FPS Summer Research 2001

Faculty of Pharmaceutical Sciences, University of British Columbia

Alan C. Hayman Summer Student Research Competition 2001

Partial Proceedings from the Faculty of Pharmaceutical Sciences Summer Student Research Program Poster Competition

An evaluation of factors influencing the safety and efficacy of warfarin anticoagulation

Erin Neall, Stephen Shalansky and Larry Lynd, Faculty of Pharmaceutical Sciences, The University of British Columbia and St. Paul’s Hospital

Objective: The purpose of this study was to measure the frequency and patterns of alternative medication use in patients taking warfarin. This study was also designed as a pilot to assess the relative risk of specific alternative medicines on warfarin-related outcomes in this population.

Methods: A cross-sectional survey was completed by 59 subjects taking warfarin for a variety of indications. Patients were interviewed by phone or in person between June 2001 and August 2001. Prescription records and international normalized ratio (INR) results were also reviewed.

Results: The mean age of the participants was 63.29 (+/-14.31) years and their average dose of warfarin was 4.29 (+/-2.06) mg daily. Thirty-six per cent (n=21) of the patients reported using at least one alternative medication at least once weekly in the previous month, which is a similar frequency to that reported in two previous surveys of Canadian cardiovascular patients. Twenty nine per cent (n=17) reported using an alternative medication that could theoretically interact with warfarin. The most commonly used alternative medications included: vitamin E (22.0%), garlic (8.5%), chamomile (6.8%), and ginko biloba (6.8%), all of which can potentially interact with warfarin. None of the patients reported an increase in their use of alternative medications in the month prior to the interview. The reported exposure to other factors that may influence warfarin’s anticoagulation effects included: interacting prescription medication use (50.5%), daily use of interacting over-the-counter medications (40.7%), concomitant illness (30.5%), and change in consumption of foods containing Vitamin K (8.5%). Ongoing analysis will assess the relative risk of specific alternative medicines on the incidence of warfarin-related outcomes (bleed or elevated INR). This analysis will control for the influence of other factors, listed above, known to influence warfarin anticoagulation.

Conclusions: Patients taking warfarin commonly report the use of alternative medications that have been reported to increase bleeding risk through various mechanisms. Pharmacists should review the potential implications of alternative medicine use when counseling patients prescribed oral anticoagulants.

Acknowledgements: Funding for this project was provided by the Canadian Institute of Health Research and the St. Paul’s Hospital Foundation. We are grateful to Biljana Radulovic for her help recruiting patients for this survey.

Evaluation of pharmaceutical care interventions by SPEP students

Anita Sabatino and Rosemin Kassam. Faculty of Pharmaceutical Sciences, University of British Columbia

Objective: To quantify the impact of undergraduate students on the provision of pharmaceutical care for the first year of the Structured Practice Educational Program (SPEP).

Methods: A descriptive analysis of the processes of care used by undergraduate students during their SPEP rotations was used to quantify their impact on the provision of pharmaceutical care. Community pharmacies meeting the specific SPEP recruitment criteria were recruited as clerkship sites for SPEP. Documentation tools used to summarize the students’ processes of care included the Modified Pharmacist’s Work-up of Drug Therapy (PWDT) and the Pharmacy Care plan. The Modified PWDT was completed for all patients who were interviewed by the students. The Pharmacy Care Plan was completed for all interventions (initial and follow-up) made by the students. From the Modified PWDT information was collected regarding the patient’s age, gender, medical condition(s), drug therapy, total number of medications, and drug related problems. For each drug-related problem identified, it was noted whether an initial intervention or a followed-up intervention was initiated, and whether the problem had been resolved. From the Pharmacy Care Plans completed, the information collected included the specific drug-related problem category identified, the type of drug-related problem (actual or potential), the medical condition and drug category associated with the drug-related problem, as well as the student’s recommendations, actions and outcome of the actions. Information was also recorded when a follow-up assessment was completed, the individual contacted and the outcome of the care being evaluated.

Results: Data analysis is currently ongoing. One hundred and twenty two students completed the SPEP clerkship program, with two hundred and fifty community pharmacies participating in the program. Preliminary analysis suggests that students initiated “comprehensive” pharmaceutical care on 96 patients. There were 214 drug-related problems (actual and potential) identified in these patients. The most three most common medical conditions reported by these patients included hypertension, asthma and diabetes. The three most common medications reported included calcium, acetaminophen and metformin. Results of the complete analysis will be presented on September 27, 2001.

Conclusions: This study demonstrates that the SPEP program has successfully made the transition from the traditional dispensing-focused clerkship program to one where there is a greater focus on the provision of pharmaceutical care. The results however indicate that the SPEP curriculum needs to emphasize more “comprehensive” pharmaceutical care in the coming years.

Development of an evaluation profile for the faculty of pharmaceutical science’s web-based Learning Centre

Claire L. Moffett, Simon P. Albon, and Michael D. Pungente. Faculty of Pharmaceutical Sciences, The University of British Columbia.

Purpose: The purpose of this project was to develop an evaluation profile for the Faculty of Pharmaceutical Science’s Web-Based Learning Centre (WBLC). The aim of this four-component evaluation profile is to assess the effectiveness and ultimately the sustainability of the WBLC to support student learning and teaching practice within our faculty.

Methods: The initial framework of the evaluation profile was developed based on a literature investigation as well as consultations with external agencies such as Distance Education and Technology (DE&T). An iterative process of design, evaluation, and redesign through a series of intensive brainstorming sessions with the evaluation team and DE&T resulted in the final draft of the profile. A faculty survey for the evaluation process was developed through a series of meetings with the evaluation team. Using the four main components of the evaluation profile, the team focused on the main elements of the evaluation. Further support for the survey development was provided by a primary and secondary literature search. The literary investigation provided guidance regarding the format and wording of the questionnaire.

Results: An evaluation profile containing four components was successfully developed. The evaluation profile was developed to serve as a framework for the future development of specific tools that will be used to evaluate all aspects of the WBLC.

The four main components of the evaluation profile are as follows:

Evaluation Component Elements
1.  Effectiveness of the WBLC Quality, Usefulness, Patterns of Use and Access
2.  Cost/Benefit Analysis Costs and Benefits
3.  Ease of Update Availability, Flexibility and Time
4.  Support Users and Financial

Conclusions: The evaluation profile of the Faculty of Pharmaceutical Sciences’s WBLC was completed. A survey focussing on faculty use and perceptions of the WBLC was completed based on the fourth component of the evaluation profile, and will be implemented in the 2001 – 2002 academic year. This initial evaluation profile will serve as a framework for future development of the WBLC.

Acknowledgements: Funding for this project was provided by the 2001 – 2002 Teaching and Learning Enhancement Fund (TLEF) of the University of British Columbia.

A survey of physician dispensing of non-prescribed emergency contraceptive pills for women in british Columbia

Carolyn Cheung, Judith A. Soon, and Marc Levine. Collaboration for Outcomes Research and Evaluation (CORxE UBC), Faculty of Pharmaceutical Sciences, The University of British Columbia.

Purpose: Emergency contraceptive pills (ECPs) are prescribed and distributed in British Columbia through a number of sources, including general practitioners (GPs), emergency departments, public health nurses, Planned Parenthood and university/college student medical services. Historical data on ECP use suggest that only approximately 65% of annual provincial sales of Ovral® can be found in the BC PharmaNet prescription database or in Planned Parenthood and Youth Clinics reports. Thus, the provision of ECPs by physicians without a prescription or “out-of-cupboard” may be as high as 35% of cases. The purpose of the present study was to pilot test a method of surveying GPs in BC to estimate the overall frequency of non-prescribed ECP use in the province and to obtain a sample size estimate for a full study.

Methods: A brief one page questionnaire and cover letter was designed for the GPs survey, and approval was obtained from the UBC Behavioural Research Ethics Board. The protocol involved initial telephone contact with the physician’s office to advise that a cover letter and one page questionnaire would be faxed. The physician then completed and faxed the survey to the research group. Telephone contact was made at one week for non-responders. Preliminary evaluation of the survey was conducted with a convenience sample of six Lower Mainland physicians. Based on responses, the survey was modified. Using the BC College of Physician and Surgeons electronic database to filter for GPs, a random sample stratified by health district was prepared of all apparent GPs in the province. A pilot study of 36 GPs from the stratified random sample was conducted. Questionnaires were also designed to assess the distribution of ECPs by public health nurses, emergency departments, and university/college medical clinics (data not presented).

Results: Based on the data gathered from the preliminary research and ongoing pilot study (n = 14), GPs in BC provide 4.00 ± 4.30 non-prescribed ECP (ECPNON-Rx) treatments and 4.07 ± 5.21 tablets per non-prescribed ECP treatment annually. To date, the pilot study has resulted in a 45% response rate among GPs available to complete the survey. A total of 16.7% of the physicians designated as GPs in the College of Physician and Surgeons database were no longer active.

Conclusions: The findings of this study suggest that “out-of-cupboard” use is projected to be over 63,000 Ovral® tablets per year. This represents 49% of ECP sales in 2000 previously unaccounted for by PharmaNet, Planned Parenthood and Youth clinic data. Based on combined preliminary research and pilot study data, and assuming a conservative physician response rate of 30%, 237 GPs would have to be sampled to obtain the number of non-prescribed ECP treatments they provide annually ± 1.0. The full study will be completed within the next six months.

Acknowledgements: Funding for the study was been provided by Women’s Health Bureau BC Ministry of Health, BC Women’s Hospital and Health Centre, and a CIHR/Burroughs Wellcome Studentship.

Informed shared decision making: an exploratory study in pharmacy

Maxwell Murray, Simon Albon, Carlyn Volume, William Godolphin, Angela Towle, Lesley Bainbridge, Melinda Suto, and Rosemin Kassam. Faculty of Pharmaceutical Sciences, University of British Columbia, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Faculty of Medicine, University of British Columbia, and School of Rehabilitation Sciences, University of British Columbia.

Background: Through its adoption of the pharmaceutical care (PC) model of practice, the profession of pharmacy is shifting its focus from products to patients. An essential prerequisite to providing PC is the development of a covenantal relationship with the patient. In a covenantal relationship, the pharmacist and patient commit to working as partners in the identification, resolution, and prevention of the patient’s drug-related problems. This step of the PC process is essential to ensuring the care provided by the pharmacist centers around the patient’s own needs, values, and desires. Building an effective therapeutic relationship requires pharmacists to have highly developed professional and interpersonal skills, specifically those related to communication. These skills, and more specifically, how the relationship is attained, are not well addressed in current pharmacy curricula or continuing education programs. The informed shared decision making (ISDM) model is a model for interpersonal communication originally developed for physicians. This model has the potential to enhance the pharmacist-patient relationship by providing pharmacists with a systematic approach to engaging patients in covenantal relationships. It also provides a mechanism for pharmacists and patients to work collaboratively towards the identification, resolution, and prevention of drug-related problems.

Purpose: The objectives of this study were:

1) to assess the relevance of the physician-developed ISDM competencies to pharmacy practice;

2) to adapt the physician-based ISDM competencies to pharmacy;

3) to identify barriers to implementing ISDM in pharmacy practice;

4) to identify typical situations in which ISDM is or could be used in pharmacy; and

5) to identify potential competencies required by patients to participate in informed shared decision making.

Methods: To meet the objectives of this study, twenty pharmacists, who act as preceptors in the Structured Practice Education Program (SPEP) in the Faculty of Pharmaceutical Sciences at U.B.C., were recruited and interviewed using a standardized interview protocol. Five pharmacists were selected from each of the following categories: hospital pharmacists with BScPharm degrees, hospital pharmacists with PharmD degrees, community pharmacists practicing as dispensing pharmacists, and community pharmacists who practice as disease management consultants. Prior to the interview, each participant received an information package containing a letter outlining the ISDM model, the project objectives, the list of physician-based ISDM competencies, a sample consent form, and the interview questions. All interviews were conducted face-to-face, tape-recorded, and transcribed verbatim. Demographic data was collected from each pharmacist at the time of the interview. Responses were summarized into tables grouped according to the pharmacist categories. Summaries were analyzed to identify common themes for each category and to produce an overall pharmacist assessment of the physician-based ISDM competencies.

Results: Of the twenty pharmacists interviewed, 55% were males and 45% were females. Twenty-five percent were between the ages of 20 and 29, 35% between 30 and 39, 25% between 40 and 49, and 15% were 50 years of age or older. Nine of the pharmacists had hospital residencies and two had Master’s degrees in Pharmaceutical Sciences. The mean time since graduating from their undergraduate pharmacy programs was 14.3 years. For the five pharmacists with PharmD degrees, it has been a mean of 4.8 years since graduating from that program. Results obtained from the interview transcript analysis are currently being summarized.

Conclusions: An analogous set of ISDM competencies can be developed for pharmacists using the competencies already established for physicians using an inductive method of data collection.

Acknowledgements: The authors would like to acknowledge Apotex Inc., The Association of Faculties of Pharmacy of Canada, The College of Pharmacists of British Columbia, The British Columbia Pharmacy Association, and The Faculty of Pharmaceutical Sciences, U.B.C. for their support of this project.

Development of a collaborative pharmacist research network

Stanley Lin, David Fielding, Elan Paluck. CORxE UBC, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC.

Purpose: Growing numbers of practice-based research networks that systemically collect information related to patient care have emerged in most health professions yet large-scale research networks comprised of community pharmacists remain rare. The goal of this study is to develop a community pharmacist research network for the Collaboration for Outcomes Research and Evaluation (CORxE UBC). This project specifically sought to identify facilitators and barriers that are indigenous to pharmacy practice in B.C. for establishing a research network and inform a strategic plan for implementing and maintaining the network.

Methods: Key pharmacy practice stakeholders (n=24) representing independent pharmacies and major pharmacy chains, the BC College of Pharmacists, BC Pharmacy Association, and Continuing Pharmacy Education were invited to attend a focus group meeting. Focus group methodology developed by Kruger (1998) served as the template. In preparation of the focus group, seven open-ended questions tapping various aspects of initiating and maintaining a pharmacist research network were designed, and then subjected to extensive peer and expert review. For the purposes of the study, research was defined as including the tasks of recruiting patients, obtaining informed consent, collecting patient data, and transmitting data to the investigators. During the focus group, large group discussions were audiotaped while small group discussions were recorded by note takers. All findings were later transcribed and systematically analyzed for content and theme.

Results: Participants (n=21) indicated that many pharmacists are interested in research and that initiating a network or recruiting pharmacists to join would not be problematic; however, the endorsement and sanction from management and the university would be critical motivators for their participation. No major difficulties in conducting research within a community pharmacy setting were identified, but the design of study must be simple, clear, applicable to pharmacy practice, and sensitive to pharmacists’ needs and workload. Proper training and support for network pharmacists should be provided and reimbursement, either honorary or monetary form, was an important consideration. Network communications through phone calls, mails, e-mails, and meetings should be regular to meet the needs of the project as well pharmacists. Constant feedback and evaluation of on-going projects would help to maintain interest and morale.

Conclusions: Establishing a Collaborative Pharmacist Research Network appears to be a feasible and acceptable initiative for CORxE UBC. The facilitators and barriers identified and recommendations made with regard to the research network are invaluable in the preparation of CORxE UBC’s implementation and maintenance plan for the research network.

Acknowledgements: Funding for this project was provided by CIHR/Burroughs Wellcome Fund.

Patterns of physician prescribing of ovral® for emergency contraception in British Columbia

Howard Chi Sing Lau, Judith Soon, and Marc Levine. Collaboration for Outcomes Research and Evaluation (CORxE UBC). Faculty of Pharmaceutical Sciences. UBC.

Purpose: Unintended pregnancies and subsequent abortions are major public health issues in British Columbia despite evidence that post-coital emergency contraceptive pills (ECPs) are effective. The objectives of this study were to establish baseline data on physician-prescribed ECPs for a prospective evaluation of the expanded access program and to investigate the association between historical trends in the use of physician-prescribed ECPs and pregnancy and abortion rates in BC.

Methods: B.C. PharmaNet prescription records for Ovral® were obtained for the period from January 1, 1996 to December 31, 1999. Prescription records with a quantity of less than 21 tablets were considered to be for possible ECP use. The database records were separated in Excel® by year dispensed, regional heath district, and age group. Pregnancy and abortions counts and rates stratified by age group and by health region were obtained from B.C. Vital Statistics for the calendar years 1996-1999.

Results: Between 1996 – 1999, 64.6% of all Ovral® prescriptions were deemed for ECP use. Of those, 94.2% were for a quantity of 4 tablets. The average number of physician-prescribed ECPs during the 4 year period was 10.3 ± 0.4 ECPs/1000 women/year. Though variability was low, there were 5% fewer ECP prescriptions in 1998 and 1999 compared to 1996. There was a regional disparity in the provision of physician-prescribed ECPs, ranging from a low of 3.7/1000 women/year in the Northern Interior health district and a high of 17/1000 women/year in the Richmond health district. During the same 4 year period, there was a trend to declining pregnancy and abortion rates for 15-44 year-olds, by 9.6% and 5.3%, respectively. Among the highest users of ECPs (15 – 24 year olds), the decline in pregnancy and abortion rates could also not be accounted for by the trend in ECP prescribing.

Conclusions: Physician-prescribed Ovral® use for ECPs remained above 10 ECPs/1000 women/year between 1996-1999 and can not account for the observed change in pregnancy and abortion rates. These baseline data will be used to determine whether the December 1, 2000 policy change authorizing pharmacists to be able to initiate ECPs will result in increased access to ECPs by women or are a transfer of ECP prescriptions from physicians to pharmacists.

Acknowledgements: This research was funded in part by the Student Summer Works Program and the David Collins Dawson Fund.

Effectiveness of bupropion for smoking cessation: a pilot test of the baseline survey instrument

Joanne P. Li, Elan C. Paluck, David W. Fielding. CORxE UBC, Faculty of Pharmaceutical Sciences

Purpose: The purpose of this project is to pilot test a questionnaire that will be used to gather baseline patient data in a province-wide study investigating the effectiveness of the smoking cessation agent bupropion.

Methods: Previously reported efficacy trials on bupropion were reviewed to observe the baseline characteristics of sample populations measured. Based on these observations, the baseline survey instrument was designed and pre-tested. Peer-, colleague-, and expert-review were employed to establish the instrument’s face and content validity. It was then pilot tested for acceptability and readability in a convenience sample of 13 pharmacies over a 5-week period. Participating pharmacists invited smokers 19 years of age or older who were presenting with a prescription for bupropion to complete the questionnaire. Both the pharmacists and patients provided constructive feedback on the clarity of the instrument. Data obtained from completed questionnaires were analyzed with the Statistical Package for Social Sciences (SPSS version 10.0) for Windows.

Results: Recruitment occurred at 9 of the 13 pharmacies, as 4 were unable to recruit participants due to low bupropion use at their pharmacy. A total of 14 bupropion users participated in the pilot test. Of the 14 patients, 50% were female, 71.5% were under the age of 40, and 85.7% rated their health as good or very good compared to others their age. When asked to report their readiness to quit smoking, 21.4% indicated that they plan to quit within the next 6 months, 42.9% within the next month, 28.9% within the next week, and 7.1% had quit successfully for at least one day. Patients scored a mean of 6.27 (± 2.70) out of 11 on the Fagerström Tolerance Questionnaire (FTQ), indicating a “high” level of nicotine dependence. Participants reported an average of 2.1 previous attempts at smoking cessation and nicotine gum was the most common method used. 21.4% of participants indicated that they intended to use the nicotine patch as a supplement with to their bupropion therapy.

Conclusions: The questionnaire was well accepted in terms of length, readability, and content by patients and pharmacists. Characteristics of the patient sample in the pilot study were similar to those of participants in the efficacy trials of bupropion. The low number of patients being treated with bupropion in the pilot test region suggests that the sampling strategy for recruiting 450 patients in the full-scale study may need to be reconsidered to obtain the target. Although bupropion therapy is intended to commence one week before the target quit date, 64.3% (n=9) of the patients did not intend to quit within the next week. This suggests that the patients are unaware of this fact, they are not sufficiently motivated to quit smoking, or that they are not planning to initiate the cessation attempt until a later date. Mean FTQ scores were relatively low compared to those of the sample populations of other smoking cessation studies. This, however, may indicate better success with bupropion for this sample of patients since previous research has demonstrated that lower FTQ scores are predictive of bupropion efficacy.

Acknowledgments: CIHR/Burroughs-Wellcome Fund, CORxE UBC Researchers

Effects of acetylsalicylic acid on Diabetic Heart Dysfunction

Ivana Dojcinovic, Violet G. Yuen, Mary Battell and John H. McNeill. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, B.C.

Purpose: One of the most important complications of poorly controlled diabetes is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy have ventricular dysfunction, which can lead to accelerated heart failure. It has been suggested that high doses of acetylsalicylic acid (ASA) can improve the severity of diabetes by lowering plasma glucose concentration. The purpose of this study was to investigate if ASA treatment can improve ventricular heart function in experimental diabetes.

Methods: Male Wistar rats were randomly divided into four groups: control (C), control treated with 50mg/kg ASA (CT), diabetic (D), and diabetic treated with 50mg/kg ASA. Diabetes was induced by a single tail vein injection of streptozotocin (60mg/kg). ASA was administered daily by oral gavage. After 8 weeks of treatment, the hearts were isolated and perfused. Perfusion was initiated in the retrograde manner through the aorta. Cardiac work was initiated by switching from the retrograde mode to the working heart mode so that buffer enters the left ventricle via the left atrium and exits through the aorta. The heart was paced at a constant heart rate of 300 beats/min. Left ventricular performance was assessed in terms of rate of ventricular contraction (+dP/dT), rate of ventricular relaxation (-dP/dT) and left ventricular developed pressure (LVDP) in response to increasing left atrial filling pressures (preload). The effects of treatment on the food and fluid intake, fasting plasma glucose, triglycerides, free fatty acid and insulin levels were also examined.

Results: Treatment of the control groups with ASA did not produce any changes in food and fluid intake, plasma glucose, triglyceride, free fatty acid, and insulin levels. ASA did not lower the elevated fasting plasma glucose and triglyceride levels in diabetic rat groups. There was also no effect of ASA treatment on the low insulin levels and high food and fluid intake of diabetic rat groups. However, ASA treatment slightly but significantly lowered the free fatty acid levels in diabetic rats. Hearts from both untreated and treated diabetic groups showed a depressed response to increases in atrial filling pressures from 10 to 11 mmHg in terms of +dP/dT, -dP/dT and LVDP. The treatment had no effect on the ventricular response in control rats.

Conclusions: ASA did not have any effect on the plasma glucose levels of both control and diabetic rats and was not able to improve ventricular heart function in experimental diabetes under conditions of increasing preload at the dose used in this study.

Acknowledgements: ID was partially funded by Summer Career Placements.

Development of web-enabled cross-disciplinary case-based problems using the faculty of pharmaceutical sciences Web-Based Learning Centre (wblc)

Philip Hui and Simon P. Albon. Faculty of Pharmaceutical Sciences, The University of British Columbia

Objectives: The objective of this project was to establish an interdisciplinary approach to teaching and learning in the pharmaceutical sciences through the development, implementation and utilization of WBLC-enabled cross-disciplinary case-based problems. Specific aims included:

1) to create an effective and efficient case writing process that addressed student learning needs, faculty learning objectives, course delivery needs and curriculum outcomes;

2) to develop patient-centred, case-based problems that help learners integrate knowledge across the disciplines of pharmaceutical sciences and,

3) to deliver the problems on-line through the WBLC to support the interdisciplinary nature of the cases and to promote fundamental changes to faculty-student contact time.

Methods: Development of cross-disciplinary case-based problems for WBLC delivery required four phases:

1) identifying student learning needs as the foundation for case development;

2) developing cross-disciplinary case-based problems using macro- and micro-processes,

3) implementation planning and

4) web-enabling.

Identifying student learning needs involved meeting with faculty members across pharmacy disciplines and with students to determine knowledge and skill sets that were difficult to teach and/or to learn. Knowledge and skills sets were identified with consideration for the WBLC project objectives, course instructional objectives and the ability-based outcomes of the Faculty’s new curriculum. Bridging the teaching and learning needs of faculty and students was accomplished using a macro-process to create patient-centered clinical practice topics. The macro-process involved meetings with faculty experts to identify appropriate cross-disciplinary clinical topics and collection of discipline-specific learning materials relevant to the topic. The micro-process, including evaluation, iteration and refinement through faculty interaction, was used to generate the final case and corresponding guiding questions. Implementation planning involved working with faculty members to integrate the case into their course design as an assessable learning opportunity. Web-enabling involved posting the case in the appropriate WBLC course with strategic linking to appropriate content in the WBLC. Bulletin board forums were set up to facilitate case discussion.

Results: A prototypical WBLC-enabled patient-centred cross-disciplinary case-based problem was successfully created using an effective and efficient case writing process. The case topic involved the use of risperidone in the treatment of schizophrenia. The case was written as a unifying story including five stages of increasing complexity and incorporating aspects of pharmaceutics and biopharmaceutics, pharmaceutical chemistry, pharmacology and toxicology, professional practice and clinical pharmacy. The stages can be delivered in a longitudinal fashion to coincide with the progression of learning materials taught at the course and program levels or independently as required. WBLC-enabling provided on-line access to the case and guiding questions along with integration through strategic links to relevant resource materials within the WBLC. Case designer and tutor manuals were developed to support the case. The WBLC-enabled case-based problem will be implemented and tested in Pharmacy 311 during the 2001-2002 academic year.

Conclusions: A prototypical WBLC-enabled patient-centred cross-disciplinary case-based problem was successfully created using an effective and efficient case writing process. This web-enabled case-based problem represents a new pedagogical tool in the Faculty of Pharmaceutical Sciences that is expected to help learners integrate knowledge across the disciplines of pharmaceutical sciences and promote fundamental changes to faculty-student contact time.

Acknowledgements: The authors would like to acknowledge generous support from the University of British Columbia’s Teaching and Learning Enhancement Fund (to SPA), the Government of British Columbia’s Student Summer Career Placement Program, the Faculty of Pharmaceutical Sciences, Dr. Ric Procyshyn, Dr. Helen Burt, and Ms. Lynda Eccott.

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