs and requirements, work process expectations and outputs, and available information, machine and robotics technologies. The practice of pharmacy informatics also may involve drug information analysis, project management, customer and vendor relations, communications, system administration, technical troubleshooting, computer programming, contracting and business leadership.
Pharmacy Informatics
Pharmacy informatics, also referred to as pharmacoinformatics, is the application of computers to the storage, retrieval and analysis of drug and prescription information. Pharmacy informaticists work with pharmacy information management systems that help the pharmacist make excellent decisions about patient drug therapies with respect to, medical insurance records, drug interactions, as well as prescription and patient information.
Pharmacy informatics is the study of interactions between people, their work processes and engineered systems within health care with a focus on pharmaceutical care and improved patient safety.
Pharmacy informatics can be thought of as a sub-domain of the larger professional discipline of health informatics. Some definitions of pharmacy informatics reflect this relationship to health informatics. For example, the Health Information Management Systems Society (HIMSS) defines pharmacy informatics as, "the scientific field that focuses on medication-related data and knowledge within the continuum of healthcare systems - including its acquisition, storage, analysis, use and dissemination - in the delivery of optimal medication-related patient care and health outcomes"
Pharmacy informatics is the study of interactions between people, their work processes and engineered systems within health care with a focus on pharmaceutical care and improved patient safety.
Pharmacy informatics can be thought of as a sub-domain of the larger professional discipline of health informatics. Some definitions of pharmacy informatics reflect this relationship to health informatics. For example, the Health Information Management Systems Society (HIMSS) defines pharmacy informatics as, "the scientific field that focuses on medication-related data and knowledge within the continuum of healthcare systems - including its acquisition, storage, analysis, use and dissemination - in the delivery of optimal medication-related patient care and health outcomes"
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 will be paid for their patient care skills.[9]
This 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. They are also being paid for by the government for medicine use reviews. In the United States, pharmaceutical care or Clinical pharmacy has had an evolving influence on the practice of pharmacy.[10] Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now required before entering practice and many pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy.
This 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. They are also being paid for by the government for medicine use reviews. In the United States, pharmaceutical care or Clinical pharmacy has had an evolving influence on the practice of pharmacy.[10] Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now required before entering practice and many pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care 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.[citation needed] 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.[8]
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. This system reflects much similarity to the checks and balances system of the U.S. and many other governments.
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).
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. This system reflects much similarity to the checks and balances system of the U.S. and many other governments.
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).
Pharmacy informatics
Pharmacy informatics is the combination of pharmacy practice science and applied information science. Pharmacy informaticists work in many practice areas of pharmacy, however, they may also work in information technology departments or for healthcare information technology vendor companies. As a practice area and specialist domain, pharmacy informatics is growing quickly to meet the needs of major national and international patient information projects and health system interoperability goals. Pharmacists are well trained to participate in medication management system development, deployment and optimization.
Military pharmacy
Military pharmacy is an entirely different working environment due to the fact that technicians perform most duties that in a civilian sector would be illegal. State laws of Technician patient counseling and medication checking by a pharmacist do not apply.
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.
Veterinary pharmacy
Veterinary pharmacies, sometimes called animal pharmacies may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals as well as the regulations on veterinary medicine are often very different from those related to people, veterinary pharmacy is often kept separate from regular pharmacies.
Internet pharmacy
Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some patients by their physicians if they are homebound.
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.
Of particular concern with internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.
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.[citation needed] In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed Internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada.
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.
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.
Of particular concern with internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.
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.[citation needed] In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed Internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada.
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.
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.[7] Traditionally consultant pharmacists were usually independent business owners, though in the United States many now work for several large pharmacy management companies (primarily Omnicare, Kindred Healthcare and PharMerica). This trend may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ consultant pharmacists and/or provide consulting services.
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.
Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can obtain from community pharmacies.
Clinical pharmacy
Clinical pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention.[6] Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside Hospitals and clinics. Clinical pharmacists often collaborate with Physicians and other healthcare professionals. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They work collaboratively with physicians, nurses and other healthcare personnel in various medical and surgical areas.
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. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding.
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. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding.
Community pharmacy
A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; 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 cosmetics, shampoo, bandages, office supplies, confectionary, and snack foods.
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 cosmetics, shampoo, bandages, office supplies, confectionary, and snack foods.
Japanese pharmacy
In ancient Japan, the men who fulfilled roles similar to those of modern pharamacists were highly respected. The place of pharmacists in society was expressly defined 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
Chinese Pharmacy
The beginnings of pharmacy in China are ancient. It stemmed from Chinese alchemy. Shennong is said to have tasted hundreds of herbs to test their medical value. The most well-known work attributed to Shennong is The Divine Farmer's Herb-Root Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes 365 medicines derived from minerals, plants, and animals. Shennong is credited with identifying hundreds of medical (and poisonous) herbs by personally testing their properties, which was crucial to the development of Traditional Chinese medicine.
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.
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), the Pakistan Pharmacists Society(PPS) 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.
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), the Pakistan Pharmacists Society(PPS) 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.
Saturday, June 14, 2008
sidhhamdicne for heart disese
there are so many variets of heart diseases are there.. according to the variety and severity we have to take mode of therapy....
some conditions need only surgery... tof or valve replacement like kind of diseases.... but in case of cardiac failure or single or double vessel diseses we can try siddha medicine vaai.. arrithamyas.. irregular heart beats.. some commn medines are arunja marutham pattai. avaram poo thamaraipoo and orthalthamarai semparuthi powders vey good for heart.. and also some combination avail.. then garlic pepper.. vanga parpam.. thamira parpam silver parpam available.
some conditions need only surgery... tof or valve replacement like kind of diseases.... but in case of cardiac failure or single or double vessel diseses we can try siddha medicine vaai.. arrithamyas.. irregular heart beats.. some commn medines are arunja marutham pattai. avaram poo thamaraipoo and orthalthamarai semparuthi powders vey good for heart.. and also some combination avail.. then garlic pepper.. vanga parpam.. thamira parpam silver parpam available.
Healing heart diseases
endocarditis,heart valve diseases,various symptoms of pericardium,various symptoms of the heart itself,palpitation,angina pectoris,and all known and unknown heart related problems....
heal the following points 3 minutes each....
heart
liver
stomach
intestines
pancreas
kidneys
spinal cord
important:
healing the heart from the back instead of chest side is always better and safer,particulaly if devices like pacemaker are installed,never heal from the chest side.
2nd degree healers can use the sympols to purify and heal the above points.i personally prefer the 1st degree hands on healing.
try this technique.it works fast.
heal the following points 3 minutes each....
heart
liver
stomach
intestines
pancreas
kidneys
spinal cord
important:
healing the heart from the back instead of chest side is always better and safer,particulaly if devices like pacemaker are installed,never heal from the chest side.
2nd degree healers can use the sympols to purify and heal the above points.i personally prefer the 1st degree hands on healing.
try this technique.it works fast.
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