Adapting the US Institute for Safe Medication Practices' Medication Safety Self Assessment tool for community pharmacies in Finland.

OBJECTIVES: To adapt a US Institute for Safe Medication Practices' Medication Safety Self Assessment (MSSA) tool to, and test its usefulness in, Finnish community pharmacies. METHODS: A three-round Delphi survey was used to adapt self-assessment characteristics of the US MSSA tool to Finnish requirements, and to obtain a consensus on the feasibility and significance of these characteristics in assessing the safety of medication practices in community pharmacies. The Delphi modified self-assessment tool was piloted in 18 community pharmacies in order to refine the tool, using a questionnaire containing structured and open-ended questions. KEY FINDINGS: A total of 211 self-assessment characteristics were accepted to the self-assessment tool for pilot use by expert panellists in the Delphi rounds. Most pilot users considered the tool as useful in: identifying medication safety targets for development; medication safety assessment; and identifying the strengths of medication safety. The substance of the self-assessment tool was considered as comprehensive and essential for medication safety. Most criticism was regarding: the multiplicity of self-assessment characteristics; interpretation of some characteristics; and that all the characteristics were not yet available. After the modification, according to the pilot users' comments, the final Finnish tool consisted of 230 medication safety characteristics. CONCLUSIONS: The study indicated the feasibility of adapting a US medication safety self-assessment tool for use in community pharmacy practice in Finland. More efforts should be made to familiarise Finnish community pharmacists with the self-assessment tool and its benefits, and get them to use the tool as part of their long-term quality improvement.

Effects of various absorption enhancers on transport of clodronate through Caco-2 cells.

The major disadvantage concerning clinical use of bishosphonate drugs, like clodronate, is their poor and variable absorption after oral administration. The objective of this study was to assess the effects of four different absorption enhancers-palmitoyl carnitine chloride (PCC), N-trimethyl chitosan chloride (TMC), sodium caprate (C10), and ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA)-on the transport of clodronate using Caco-2 cell culture model. The transport experiments were performed in a normal (1.3mM) and in a minimum-calcium concentration (apically calcium-free medium and basolaterally 100 microM calcium concentration). In the normal calcium concentration, a strong enhancement in clodronate permeation was observed with the enhancers: EGTA (2.5mM), TMC (1.5% w/v), and PCC (0.2mM) increased the transport of 1mM clodronate 190-, 20-, and 10-fold, respectively, and the transport of 10mM clodronate 130-, 70-, and 35-fold. In the minimum-calcium concentration, the effects of the absorption enhancers on the transport of clodronate were not so potent: TMC, PCC, and EGTA caused 2- to 20-fold enhancement in clodronate permeation whereas C10 (10mM) was without any effect. According to the results, the permeation of clodronate through Caco-2 cells could be significantly promoted by the absorption enhancers, which cause widening of the tight junctions and, thus, increase the permeability of the paracellular route.