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The Role of Academic Pharmacy in Tobacco Cessation and Control
McBane, Sarah E.
Corelli, Robin L.
Albano, Christian B.
Conry, John M.
Della Paolera, Mark A.
Kennedy, Amy K.
Jenkins, Antoine T.
Hudmon, Karen Suchanek
American Journal of Pharmaceutical Education
Despite decades of public health initiatives, tobacco use remains the leading known preventable cause of death in the United States. Clinicians have a proven, positive effect on patients' ability to quit, and pharmacists are strategically positioned to assist patients with quitting. The American Association of Colleges of Pharmacy recognizes health promotion and disease prevention as a key educational outcome; as such, tobacco cessation education should be a required component of pharmacy curricula to ensure that all pharmacy graduates possess the requisite evidence-based knowledge and skills to intervene with patients who use tobacco. Faculty members teaching tobacco cessation-related content must be knowledgeable and proficient in providing comprehensive cessation counseling, and all preceptors and practicing pharmacists providing direct patient care should screen for tobacco use and provide at least minimal counseling as a routine component of care. Pharmacy organizations should establish policies and resolutions addressing the profession's role in tobacco cessation and control, and the profession should work together to eliminate tobacco sales in all practice settings where pharmacy services are rendered.
academic pharmacy; policy; public health; smoking; tobacco
Related Articles
Consumer perceptions of the sale of tobacco products in pharmacies and grocery stores among U.S. adults
Patwardhan, Pallavi
McMillen, Robert
Winickoff, Jonathan P
BMC Research Notes
Pharmacy-based tobacco sales are a rapidly increasing segment of the U.S. retail tobacco market. Growing evidence links easy access to tobacco retail outlets such as pharmacies to increased tobacco use. This mixed-mode survey was the first to employ a nationally representative sample of consumers (n = 3057) to explore their opinions on sale of tobacco products in pharmacies and grocery stores.
The majority reported that sale of tobacco products should be either 'allowed if products hidden from view' (29.9%, 25.6%) or 'not allowed at all' (24.0%, 31.3%) in grocery stores and pharmacies, respectively. Significantly fewer smokers, compared to non-smokers, reported agreement on point-of-sale restrictions on sales of tobacco products (grocery stores: 27.1% vs. 59.6%, p < .01; pharmacy: 32.8% vs. 62.0%, p < .01). Opinions also varied significantly by demographic characteristics and factors such as presence of a child in the household and urban/rural location of residence.
Overall, a majority of consumers surveyed either supported banning sales of tobacco in grocery stores and pharmacies or allowing sales only if the products are hidden from direct view. Both policy changes would represent a departure from the status quo. Consistent with the views of practicing pharmacists and professional pharmacy organizations, consumers are also largely supportive of more restrictive policies.
Pharmacies; Consumer perceptions; Tobacco sales, Survey research
Related Articles
The Ethics of Dietary Supplements and Natural Health Products in Pharmacy Practice: A Systematic Documentary Analysis
Boon, Heather
Hirschkorn, Kristine
Griener, Glenn
Cali, Michelle
The International journal of pharmacy practice
Aims and Objectives
Many natural health products (NHPs) and dietary supplements (DS) are purchased in pharmacies and it has been argued that pharmacists are in the best position to provide patients with evidence-based information about them. This study was designed to identify how the pharmacist's role with respect to NHPs/DS is portrayed in the literature.
A systematic search was conducted in a variety of health databases to identify all literature that pertained to both pharmacy and NHPs/DS. Of the 786 articles identified, 665 were broad-coded and 259 were subjected to in-depth qualitative content analysis for emergent themes.
Key Findings
Overwhelmingly, support for the sale of NHPs/DS in pharmacies is strong. Additionally, a role for pharmacists in NHP/DS counselling is underscored. But another recurrent theme is that pharmacists are ill-equipped to counsel patients about these products that are available on their shelves. This situation has led some to question the ethics of pharmacists selling NHPs/DS and to highlight the existence of an ethical conflict stemming from the profit-motive associated with NHP/DS sales.
This analysis raises concerns about the ethics of NHPs/DS being sold in pharmacies, and about pharmacists being expected to counsel about products of which they have little knowledge.
Related Articles
A Randomized Trial Evaluating Two Approaches for Promoting Pharmacy-Based Referrals to the Tobacco Quitline: Methods and Baseline Findings
Zillich, Alan J.
Corelli, Robin L.
Zbikowski, Susan M.
Magnusson, L. Brooke
Fenlon, Christine M.
Prokhorov, Alexander V.
de Moor, Carl
Hudmon, Karen S.
Research in social & administrative pharmacy : RSAP
Historically, community pharmacies have not integrated tobacco cessation activities into routine practice, instead unbundling them as unique services. This approach might have limited success and viability.
The objective of this report is to describe the methods and baseline findings for a two-state, randomized trial evaluating two intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline.
Participating community pharmacies in Connecticut (n=32) and Washington (n=32) were randomized to receive either (a) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline, or (b) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians).
Pharmacists (n=124) and pharmacy technicians (n=127), representing 64 participating pharmacies with equal numbers of retail chain and independently-owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were "not at all" familiar with the tobacco quitline. During the baseline (pre-intervention) monitoring period, the quitline registered 120 patients (18 in CT and 102 in WA) who reported that they heard about the quitline from a pharmacy.
Novel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.
Tobacco; tobacco cessation; smoking; smoking cessation; pharmacist; community pharmacy; quitline; brief intervention
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Pharmacy Students' Perceptions of Tobacco Sales in Pharmacies and Suggested Strategies for Promoting Tobacco-Free Experiential Sites
Hudmon, Karen Suchanek
Hussar, Daniel A.
Fenlon, Christine M.
Corelli, Robin L.
American Journal of Pharmaceutical Education
The objectives of this report were to estimate the extent to which pharmacy student perceptions are aligned with the 2003 resolution of the American Association of Colleges of Pharmacy (AACP) addressing the use of experiential sites that sell cigarettes and other tobacco products.
Pharmacy students participating in a national tobacco cessation training program completed posttraining survey instruments and indicated their opinion about tobacco sales in pharmacies. Responses were examined with respect to students' sex and tobacco use status.
Of 3,064 students, 3.5% were in favor of tobacco sales in pharmacies. Opinions varied by students' sex (p < 0.001) and tobacco use status (p < 0.001); in logistic regression analyses, males (OR = 2.62; 95% CI, 1.77, 3.89) and current tobacco users (OR = 2.31; 95% CI, 1.41, 3.76) were most likely to be in favor of tobacco sales.
Few pharmacy students are in favor of tobacco sales in pharmacies. Given the overall lack of support, and acting in accordance with the 2003 AACP resolution, pharmacy schools are encouraged to use only experiential sites that do not sell tobacco products. Suggested strategies for moving toward this goal are presented.
tobacco; pharmacies; pharmacy education; experiential sites; community pharmacy
Related Articles
Ask, advise and refer: hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies
Patwardhan, Pallavi D.
Chewning, Betty A.
The International journal of pharmacy practice
To conduct a preliminary qualitative study identifying key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).
Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.
Key findings
All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist–patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.
This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.
community pharmacist; health promotion; pharmaceutical care; public health; smoking cessation; tobacco cessation
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Tobacco sales in pharmacies: time to quit
Hudmon, K Suchanek
Fenlon, C M
Corelli, R L
Prokhorov, A V
Schroeder, S A
Tobacco Control
To assess the pharmacy profession's perceptions of tobacco sales in US pharmacies and explore whether a policy prohibiting sales of tobacco in pharmacies would alter adult consumer shopping behaviour.
Subjects and design
In California, surveys were administered to 1168 licensed pharmacists and 1518 pharmacy students, and telephone interviews were conducted with 988 adult consumers.
Most (58.1%) licensed pharmacists were strongly against sales of tobacco in pharmacies, 23.6% were against it, 16.7% were neutral, 1.2% were in favour of it, and 0.4% were strongly in favour of it. Pharmacists who were current tobacco users were more likely to be in favour of tobacco sales in pharmacies than were pharmacists who were current non‐users (p < 0.005). Similar statistics were observed for pharmacy students. Most consumers (72.3%) disagreed with the statement, "I am in favour of tobacco products being sold in drugstores"; 82.6% stated that if the drugstore where they most commonly shopped were to stop selling tobacco products, they would shop there just as often, 14.2% would shop there more often, and 3.2% would shop there less often.
Little professional or public support exists for tobacco sales in pharmacies.
health professional; pharmacist; pharmacy; tobacco sales
Related Articles
Understanding Community Norms Surrounding Tobacco Sales
McDaniel, Patricia A.
Malone, Ruth E.
PLoS ONE
In the US, denormalizing tobacco use is key to tobacco control; less attention has been paid to denormalizing tobacco sales. However, some localities have placed limits on the number and type of retailers who may sell tobacco, and some retailers have abandoned tobacco sales voluntarily. Understanding community norms surrounding tobacco sales may help accelerate tobacco denormalization.
We conducted 15 focus groups with customers of California, New York, and Ohio retailers who had voluntarily discontinued tobacco sales to examine normative assumptions about where cigarettes should or should not be sold, voluntary decisions to discontinue tobacco sales, and government limits on such sales.
Groups in all three states generally agreed that grocery stores that sold healthy products should not sell tobacco; California groups saw pharmacies similarly, while this was a minority opinion in the other two states. Convenience stores were regarded as a natural place to sell tobacco. In each state, it was regarded as normal and commendable for some stores to want to stop selling tobacco, although few participants could imagine convenience stores doing so. Views on government's role in setting limits on tobacco sales varied, with California and New York participants generally expressing support for restrictions, and Ohio participants expressing opposition. However, even those who expressed opposition did not approve of tobacco sales in all possible venues. Banning tobacco sales entirely was not yet normative.
Limiting the ubiquitous availability of tobacco sales is key to ending the tobacco epidemic. Some limits on tobacco sales appear to be normative from the perspective of community members; it may be possible to shift norms further by problematizing the ubiquitous presence of cigarettes and drawing connections to other products already subject to restrictions.
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A demonstration study comparing "role-emergent" versus "role-established" pharmacy clinical placement experiences in long-term care facilities
Kassam, Rosemin
Kwong, Mona
Collins, John B
BMC Medical Education
Increasing challenges to recruit hospital sites with full-time on-site pharmacy preceptors for institutional-based Advanced Pharmacy Practice Experiences (APPE) has made it necessary to consider alternate experiential models. Sites with on-site discipline specific preceptors to supervise students have typically been referred to in the literature as "role-established" sites. In British Columbia, long-term care (LTC) facilities offered a unique opportunity to address placement capacity issues. However, since the majority of these facilities are serviced by off-site community pharmacists, this study was undertaken to explore the viability of supervising pharmacy students remotely – a model referred to in the literature as "role-emergent" placements. This paper's objectives are to discuss pharmacy preceptors' and LTC non-pharmacist staff experiences with this model.
The study consisted of three phases: (1) the development phase which included delivery of a training program to create a pool of potential LTC preceptors, (2) an evaluation phase to test the viability of the LTC role-emergent model with seven pharmacists (two role-established and five role-emergent) together with their LTC staff, and (3) expansion of LTC role-emergent sites to build capacity. Both qualitative and quantitative methods were used to obtain feedback from pharmacists and staff and t-tests and Mann–Whitney U tests were used to examine equivalency of survey outcomes from staff representing both models.
The 76 pharmacists who completed the training program survey rated the modules as "largely" meeting their learning needs. All five role-emergent pharmacists and 29 LTC participating staff reported positive experiences with the pharmacy preceptor-student-staff collaboration. Preceptors reported that having students work side-by-side with facility staff promoted inter-professional collaboration. The staff viewed students' presence as a mutually beneficial experience, suggesting that the students' presence had enabled them to deliver better care to the residents. As a direct result of the study findings, the annual role-emergent placement capacity was increased to over 45 by the end of the study.
This study demonstrated that role-emergent LTC facilities were not only viable for quality institutional APPEs but also provided more available sites, greater student placement capacity, and more trained pharmacy preceptors than could be achieved in role-established facilities.
Residential care; Long-term care; Pharmacy; Clerkship; Clinical education; Clinical practice; Non-traditional clinical placements; Role-emergent; Role-emerging; Institutional; Experiential
Related Articles
Enhanced medication management services in the community
Riley, Karen
Canadian Pharmacists Journal : CPJ
Pharmacists are now receiving reimbursement by the Ontario government to do medication reviews for patients on 3 or more medications. However, they are often too busy in the community setting to thoroughly review medications with patients. Having a designated pharmacist to provide medication reviews could increase the number of reviews performed.
Step 1 involved developing a business plan to determine the number of medication reviews that needed to be done to pay a pharmacist a full-time salary. Step 2 involved establishing the core elements of medication therapy management that included medication review, a medication-related action plan, documentation and follow-up. In step 3, eligible patients were called and invited to attend an appointment to review their medications with the pharmacist. Upon completion of the medication reviews, a random group of patients were requested to complete a satisfaction survey after the medication review.
Three hundred thirty-six patients received billable medication reviews from April 4 to July 27, 2012. Twenty-seven additional visits were performed as follow-up visits. Eighty pharmaceutical opinions met the eligibility criteria for billing. Fifteen patients received counselling for smoking cessation. Medication reviews were completed for 19 patients from 8 other pharmacies. Extra revenue was generated through the sales of replacements of expired products. An average of 2.08 drug-related problems per patients was identified. One hundred percent of the patients were very satisfied with the service.
A full-time pharmacist position providing enhanced medication management services generated enough income to pay for a full-time pharmacist's salary. The benefits to the patients were an increase in identification and resolution of drug-related problems, as well as an opportunity to receive disease state education and experience an improvement in disease states. Patients were extremely satisfied with the medication review process and the service provided to them. Can Pharm J 2013;146:162-168.
Related Articles
Why California retailers stop selling tobacco products, and what their customers and employees think about it when they do: case studies
McDaniel, Patricia A
Malone, Ruth E
BMC Public Health
In California, some 40, 000 retailers sell tobacco products. Tobacco's ubiquitousness in retail settings normalizes use and cues smoking urges among former smokers and those attempting cessation. Thus, limiting the number of retailers is regarded as key to ending the tobacco epidemic. In the past decade, independent pharmacies and local grocery chains in California and elsewhere have voluntarily abandoned tobacco sales. No previous studies have examined the reasons for this emerging phenomenon. We sought to learn what motivated retailers to discontinue tobacco sales and what employees and customers thought about their decision.
We conducted case studies of seven California retailers (three grocery stores, four pharmacies) that had voluntarily ceased tobacco sales within the past 7 years. We interviewed owners, managers, and employees, conducted consumer focus groups, unobtrusively observed businesses and the surrounding environment, and examined any media coverage of each retailer's decision. We analyzed data using qualitative content analysis.
For independent pharmacies, the only reason given for the decision to end tobacco sales was that tobacco caused disease and death. Grocers listed health among several factors, including regulatory pressures and wanting to be seen as "making a difference." Media coverage of stores' new policies was limited, and only three retailers alerted customers. Management reported few or no customer complaints and supportive or indifferent employees. Pharmacy employees were pleased to no longer be selling a deadly product. Grocery store management saw the decision to end tobacco sales as enhancing the stores' image and consistent with their inventory of healthy foods. Focus group participants (smokers and nonsmokers) were largely unaware that retailers had stopped selling tobacco; however, almost all supported the decision, viewing it as promoting public health. Many said knowing this made them more likely to shop at the store. Most thought that advertising the store's policy was essential to generate good public relations and tobacco norm changes.
Voluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco in California. Our findings suggest that such voluntary initiatives by retailers are welcomed by consumers and should be publicized, enhancing public health efforts.
Related Articles
Community pharmacists' involvement in smoking cessation: familiarity and implementation of the National smoking cessation guideline in Finland
Kurko, Terhi
Linden, Kari
Pietilä, Kirsi
Sandström, Patrick
Airaksinen, Marja
BMC Public Health
Guidelines on smoking cessation (SC) emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the National SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services.
A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n = 2291). Response rate was 54% (n = 1190). Factors related to the SC Guideline familiarity were assessed by bivariate and multivariate analysis.
Almost half (47%) of the respondents (n = 1190) were familiar with the SC Guideline and familiarity enhanced Guideline implementation. The familiarity was associated with the respondents' perceptions of their personal SC skills and knowledge (OR 3.8); of customers' value of counseling on nicotine replacement therapy (NRT) (OR 3.3); and regular use of a pocket card supporting SC counseling (OR 3.0). Pharmacists' workplaces' characteristics, such as size and geographical location were not associated with familiarity. In addition to recommending NRT, the pharmacists familiar with the Guideline used more frequently other Guideline-based SC methods, such as recommended non-pharmacological SC aids, compared to unfamiliar respondents.
SC Guideline familiarity and implementation is crucial for community pharmacists' involvement in SC actions in addition to selling NRT products. Pharmacists can constitute a potential public health resource in SC easily accessible throughout the country.
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Audit of Renal Drug Dosing: Comparison of 2 Methods and Evaluation of Pharmacists' Knowledge, Attitudes, and Behaviour
Caouette, Kimberley L
Raymond, Colette B
Meyer, Lindsay D
Honcharik, Nicholas
The Canadian Journal of Hospital Pharmacy
The renal dosing directive of the Winnipeg Regional Health Authority Pharmacy Program outlines an auditable pharmacy service whereby pharmacists are required to perform documentation (i.e., document their rationale) only if they do not adjust the dose of any medications listed in the directive.
To compare the suitability of manual orders (hard copy) and reports from the pharmacy information system (computer-generated) for determining pharmacists' compliance with the renal dosing directive; to measure compliance with the renal dosing directive; and to determine pharmacists' opinions about audit programs.
A retrospective audit was used to compare 400 manual orders with the corresponding orders in reports from the pharmacy information system, to determine compliance with the renal dosing directive. An e-mail survey was performed to gather pharmacists' opinions about audit programs.
Of the 400 orders evaluated, 86 (22%) required consideration of a dose adjustment. Of these, 78 (91%) showed that dosing followed the guidelines for renal dysfunction in standard pharmacy references. Six (7%) of 86 manual orders and 8 (9%) of 86 pharmacy information system orders were not compliant with the renal dosing directive (i.e., no dosage adjustment and no documentation of rationale). Of 77 pharmacists approached, 34 (44%) completed the survey. Most respondents (31/34 [91%]) agreed that auditing is beneficial to patients, and the same number (31/34 [91%]) agreed that auditing provides important information to the pharmacy program. Only 17 (50%) were aware of medications listed in the renal dosing directive, and 14 (41%) felt that they had received sufficient education about pharmacy directives. Most respondents (29/34 [85%]) agreed that audits would reveal areas for improvement, and all (34/34 [100%]) would comply with any changes required to facilitate performance of an audit if such changes did not increase workload.
Similar results were obtained with the 2 auditing methods used for this study (manual orders and reports from the pharmacy information system). However, pharmacists' current use of electronic documentation limits the feasibility of pharmacy information system audits. Survey respondents claimed that they were not familiar with the renal dosing directive, but they did agree that auditing clinical services is beneficial.
renal dose adjustments; pharmacists' compliance; pharmacists' behaviours and attitudes; ajustements posologiques chez les insuffisants rénaux; conformité de la part des pharmaciens; comportements et attitudes des pharmaciens
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New York City pharmacists' attitudes toward sale of needles/syringes to injection drug users before implementation of law expanding syringe access
Coffin, Phillip O.
Linas, Benjamin P.
Factor, Stephanie H.
Vlahov, David
Journal of Urban Health : Bulletin of the New York Academy of Medicine
In May 2000, New York State passed legislation permitting the sale, purchase, and possession of up to 10 needles and syringes (hereafter "syringes") without a prescription, intended to reduce blood-borne pathogen transmission among injection drug users (IDUs). To obtain baseline data on pharmacists' attitudes and practices related to human immunodeficiency virus (HIV) prevention and IDUs, a telephone survey was administered to 130 pharmacists systematically selected in New York City. Less than half of pharmacists were aware of the new law; 49.6% were willing to or supported providing nonprescription sales of syringes to IDUs. Pharmacists in support tended to be less likely to consider customer appearance "very important." Managing and supervising pharmacists were more likely than staff pharmacists to support syringe sales to IDUs. Managing and supervising pharmacists who stocked packs of 10 syringes and personal sharps disposal containers, pharmacists who supported syringe exchange in the pharmacy, and pharmacists who were willing to sell syringes to diabetics without a prescription were more likely to support syringe sales to IDUs. Syringe disposal was a prominent concern among all pharmacists. Those not in support of syringe sales to IDUs tended to be more likely to believe the practice would increase drug use. These data suggest the need for initiatives to address concerns about syringe disposal and tailored continuing education classes for pharmacists on HIV and viral hepatitis prevention among IDUs.
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Enhancing Collaborative Pharmaceutical Care for Patients with Chronic Kidney Disease: Survey of Community Pharmacists
Zhu, Lisa
Fox, Andrea
Chan, Yu Chun
The Canadian Journal of Hospital Pharmacy
The Kidney Care Clinic at Sunnybrook Health Sciences Centre provides multidisciplinary care for patients with stage 4 or 5 chronic kidney disease. These patients are at high risk of drug therapy problems. Clinic pharmacists review medications and provide recommendations at each visit, but potential gaps in care exist between clinic visits. Community pharmacists are ideally situated to identify and resolve drug therapy problems between visits.
To determine community pharmacists' confidence in managing care for patients with chronic kidney disease; to identify opportunities for improving collaboration between clinic and community pharmacists; and to determine the key clinical information that community pharmacists would use when caring for these patients.
An anonymous survey was sent by mail and electronically to community pharmacies that were providing prescription medications for clinic patients. A total of 318 surveys were sent to 96 pharmacies. Data analysis was based on descriptive statistics, including frequencies, ranges, and measures of central tendency.
Fifty-one completed surveys were returned (response rate 16%). Thirty-five (69%) of the responding pharmacists were not aware or were unsure that a patient from the Kidney Care Clinic was a client of their pharmacy. Forty-six (90%) were confident in providing counselling about medications used to manage chronic kidney disease, and 32 (63%) indicated confidence in recommending drug dosing changes based on kidney function. Forty-five (88%) of the pharmacists indicated a willingness to play a greater role in reviewing medications for patients with chronic kidney disease, and all agreed that they would benefit from education about the complications of this disease and their management. Clinical information ranked most useful included an updated medication list with indications and details regarding recent medication changes.
Community pharmacists indicated willingness to have greater involvement in the care of patients with chronic kidney disease. The survey results revealed a need to increase awareness of clinic patients among community providers. Participants were receptive to continuing education, and initial efforts should focus on dosing adjustments of renal drugs and the complications of chronic kidney disease. Tools for transferring clinical information must be developed.
seamless care; pharmaceutical care; chronic kidney disease; collaborative; clinic; community pharmacist; soins continus; soins pharmaceutiques; insuffisance rénale chronique; collaboration; clinique; pharmacien communautaire
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Tobacco users' perceptions of a brief tobacco cessation intervention in community pharmacies
Patwardhan, Pallavi D.
Chewning, Betty A.
Journal of the American Pharmacists Association : JAPhA
To explore factors affecting tobacco users' perceived appropriateness of a brief and proactive tobacco cessation counseling program, ask, advise, refer (AAR), at community pharmacies.
Inductive thematic analysis.
Southern Wisconsin during fall of 2008.
24 tobacco users who had recently received brief and proactive tobacco cessation counseling at a community pharmacy.
Semistructured telephone interviews conducted by primary author.
Main outcome measures
Perceptions of a brief and proactive tobacco cessation counseling program conducted at community pharmacies.
In conducting the thematic analysis, eight distinct themes were identified. Display of information and resources at pharmacies for use by tobacco users as needed was identified as the most predominant theme and was found to be most helpful by many respondents. Other themes identified in decreasing order of prevalence were: tobacco users' perceptions of the role of pharmacists in health care, tobacco users' belief that smoking could interact with a current medication or health condition, tobacco users' sensitivity toward their tobacco use behavior or being told what to do, nonconfrontational and friendly approach of pharmacists, tobacco users' readiness to quit at the time of AAR counseling, tobacco user initiation of tobacco use discussion, and tobacco users' belief that tobacco use is bad.
Overall, this qualitative investigation suggests that several factors might influence tobacco users' perceived appropriateness of AAR counseling at community pharmacies. AAR might be well received by tobacco users and pharmacy patrons as long as it is done in a professional and respectful manner.
Tobacco cessation; counseling (patient); public health; community pharmacists; perceptions
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Availability of Tobacco and Alcohol Products in Los Angeles Community Pharmacies
Corelli, Robin L.
Aschebrook-Kilfoy, Briseis
Kim, Gilwan
Ambrose, Peter J.
Hudmon, Karen Suchanek
Journal of Community Health
The availability of tobacco and alcohol products in community pharmacies contradicts the pharmacists' Code of Ethics and presents challenges for a profession that is overwhelmingly not in favor of the sale of these products in its practice settings. The primary aim of this study was to estimate the proportion of pharmacies that sell tobacco products and/or alcoholic beverages and to characterize promotion of these products. The proportion of pharmacies that sell non-prescription nicotine replacement therapy (NRT) products as aids to smoking cessation also was estimated. Among 250 randomly-selected community pharmacies in Los Angeles, 32.8% sold cigarettes, and 26.0% sold alcohol products. Cigarettes were more likely to be available in traditional chain pharmacies and grocery stores than in independently-owned pharmacies (100% versus 10.8%; P < 0.001), and traditional chain drug stores and grocery stores were more likely to sell alcoholic beverages than were independently-owned pharmacies (87.5% vs. 5.4%; P < 0.001). Thirty-four (41.5%) of the 82 pharmacies that sold cigarettes and 47 (72.3%) of the 65 pharmacies that sold alcohol also displayed promotional materials for these products. NRT products were merchandised by 58% of pharmacies. Results of this study suggest that when given a choice, pharmacists choose not to sell tobacco or alcohol products.
Tobacco sales; Alcohol sales; Tobacco control; Pharmacies
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Developing Preceptors through Virtual Communities and Networks: Experiences from a Pilot Project
Ackman, Margaret L
Romanick, Marcel
The Canadian Journal of Hospital Pharmacy
Supporting preceptors is critical to the expansion of experiential learning opportunities for the pharmacy profession. Informal learning opportunities within communities of practitioners are important for hospital preceptors. However, such communities may be limited by geographic separation of preceptors from peers, faculty members, and supports within the pharmacy services department.
To use computer-mediated conferencing to create a sense of community among preceptors, specifically by using this medium to provide initial development of and continuing support for preceptors, and to examine preceptors' satisfaction with this approach.
Thirty-nine preceptors who had completed a day-long face-to-face preceptor development workshop and who were supervising students in 1 of 2 specific rotation blocks were invited to participate in the study. The pharmacists used computer-mediated conferencing to meet for virtual networking about specific topics. They met once before the student rotation to receive instructions about the technology and to discuss student orientation and scheduling, and 3 times during the student rotation for open discussion of specific topics. Evaluation and feedback were solicited by means of an electronic survey and virtual (i.e., computer-based) feedback sessions with an independent facilitator.
The response rate was 66% (26/39) for the electronic survey, but only 15% (6/39) for the virtual feedback sessions. All of the respondents were experienced preceptors, but for 92% (22/24), this was their first experience with computer-mediated conferencing. Overall, the sessions had a positive reception, and participants found it useful to share information and experiences with other preceptors. The main challenges were related to the technology, perceived lack of support for their participation in the sessions, and inconvenience related to the timing of sessions.
Computer-mediated conferencing allowed preceptors to learn from and to support each other despite geographic distance. The participants felt that these sessions encouraged them to serve as preceptors regularly. Such encouragement could contribute to the retention of preceptors, which is important to the expansion of experiential learning.
preceptorship; computer-mediated conferencing; students; préceptorat; téléconférence assistée par ordinateur; étudiants
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Patients' perception, views and satisfaction with pharmacists' role as health care provider in community pharmacy setting at Riyadh, Saudi Arabia
Al-Arifi, Mohamed N.
Saudi Pharmaceutical Journal : SPJ
This study will provide guiding information about the population perception, views and satisfaction with pharmacist's performance as health care provider in the community pharmacy setting in Riyadh, Saudi Arabia.
The study was conducted in Riyadh, Saudi Arabia, from July through December 2010. A total of 125 community pharmacies in Riyadh city were randomly selected according to their geographical distribution (north, south, east, and west). They represent about 10–15% of all community pharmacies in the city. The questionnaire composed of 8 items about patients' views and satisfaction with the pharmacists' role in the current community pharmacy practice. The questionnaire was coded, checked for accuracy and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, Illinois).
The response rate was almost 85% where 2000 patients were approached and 1699 of them responded to our questionnaire. The majority of respondents is young adults and adults (82.8%), male (67.5%) and married (66.9%). Seventy one percent of respondents assured that community pharmacist is available in the working while only 37.3% of respondents perceived the pharmacist as a mere vendor. About 38% assured sou moto counseling by the pharmacist, 35% reported pharmacist plays an active role in their compliances to treatments, 43% acknowledged the role of pharmacist in solving medication related problems, 34% considered the pharmacist as a health awareness provider and 44.6% felt that pharmacist is indispensable and an effective part of the health care system.
The image and professional performance of community pharmacist are improving in Saudi Arabia. The Saudi patients show better satisfaction, perception and appreciation of the pharmacists' role in the health care team. However, extra efforts should be paid to improve the clinical skills of the community pharmacists. Community pharmacists need to be able to reach out to patient, assess their hesitations and promptly offer solution which was appreciated by the patients as the survey indicates. They should play a pro-active role in becoming an effective and indispensable part of health care. Furthermore, they should be able to advice, guide, direct and persuade the patient to comply correct usage of drugs. Finally, community pharmacists should equip themselves with appropriate knowledge and competencies in order to tender efficient and outstanding pharmaceutical health care.
Community; Pharmacist; Satisfaction; Care; Drug; Perception
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Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project
Oqua, Dorothy
Agu, Kenneth Anene
Isah, Mohammed Alfa
Onoh, Obialunamma U
Iyaji, Paul G
Wutoh, Anthony K
King, Rosalyn C
The use of medicines is an essential component of many public health programs (PHPs). Medicines are important not only for their capacity to treat and prevent diseases. The public confidence in healthcare system is inevitably linked to their confidence in the availability of safe and effective medicines and the measures for ensuring their rational use. However, pharmacy services component receives little or no attention in most public health programs in developing countries. This article describes the strategies, lessons learnt, and some accomplishments of Howard University Pharmacists and Continuing Education (HU-PACE) Centre towards improving hospital pharmacy practice through PHP in Nigeria.
In a cross-sectional survey, 60 hospital pharmacies were randomly selected from 184 GHAIN-supported health facilities. The assessment was conducted at baseline and repeated after at least 12 months post-intervention using a study-specific instrument. Interventions included engagement of stakeholders; provision of standards for infrastructural upgrade; development of curricula and modules for training of pharmacy personnel; provision of job aids and tools amongst others. A follow-up hands-on skill enhancement based on identified gaps was conducted. Chi-square was used for inferential statistics. All reported p-values were 2-tailed at 95% confidence interval.
The mean duration of service provision at post-intervention assessment was 24.39 (95% CI, 21.70–27.08) months. About 16.7% of pharmacies reported been trained in HIV care at pre-intervention compared to 83.3% at post-intervention. The proportion of pharmacies with audio-visual privacy for patient counseling increased significantly from 30.9% at pre-intervention to 81.4% at post-intervention. Filled prescriptions were cross-checked by pharmacist (61.9%) and pharmacy technician (23.8%) before dispensing at pre-intervention compared to pharmacist (93.1%) and pharmacy technician (6.9%) at post intervention. 40.0% of pharmacies reported tracking consumption of drugs at pre-intervention compared to 98.3% at post-intervention; while 81.7% of pharmacies reported performing periodic stock reconciliation at pre-intervention compared to 100.0% at post-intervention. 36.5% of pharmacies were observed providing individual counseling on medication use to patients at pre-intervention compared to 73.2% at post-intervention; and 11.7% of pharmacies had evidence of monitoring and reporting of suspected adverse drug reaction at pre-intervention compared to 73.3% at post-intervention. The institution of access to patients' clinical information by pharmacists in all pharmacies at post-intervention was a paradigm shift.
Through public health program, HU-PACE created an enabling environment and improved capacity of pharmacy personnel for quality HIV/AIDS and TB services. This has contributed in diverse ways to better monitoring of patients on pharmacotherapy by pharmacists through access of pharmacists to patients' clinical information.
Pharmaceutical care; HIV/AIDS; Public health programs; Patients; Nigeria
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Pharmaceutical Consultation in UAE Community Pharmacies
Hamoudi, N. M.
Shirwaikar, A. A.
Ali, H. S.
Al Ayoubi, E. I.
Indian Journal of Pharmaceutical Sciences
In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE). Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist's opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full instruction while 31% agreed about full investigation. In conclusion, reorganization of the pharmacist's activities may improve pharmaceutical consultations. Pharmacists must be exposed to recent trends in drug therapy, dosage forms, dosage, adverse effects and interaction. This will go a long way in providing rational use of drugs to the patients and improve their quality of life.
Attitudes and behaviors; community pharmacists; patient counseling; patient information leaflets; personal consultation
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Community Pharmacists role in obesity treatment in Kuwait: a cross-sectional study
Awad, Abdelmoneim
Waheedi, Mohammad
BMC Public Health
Obesity is a growing health concern in Kuwait. Obesity has been identified as a key risk factor for many chronic diseases including hypertension, dyslipidemia and type 2 diabetes mellitus. It has been shown that community pharmacists' involvement is associated with successful weight management in developed countries. This study was conducted to investigate the role of community pharmacists in obesity counseling, and to identify the barriers to counseling in Kuwait.
A descriptive cross-sectional study involved 220 community pharmacies that were selected via stratified and systematic random sampling. A pretested self-administered questionnaire collected information on frequency and comfort level with obesity counseling, and the perceived effectiveness of four aspects of obesity management (diet and exercise, prescribed antiobesity medications, diet foods, and nonprescription products and dietary supplements). Information on perceived confidence in achieving positive outcomes as a result of counseling and barriers to counseling was also collected. Descriptive and Spearman' r analysis were conducted using SPSS version 17. Responses with Likert scale rating 1(low score) to 5 (high score) and binary choices (yes/no) were presented as mean (SD) and (95% CI), respectively.
The response rate was 93.6%. The overall mean (SD) responses indicated that pharmacists counseled obese patients sometimes to most of the time, 3.67 (1.19) and were neutral to comfortable with counseling about aspects of obesity management, 3.77 (1.19). Respondents perceived obesity management aspects to be somewhat effective, 3.80 (1.05). Of the four aspects of obesity management, diet and exercise, and diet foods were the highest ranked in terms of frequency of counseling, comfort level and perceived effectiveness. Pharmacists were neutral to confident in achieving positive outcomes as a result of obesity counseling, 3.44 (1.09). Overall mean responses of counseling obese patients by pharmacists were positively correlated with their perceived comfort with counseling and perceived effectiveness of obesity management aspects. The most anticipated barriers to obesity counseling were lack of patient awareness about pharmacists' expertise in counseling 76.2% (95% CI: 69.7-81.7) and pharmacists' opinions that obese patients lack willpower and are non-adherent to weight reduction interventions 71.8% (95% CI: 65.1-77.8).
Strengths, weaknesses and barriers related to obesity counseling by pharmacists in Kuwait were identified, and suggestions were provided to strengthen that role.
Community pharmacists; Obesity; Obesity counseling; Kuwait
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Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland
Sinclair, H.
Bond, C.
Lennox, A
Silcock, J.
Winfield, A.
Donnan, P.
Tobacco Control
OBJECTIVE—To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model. DESIGN—A randomised controlled trial of community pharmacies and pharmacy customers. SETTING—All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited. SUBJECTS—All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%). MAIN OUTCOME MEASURES—The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months. RESULTS—The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p<0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering. CONCLUSIONS—The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets. Keywords: community pharmacy; health education; smoking cessation
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Stigmatizing attitudes and low levels of knowledge but high willingness to participate in HIV management: A community-based survey of pharmacies in Pune, India
Gupta, Amita
Sane, Suvarna S
Gurbani, Ajay
Bollinger, Robert C
Mehendale, Sanjay M
Godbole, Sheela V
BMC Public Health
The World Health Organization (WHO) recommends that the role of pharmacists in low-income settings be expanded to address the increasing complexity of HIV antiretroviral (ARV) and co-infection drug regimens. However, in many such settings including in India, many pharmacists and pharmacy workers are often neither well trained nor aware of the intricacies of HIV treatment. The aims of our study were; to determine the availability of ARVs, provision of ARVs, knowledge about ARVs, attitudes towards HIV-infected persons and self-perceived need for training among community-based pharmacies in an urban area of India.
We performed a survey of randomly selected, community-based pharmacies located in Pune, India, in 2004-2005 to determine the availability of ARVs at these pharmacies, how they were providing ARVs and their self-perceived need for training. We also assessed knowledge, attitudes and perceptions on HIV and ARVs and factors associated with stocking ARVs.
Of 207 pharmacies included in the survey, 200 (96.6%) were single, private establishments. Seventy-three (35.3%) pharmacies stocked ARVs and 38 (18.4%) ordered ARVs upon request. The reported median number of ARV pills that patients bought at one time was 30, a two week supply of ARVs (range: 3-240 pills). Six (2.9%) pharmacy respondents reported selling non-allopathic medicines (i.e. Ayurvedic, homeopathy) for HIV. Ninety (44.2%) pharmacy respondents knew that ARVs cannot cure HIV, with those stocking ARVs being more likely to respond correctly (60.3% vs. 34.8%, p = 0.001). Respondents of pharmacies which stocked ARVs were also more likely to believe it was a professional obligation to provide medications to HIV-infected persons (91.8% vs. 78.8%, p = 0.007) but they were also more likely to believe that HIV-infected persons are unable to adhere to their medicines (79.5% vs. 40.9%, p < 0.01). Knowledge of the most common side effects of nevirapine, abnormal liver enzyme profile and skin rash, was reported correctly by 8 (3.9%) and 23 (11.1%) respondents, respectively. Seven (3.4%) respondents reported that they had received special training on HIV, 3 (1.5%) reported receipt of special training on ART and 167 (80.7%) reported that they believed that pharmacy staff should get special training on ART.
There is a high willingness to participate in HIV management among community-based pharmacies but there is a tremendous need for training on HIV therapies. Furthermore, stigmatizing attitudes towards HIV-infected persons persist and interventions to reduce stigma are needed, particularly among those that stock ARVs.
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Using Medications Sales from Retail Pharmacies for Syndromic Surveillance in Rural China
Yan, Weirong
Cheng, Liwei
Tan, Li
Yu, Miao
Nie, Shaofa
Xu, Biao
Palm, Lars
Diwan, Vinod
Online Journal of Public Health Informatics
To use an unconventional data - pharmaceutical sales surveillance for the early detection of respiratory and gastrointestinal epidemics in rural China.
Drug sales data as an early indicator in syndromic surveillance has attracted particular interest in recent years (1, 2), however previous studies were mostly conducted in developed countries or areas. In China, many people (around 60%) choose self-medication as their first option when they encounter a health problem (3), and electronic sales information system is gradually used by retail pharmacies, which makes drug sales data become a promising data source for syndromic surveillance in China.
This experimental study was conducted in four rural counties in central China. From Apr. 1st 2012, there are 56 retail pharmacies joined the study, including 21 county pharmacies and 35 township pharmacies. 123 drugs were selected under surveillance based on the analysis of local historical sales volume and consultation with local pharmacists, including 19 antibiotics, 15 antidiarrheal medications, 9 antipyretics, 41 compound cold medicine, and 39 cough suppressants. Daily sales volume of the selected drugs was recorded into the database by pharmacy staff at each participating unit via electronic file importing or manual entering. Figure 1 showed the user interface for data viewing, query and export. Field training and supervision were regularly conducted to ensure the data quality.
From Apr. 1st to Jun. 30th 2012, there were 103814 sales records reported in the system, including 44464 (42.83%) records from county pharmacies and 59350 (57.17%) from township pharmacies. Among all surveillance drugs, the sales of compound cold medicine accounted for the largest proportion (43.42%), followed by antibiotics (22.52 %), cough suppressants (18.50%), antidiarrheal drugs (9.49%) and antipyretics (6.06 %). More than 80% data were reported into the system within 24 hours after the sales date, and the reporting timeliness of county pharmacies improved with time (table 1). Missing report rate was less than 5% for all surveillance units. Several reporting mistakes were found during the first three-month implementation, which might be due to system bugs, data provider unfamiliar with the system especially when manual reporting, data providers' carelessness, and some pharmacies reluctant to share sales data amongst others.
Although the current reporting timeliness and completeness are satisfying, it is noteworthy the quality of data is not stable during the beginning phase of the implementation. Further validation of the data will be required. To ensure the accuracy of data and the effective and sustainable deployment of the system, it is imperative to establish a data sharing policy between pharmacies and public health agencies, and achieve automated data collection to avoid additional human labor involvement.
Syndromic surveillance; Medication sales; Developing settings
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Penderlea students return to school July 14.
Teachers and administrators explore science and writing during NCQuest, a collaboration between PCS and UNCW.
The Board of Education recognizes Heide Trask's Desire Brown and Pender's Tanazsa Simpson, both NCHSAA Track and Field Champions
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Pender County Schools does not discriminate on the basis of race, religion, color, national origin, sex, disability, age, immigrant status, English-speaking status, or any other characteristic protected by applicable federal or N.C. law in its programs or activities. For questions regarding the nondiscrimination policies call 910-259-2187, or write Pender County Schools.
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The crucial change in the period from January to September 2014, 12 meetings should have before our decisions could be made of two states but through the non-government sector, and in settling on the commitment of the sequel to the set of all 'clinching' support.


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PHOTOS: NYC Pride History in Pictures
We wouldn't have Pride without New York. After LGBTers stood up to arrests and violence at the Stonewall Inn in 1969, a national equality movement was born and an annual celebration of our lives began. The Center, New York's LGBT center, gathered powerful images of some of the city's earliest Pride events for a powerful new onliine exhibit entitled "Pride March—The Early Years." Take a look at the trailblazers below and see more at gaycenter.org/archives.
Above: AIDS marchers, 1983, photo by Steve Zabel
Parade banner, 1970, photo by Leonard Fin
Gay Women's Liberation Front, 23rd St. & Sixth Ave., 1972, photo by Eric Stephen Jacobs
Crowd in Central Park, 1974, photo by Richard C. Wandel
Times Square, 1973, photo by Leonard Fink
Central Park scene, 1970, photo by Richard C. Wandel
Parent, 1975, photo by Leonard Fink
Mattachine Society, 1973, photo by Leonard Fink
Andrews Sisters impersonator, 12th St. & Seventh Ave., 1973, photo by Leonard Fink
Bisexual Gay & Lesbian Youth of New York, 1974, photo by Richard C. Wandel
Beth Simchat Torah, 1975, photo by Leonard Fink
Marchers, 1981, photo by Richard C. Wandel


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Even with only 1 day of fishing, fishermen in the salmon gillnet fleet welcomed safety training at the wharf
It's that time of the year again! Fish Safe is excited to announce that we will be hosting our Beachline Safety Workshop on Wednesday, June 29 at the Gulf of Georgia Net Loft in Steveston.
Kannad Marine has issued a recall of all SAFELINK EPIRBs due to a possible defect that could result in the beacon not operating in emergency situations
Salmon drills days are coming to Port Alberni June 13 - 15
A great new video documents the history of commercial fishing and safety on BC's coast
"The Steveston Lifeboat" was in an accident while training volunteers for the Canadian Lifeboat Institution (CLI) in December 2014 and needs your help to get back on the water! Check out our blog post for ways you can help.
30 minutes is all it took from the moment a fire was discovered on the crab vessel Frederike. C-2 to the time when the entire crew was forced to abandon ship
Thanks to all the fishermen in Sidney who participated in Crab Drills Days 2016!
Flare disposal is always a pain for many fishermen and many of you have asked if there's an easy way to do this - now you can!!


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Whole Earth Discipline: Why Dense Cities, Nuclear Power, Transgenic Crops, RestoredWildlands, and Geoeng ineering Are Necessary Paperback – Sep 28 2010
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"After spreading the gospel of self-sufficiency with his inimitable Whole Earth Catalog, Stewart Brand now embraces science and engineering as the disciplines that will see us through the fast-approaching crisis of global warming. Brand's new book is like the man himself: smart, practical, wise and full of goodwill." -- Richard Rhodes, Pulitzer-Prize-winning author of The Making of the Atomic Bomb
"Stewart Brand defines iconoclastic, and has now raised the bar with the most important work of his lifetime, likely one of the most original and important books of the century. As the title connotes, the writing is about disciplined thinking. Shibboleths, ideological cant, and green fetishes are put to the side with the clarity and expertise gained by years of research and forethought, a mindbending exploration of what humankind can and must do to retain the mantle of civilization. The highest compliment one can give a book is 'it changed my mind.' It changed mine and I am grateful." -- Paul Hawken
"If you care about future of the planet or about the contest between dispassionate discourse and crusading zeal, read this book from cover to cover and get ready to join the fierce debate it will spark." -- Paul Romer
"Orthodoxy is the enemy of invention. Despair an insult to the imagination. In this extraordinary manifesto, Stewart Brand charts a way forward that shatters conventional thinking, and yet leaves one brimming with hope. It has been years since I have read a book that in so many ways changed the way I think about so many fundamental issues." -- Wade Davis
"Stewart Brand's timely and down to Earth new book gives me hope that his wisdom will help us prevent the Earth system breaking as the economic system has done. The last things we need are more theoretical models or visionary hi-tech. This book is truly important and a joy to read. It is a practical guide to damage limitation and a sustainable retreat to a far more efficient society." -- James Lovelock --This text refers to an out of print or unavailable edition of this title.
"After spreading the gospel of self-sufficiency with his inimitable Whole Earth Catalog, Stewart Brand now embraces science and engineering as the disciplines that will see us through the fast-approaching crisis of global warming. Brand's new book is like the man himself: smart, practical, wise and full of goodwill." --This text refers to an out of print or unavailable edition of this title.See all Product Description
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"Is this it?" I asked.
Soros shrugged --- a very calm reaction from an investor who might have seen his portfolio shrink by hundreds of millions of dollars in a matter of minutes.
I lost much less that day, but I had a different reaction --- panic. The thing to do, I concluded, was to trade my beloved Classic 6 in Manhattan for a self-sustaining house in the country. Ten acres would suffice, as long as they had decent water, land suitable for a large garden and enough sunlight for the solar panels.
I bought a URL for the web site I planned to launch: [...]. This was no back-to-the-land hippie retreat. I would be stepping into the smart future: small town/rural purity (Woodsmoke) with the 21st century benefits of a fast Internet (Broadband) and Amazon.com's free shipping.
Given all that, you will understand that I was quite stunned to read "Whole Earth Discipline: An Ecopragmatist Manifesto" --- by Stewart Brand, creator of the 1960s and 1970s classic, the "Whole Earth Catalog" --- and discover that the last place its author would have me go is back to the land.
In these pages, Stewart Brand lays out a mind-blowing vision for the planet's salvation: migration to the cities, power generated by mini-nuclear reactors, healthier crops through genetic engineering.
This may well be the most important book I'll read this year. Certainly, it's the most aggressively optimistic book that's also closely reported --- Brand's a student who shows his work. Granted, a lot of it is technical. Skip those pages. Just read with a pencil. Mark what seems important and/or drives you crazy. Start reading more science news --- Brand recommends NewScientist --- and keep an open mind. That is, get ready to abandon your own long-held views. And be just as ready to disagree with Brand.
The book starts with climate change --- not as a phenomenon to debate with those who don't believe it's real, but as a factor in warfare, which has historically often followed changes in climate. In the past, "wholesale carnage was common, and so was cannibalism." But in the last three centuries, historians have found, only about 3% of the world's population dies in warfare. And in our own century, war has become absolutely humane --- we now kill only enough of the enemy to guarantee victory.
But what if we experienced severe climate change? "Humanity would revert to its norm of constant battles for diminishing resources," Brand writes. "Peace lovers would be killed and eaten by war lovers."
Now that he has your attention --- and with that image, he certainly has mine --- Brand makes his case for a Green movement that is smart about science. In other words, based on facts, not emotion. Rachel Carson, he notes, was a hero for her anti-pesticide book, "Silent Spring". But after DD was banned worldwide, malaria took off in Africa, possibly killing 20-30 million children. So he wishes us to consider the direct --- and indirect --- consequences of:
-- "We're now excessively carbon-loading the atmosphere toward inferno."
-- "Cellphones are the fastest global diffusion of any technology in human history."
-- For the next three decades, the world will be demographically split: in the global north, old cities full of old people; in the global south, new cities full of young people.
-- "A white roof saves the building's tenant 20% in cooling costs."
-- Because of its nuclear plants, France exports power to coal-burning countries.
But the big phenomenon for Brand, in his new way of thinking, is this: "The takeoff of cities is the dominant economic event of the first half of this century." And when we met in New York for a short interview, that's where we started.
You see more and more people moving to cities. Why do you applaud that?
Cities innovate faster as they grow bigger. They create enormous problems, but they also create solutions faster. Cities seem to know how to get out of their own way.
What's driving the attraction of cities?
Globally, the evolution of cell phones. Once people in the bush have smart phones, people can see the wealth creation in cities.
Won't this lead to more urban gridlock?
People don't move from the country to the capital cities. They go to the nearest city.
Okay, climate change. Care to predict the year when, if we haven't taken radical steps, it becomes just too late to save the planet for humans life?
No, because you can't find a hard edge.
Explain, please.
I used to think rising sea level was not significant. You can, after all, walk back from water. Then I realized most of the wealth and productivity and expensive real estate is on the coasts. In San Francisco, real estate along the shore is susceptible to inches. So rising water is more serious to those people than drought. Very simply, the rich will say: "Stop this!"
And for those who don't live on the coasts?
Ten years of drought would have an effect. At 15 years you realize it's not going away. And once drought stays, the area does die.
In either scenario, climate is the story.
It's the ongoing story: What does climate change mean to us?
But people don't want to hear it. Why?
People turn away from news that confuses them. And these problems resist easy understanding. There's much to disagree about on almost point. Like: every year, carbon comes out of the atmosphere. Does it go to oceans or continents?
You mention the good that would follow if we all painted our roofs white. Give me five more things that we can, as individuals, do to retard climate change.
In my "Whole Earth" days, that would be my focus. Now I don't think about painting your roof white, I think about painting whole cities white.
Can you see that time?
Soon enough, I can see streets that will be embedded with solar cells.
And our power coming from mini-nuclear plants?
Micro-reactors are game changers. China is talking about building 400.
This conversation unsettles me. On one hand, you speak of urgency. On the other, you're very calm. Why aren't you screaming?
I'm a biologist. That comes with a kind of fatalism.
Working out the ideas for this book, when do you realize you were making a break with your past?
As I was pursuing urbanization, I realized there was a nest of good news in what had been treated as bad news. As a journalist, this is what you look for --- suddenly I had a story. And my changed sense of "green" is a piece of that story. That's one advantage of being 70 and having been in the public eye for 40 years.
So is "Whole Earth Discipline" a repudiation of the "Whole Earth Catalog"?
The "Catalog" was not, as some thought, counter-culture. It was counter-counter culture. It matched the passion of the hippie movement with reasoned responses. "Discipline" is the same game.
A lot of people have looked into squatter cities and shanty towns, but Brand does a better job of showing how they are part of an organic and evolutionary and even in some ways positive, optimistic process than most others I've read. There has been a lot of shouting on all sides of the debate on nuclear energy -- this is a really good attempt to get the pros and cons on the table in rational discourse and (mostly) dispense with the flame wars. Same goes for the discussions of genetically engineered crops and geo-engineering. We desperately need a much higher quality public dialog on all these subjects, and this book is a real contribution toward putting all these issues on the table in a discussable format. Stewart is right -- the time for allowing ideology and sentimentality to stand in front of what science is telling us is over, and we are going to be forced as a society to make some difficult decisions relating to the future of our climate and the management of our ecosystems. It is going to require massive involvement and a high level of innovation on the part of many actors, and it is going to require a lot of people to stretch their thinking and give up old prejudices. I don't know if Stewart is right about all the assertions in this book, but the nice thing is, neither does he, and he knows that and comes right out and says so. Loosely held opinions strongly stated. The service of this book is to unwedge the conversation, steer between Pollyanna and Chicken Little, and focus on the important issues that are surely coming our way.
His warnings are dire, but hopeful. His advice is strongly worded, but entirely justified. If you are looking for a rational voice in the debate about climate change, genetically modified organisms, the overpopulation "problem" and other issues whose specter is now cast over the future of our species, you must read this book.
It is rare to find a book that is balanced, informative and wholly engaging -- this is one of them.
In his opinion, only modernization and high tech can save humanity from climate change and its consequences. The book also contains more traditionally Green chapters on land management, wildlife preservation, etc. The bottom line is the same, however: if we want better land management, perhaps we need GE crops. If we want to preserve large wilderness preserves, we need to urbanize and make sure to develop eco-friendly technology. If we want to control population numbers, we need higher standards of living.
Brand's support for nuclear power and GE (or GM) crops will be particularly hard to swallow even for moderate Greens. Apart from Brand himself, I think James Lovelock is the only well-known Green who supports nuclear power. Interestingly, Paul Ehrlich seems to be positive to GM crops. Otherwise, opposition to both nuclear power and GM crops are almost defining features of the Green movement.
One thing is for sure. If Brand's eco-pragmatism turns out to be another failed strategy, we're in for a really rough ride...
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Weekly Update
Belle Isle GP Promotion
Use promotional code WAYNE when buying Belle Isle Grand Prix Tickets this summer and support our team!
Belle Isle GP Promotion
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All are Welcome!
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Along with the engineering division, there is an extensive business division that is responsible for communications, sponsor relations, and resource management. As members of Warrior Racing, students gain the opportunity to explore multiple career paths including those of engineering and business.


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- Miss Florida 2017 stripped of crown days after win - US Weekly
- Lindsay Lohan steps out amid relationship drama - TMZ
- Was Taylor Swift snubbed by the VMAs? - Gossip Cop
- Rachel Platten sings "Fight Song" with lots of stars - Just Jared Jr
- Farrah Abraham sizzles in a revealing bikini - Radar
- New pics from the Clooneys' Italian summer - Lainey Gossip
- Fox News snubs major DNC moment - The Hollywood Reporter
06 July 2010 at 11:14 AM
Jude Law: President's Prize in Czech Republic!
About this photo set: Jude Law wins big at the Karlovy Vary Film Festival held in Carlsbad, Czech Republic on Monday (July 5). The 37-year-old British actor (in Prada) was awarded… Read More Here
Photo #: 2464005
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text: 7. Minerals Technologies ( MTX) is a resource- and technology-based company, engaged in developing, producing and marketing a range of specialty mineral, mineral-based and synthetic mineral products, and supporting systems and services. The company operates in two reportable segments: specialty minerals and refractories. The company is scheduled to report its first quarter 2011 results on April 29. Net income is projected to increase 2% to $15.6 million or 84 cents per share from $15.3 million or 82 cents per share in the comparable quarter of last year. However, total revenue is seen declining marginally to $250 million from $253.5 million, according to analysts polled by Bloomberg. The company recently announced an agreement with JK Paper Ltd. to construct a satellite precipitated calcium carbonate (PCC) facility at JK Paper's largest pulp and paper mill located near Rayagada in the eastern state of Orissa, India. The plant will support the mill by producing more than 46,000 metric tons per year of PCC. This satellite PCC facility will be its fourth in India, constructed within a relatively short period. Once commercialized, it will bring the company's total count in Asia to 12. Of the five analysts covering the stock, 80% recommend it a buy, while the remaining rate a hold. There are no sell ratings on the stock. On average, analysts expect an upside of 16% to $75.5 in value from current levels. Prev 3 of 10 Next