Calculate the amount of calamine required to prepare 60 g of a cream
containing 10% calamine, 15% zinc oxide, aqueous cream to 100 g:
A ❏ 4
B ❏ 5
C ❏ 6
D ❏ 7
E ❏ 8
The Management of Fertility and Assisted Reproduction Workshop, an international symposium, jointly organised by the International Federation of Fertility Societies (IFFS) and the Association for Fertility and Reproductive Health (AFRH) is billed to hold from 17-19 May 2018, in Lagos, Nigeria.
The venue for the workshop is Radisson Blu, Ikeja GRA, and Lagos.
Being the first workshop of its kind in Africa, endorsed by the International Federation of Fertility Societies, it will introduce and complement a comprehensive training package for all medical practitioners.
The workshop is organised for the benefit of medical practitioners interested in the field of Assisted Reproductive Technology, which include but not limited to, clinicians, embryologists, pharmacists, researchers, nurses, counsellors, and students.
Registration rates for the International Federation of Fertility Societies (IFFS) and the Association for Fertility and Reproductive Health (AFRH) IFFS-AFRH 2018 Workshop are listed below. Workshop registration will be available online and payment is accepted with a debit card. Early Registration is advised.
For More Information
Visit: http://www.afrhnigeria.org/view.html#!/IFFS2018 or IFFS Website: www.iffs-reproduction.org
Motivation is what gets you started. Habit is what keeps you going. – Jim Rohn
Movie superstars have one thing in common: They delight their fans. The more an actor delights his fans, the higher he soars. Any actor who has the ability to make his fans laugh, cry and swing from one mood to another will ensure followership and loyalty from such fans.
Customers – just like fans – have a lot of options available to them. Technology has changed a lot of things today. The customer has a lot of choices to make from diverse alternatives. He can switch to other choices within seconds.
Sometimes, I allocate time to listen to local and international news. Each time I do this, my remote control is always beside me, any TV station that doesn’t meet up with my expectation is ditched immediately without a second thought. A lot of folks do this also. People will not waste their limited time on immaterial things. If you want people to follow you everywhere you go, you need to make a lot of sense.
Selling is acting and acting is selling
The salesman and the movie actor have one thing in common. The salesman wants to impress and satisfy the prospects and customers, while the actor’s target is to delight his fans. Both professionals have audiences to satisfy and they must do the job well.
The salesman’s customers and the actor’s fans are classified as spectators in the context of this write-up. The spectators watch while the salesman and the actor perform their duties. The salesman and the actor are expected to impress their spectators if they must stay in business. The business will go bad once the spectators feel dissatisfied.
The art of selling is a form of Acting. The difference in the selling type of acting is that the actor (the salesman) acts real life scripts and not fiction or invented story. The salesman puts all his being in the script in order to appear real before the buyer. He swings moods when necessary in order to fit into the desires of the buyer. He ensures that whatever he does in the course of selling his products and services delights the buyer. The salesman must be convincing whenever he meets the buyer. His acting will go bad if he fails to look believable.
Your presentation is your acting script
Sales presentation in selling requires high level of acting. Sales presentation is a stage performance. It is not just a presentation; it is an act tailored to fit the audience. The salesman must ensure that he is tailored to fit. His presentation style and confidence level must be appropriate. His products and services must be ideal, credible and apt for the environment.
A good presentation is the one that catches the attention of the buyer. It states what the product intends to do and how it will achieve it. It shows the why of the buying. It is not just a presentation – it is a display of anticipated performance.
Jeffrey Gitomer puts it in an exciting way when he said, ‘‘Salespeople make the fatal mistake of making a presentation. It’s not a presentation; it’s a performance.’’ It takes a lot to arrive at this point. This is where the salesman connects with the buyer. The prospect watches the salesman’s presentation skills, his oratory prowess, his self-confidence and the extent to which he knows his product, his company and the industry. All these sum up to making a movie on the part of the salesman. The salesman makes a real movie in this process! Once he gets it right, the buyer who is the spectator buys his products or services.
The more you delight the spectator, the more you sell
Today’s selling has gone beyond striving to close sales. Successful selling does not end in closing. Success in sales is a process that ensures satisfying and delighting prospects and customers. You may close a sale without satisfying the buyer. This happens sometimes and of course leads to one-off buying. Successful selling goes beyond closing.
A selling champion delights his customers by ensuring that the customer is the centre of his sales activities. Successful sales professionals get the buyer involved in the sales conversation. The prospect or customer will not get involved if he is not made to be part of the sales process. This means that the buyer should understand the salesman’s message from the beginning. No ambiguity. There is no ambiguity in sales. Clarity is the first product the salesman sells. Failure in sales begins with uncertainty. Ambiguity leads to failure.
You need to change your selling strategy if you are not meeting or exceeding your sales target. Sell like a movie superstar who inspires his spectators. Sell like a champion!
Legendary Brian Tracy was right when he said, ‘‘Once you start thinking differently, you start acting differently.’’ It’s your turn to be celebrated as the next superstar. Think it, believe it, demonstrate it and have it.
Sequel to media reports on Monday on the ravaging strange disease in Kano State, which was reported to have cliamed eight lives, the Kano government said it has dispatched a Rapid Response Team to check the authenticity of the reported outbreak of a strange killer disease in Dawakin Tofa Local Government Area of the state.
The state Commissioner of Health, Kabiru Getso, made this known through the Public Relations Officer of the ministry, Isma’il Gwammaja, on Tuesday in Kano.
He said that the story of the reported outbreak of the strange disease was reported through the media and that prompted the commissioner to direct the rapid response team to swing into action with a view to ascertaining the veracity of the report.
Mr Getso, however, revealed that as soon as the ministry received details on the findings of the team, it would be made known to members of the public.
NAN reports that on Monday evening, some media outfits in the state reported that a strange disease had claimed the lives of eight persons in Dungurawa community in Dawakin Tofa.
Ajibola Quadri Omotesho is president of the Pharmaceutical Association of Nigeria Students (PANS), University of Ilorin (UNILORIN), Ilorin, Kwara State. In this interview with Pharmanews, the final year pharmacy student discusses pharmacy students experiences in UNILORIN, being the institution with the most recently accredited faculty of pharmacy in the country, as well as the achievements of his administration and ways to improve pharmacy education in Nigeria. Excerpts:
How did you come to choose Pharmacy as a course of study?
As a kid, my happiest moment always came from making people feel better with everything I had. Also, my dad being a medical doctor and my mum, an optometrist, I took the initiative of wanting to make people healthy from both of them. Although, I initially wanted to be a medical doctor, I fell in love with Chemistry in secondary school; so I sought for a course that would balance my obsession with my subject of interest and Pharmacy was that course. Since then, I have been enjoying the ride.
What were your motivations for contesting for PANS presidency?
As the first child in a family of six, I was a born leader. Growing up, I was always motivated by the powerful quote which says “leadership is the ability to turn vision into reality”. So, for my vision to advance the status quo of PANS in the University of Ilorin, I have to be in leadership position. In order to realise my vision, I contested for the post of the president and to the glory of God, I won. In addition, motivations from friends and classmates were also important.
Could you tell us some of your achievements and challenges?
Ever since this administration came on board, we have been able to achieve giant strides. In this administration, we have maintained discipline in ensuring that students wear their laboratory clothing which was designed by us and this has been standardised for all laboratory activities.
We have also been able to actualise the commencement of the PANS Enterprise, a project initiated to provide basic services to our members, such as basic ICT services and provide for sales of laboratory materials, snacks, drinks and other essential items to ensure that every student gets everything they want at the faculty.
This administration also achieved a milestone at the last PANS national convention by mobilising the largest number of delegates so far from the University of Ilorin. Other novel ideas conceived by this administration are near realisation.
Your faculty produced its first set of pharmacy graduates in 2017. What would you say are the challenges facing pharmacy education in UNILORIN, and how can they be surmounted?
Being a new school of pharmacy, virtually all of the finances for maintenance of the laboratory materials and equipment come from the university board and sometimes generous donations from friends of the faculty from within and outside the faculty. Other schools of pharmacy have large and strong alumni associations that support the faculty in different ways which then serve to uplift pharmacy education in those schools. Faculty of Pharmaceutical Sciences, UNILORIN doesn’t have such solid alumni base which is understandable but still a challenge of sort to the pharmacy education.
Another one is on accommodation for pharmacy students. Accommodation has always been a challenge for pharmacy students in the school, as the school hostel has always been shared based on the total number of students in the faculty; and ours being a new faculty with low population of students always gets a very small slot. This affects pharmacy students’ academic performance, considering transportation issues too.
This can be resolved if there is a separate hostel built for pharmacy students; or better still, more consideration from the school for pharmacy students in allocation of hostels.
If you have the privilege to change some things about pharmacy education in UNILORIN, what would they be?
Pharmacy education in UNILORIN is a complete one, equipping every graduate of the school with solid practical knowledge with sound theoretical background. But if I am to change one thing, it is the conduct of the Students’ Industrial Work Experience Scheme (SIWES) for pharmacy students, an initiative designed to expose pharmacy students to practical experiences of how the profession is being run.
The duration of this training for pharmacy students is about three months in a particular establishment, which, from personal experience, is not usually enough. Hence I will change the duration of this training to about six months in a particular establishment, allowing students to grasp full practical knowledge, including the confidence which will help them after graduation and during internship.
The management UNILORIN recently released a circular regarding dress code for students, and there has been uproar in the media with regards to some of the dress codes prohibited. How would you react to this?
In the university, all students are assessed both in character and in learning; and a subset of character is the dressing of all students in the school. The saying, “The way you dress is the way you will be addressed “, is being preached far and wide within the school. Every student of the school is an ambassador of the school, so there is a need for the university to have a say in how students of the school should be perceived; hence the dress code.
Although some students termed the dress code prohibitions as being too harsh but I believe there are very good reasons for this prohibitions. This control has contributed to the school being the most sought after university in Nigeria as parents are assured of inculcation of good character in the students by the school.
There has been another controversy surrounding the Nigeria Bar Association and the UNILORIN law graduate, Amasa Firdaus, who was refused her call to bar for failing to remove her hijab, what is your take on this, especially as regards pharmacy students in the school.
The issue of the University of Ilorin law graduate who was refused her call to bar just because she didn’t want to remove her hijab is being viewed from different perspectives in the school – some commend her, while some condemn her. For me, it is a subject of modesty and principles. As men of honor, we must uphold both at all times; and this can be observed amongst pharmacists and pharmacy students as the wearing of hijab in line with religious injunction is viewed as an excellent dress code in pharmacy school, UNILORIN. There is no discrimination concerning wearing of hijab over here and this should be replicated elsewhere.
What is the level of support PANS-UNILORIN is receiving from technical bodies like PSN and ACPN in Kwara State?
The backbone of PANS-UNILORIN has been both the faculty board and the Pharmaceutical Society of Nigeria (PSN), Kwara State. The support received from PSN Kwara State has always been superfluous, both morally and financially, as they are always ready to welcome PANS whenever we go knocking.
The support of the PSN, Kwara State, and other technical bodies of PSN, especially during the organisation of our first PANS week cannot be overemphasised. PANS is usually given the opportunity to present its update during the monthly meetings of PSN. Important contributions from these notable personalities have been a driving force for PANS-UNILORIN and we are rapidly developing.
The national body of PANS has also been supportive, as PANS-UNILORIN has always been carried along, even before we were fully accredited
A charitable pharmacy may be defined as a not-for-profit pharmaceutical premises or pharmacy location where prescription drugs and other approved medicinal products are supplied directly to a specific population of qualified persons as allowable under the law.
In the USA, for instance, pharmacy laws vary from state to state; and in those states where regulations permit the operation of a charitable pharmacy, specific guidelines may limit the scope of prescription drugs that could be dispensed from the medicine bank.
Regulations on charitable pharmacies in states where medicine banks or drug product recycling is permitted typically cover operational areas related to:
(a) Whether individuals, manufacturers, wholesalers, hospitals or business corporations MAY or MAY NOT donate drug products to a charitable pharmacy.
(b) Whether a charitable pharmacy may or may not charge a FEE for the dispensing processes.
(c) The prescription drug products that may be: donated, received and dispensed in a charitable pharmacy.
(d) Exclusion of controlled drug substances in the list of drugs that may be stocked by a charitable pharmacy.
(e) The type of non-governmental organisations (NGOs) that are allowed under the law to operate a charitable pharmacy
(f) Whether The charitable pharmacy MAY receive donations in monetary terms or not in the operations of its free service.
(g) Geographical locations permitted by law for the charitable pharmacy because of the specific population group it is intended/allowed to serve. Cities appear more probable due to high population.
(h) Whether the patient population served in the charitable pharmacy may or may not participate in manufacturer sponsored drug-product clinical trials OR if manufacturer drug samples are allowed for distribution in the premises of the pharmacy.
(i) Time interval to product expiration (in months) permitted for DRUG donations to a charitable pharmacy; And, whether specialty medicines or refrigerated products are allowed or not.
(j) Staff recruitment, tenure of employment, volunteer services and whether workers in a charitable pharmacy may receive remuneration for work or not. For example, interns or students on attachment.
(k) Scope of services to be offered outside of prescription drug dispensing, that is, if the services includes medication therapy management, vaccination and or the dispensing of “non-proprietary” products aka over-the-counter drugs.
(l) Whether a charitable pharmacy may or may not receive and or transfer prescription products to a “for-profit pharmacy” or such other profit oriented health centers and vice versa.
(m) A clear definition of the physical appearance and or characteristics of products that may or may not be donated to a charitable pharmacy. For example, “must” be in original manufacturers’ pack unopened. Or, “may” be in original unbroken packaging from the: pharmacy, wholesaler, distributor, or manufacturer.
(n) Whether the recipient(s) of prescription products dispensed by the charitable pharmacy” must” be present in person as “proof of need” or whether a care giver or family member may present the drug-order on their behalf.
(o) How the charitable pharmacy will dispose of expired medications to a reverse distributor for destruction?
(p) The operational hours of a charitable pharmacy especially as relates to weekends and holidays.
According to a study by the Congressional Budget Office (CBO) up to 18 million persons may lose Health Insurance coverage following a repeal of The Affordable Care Act (ACA), and five million more who receive coverage under The ACAs Medicaid expansion programme could be negatively impacted in addition.
The same study estimates that by 2026, the numbers of uninsured may reach 59 million individuals. Free clinics and medicine banks therefore have a progressively complementary role in increasing patients’ accessibility to healthcare and medications, particularly in circumstances such as the flu epidemic, when emergency room ER services are typically overstretched.
A Report by The National Conference Of State Legislature 03/31/2017 titled “State Prescription Drug Return, Reuse and Recycling Laws” reveals some interesting data on the positive impact of Charitable Pharmacies in some States where the Law has been operational:
For NGOs that may be interested in the project of a charitable pharmacy, that is, in places where legislation or enactments permit; For emphasis, other important considerations of note relevant to a successful outcome shall include:
(i) How to secure a safe and adequate building (possibly a donation) towards the project?
(ii) How to recruit a volunteer team of interested professionals and how to ensure adequacy of staff once the project kicks off?
(iii) How to raise FUNDS (possibly from corporate sponsors and individuals) by philanthropy, towards the take off and for operational expenses per projections of community need?
(iv) How to identify people who are favorably disposed to charitable services in the community and those including students who may be willing to volunteer towards the initial development of the project?
(v) Identifying the type of professional manpower needed for a successful operation of a charitable pharmacy, that is, other than the pharmacist, since, state and federal law requires filing annually and appropriately too, a statement of income and or expenditure showing value of Inventory held per year.
(vi) How to screen prospective patients for eligibility and how to define eligibility criteria for a charitable pharmacy particularly in accordance with state or federal law?
In conclusion, a charitable pharmacy, as the name rightly suggests, is a pharmaceutical premises established primarily for the needy in our communities, and, it serves as a unique means of providing much needed prescription drugs to the indigent in a community so that healthcare does not elude them and their families.
On 8 March 2018, the world marked International Women’s Day to recognise the achievements of women throughout the world, as well as to highlight their rights and challenges. Currently, much effort is particularly being made by governments and other stakeholders in sub-Saharan Africa to address issues affecting women’s right and reproductive health. Yet, only very few people on the continent have dedicated their lives for this cause. Prominent among them is the pioneer and current Vice Chancellor of Ondo State University of Medical Sciences, Professor Friday Okonofua.
Okonofua is a Professor of Obstetrics and Gynaecology at the University of Benin. An internationally renowned expert in women’s sexual health and reproductive research, he has been at the forefront, championing the advancement of women’s rights and reproductive health in Nigeria and indeed Africa. He has led and conducted many seminal research programmes, as well as documenting the socio-cultural determinants of women’s health. He has equally provided critical data for developing policies and programmes for implementing best practices in sub Saharan Africa.
In recognition of his outstanding research and expertise in women’s reproductive health, he was appointed as the executive director of the International Federation of Gynaecology and Obstetrics in 2009. He was also an Honorary Adviser on Health to President Olusegun Obasanjo from July 2006 to May 29, 2007.
Professor Okonofua is a recipient of more than 40 research grants, and he is a member of several international organisations and committees, including the editorial board of the British Journal of Obstetrics and Gynaecology, where he has served for more than 12 years. He is a reviewer to 20 international journals, and a technical consultant to many international agencies, including the World Health Organisation, the Macarthur Foundation.
In 2010, he was appointed as the programme officer, Ford Foundation, West Africa Office and in 2012, he was appointed as Chairman of Ethical Review Board of the Nigerian Institute of Medical Research. In 2014, he was appointed as the Team Leader of the University of Benin chapter of the West African Regional Centre of Excellence in Reproductive Health Research and Innovation (CERHI). All three positions he holds till date.
Professor Okonofua’s vision and passion for women’s rights and their reproductive health spurred him to establish the Women’s Health and Action Research Centre (WHARC) in 1993. WHARC is non-governmental, charitable organisation focused on promoting female reproductive health research.
Located in Benin-City, Nigeria, WHARC consists of a multi-disciplinary team of health, social science and legal professionals and researchers working together to build the knowledge base and to improve the policy environment for advancing women’s health in Africa. The Centre also publishes the African Journal of Reproductive Health (AJRH), now widely recognised as the leading journal that promotes women's reproductive health and the principles of sexual rights, equity and social justice in sub-Saharan Africa.
In 1999, Okonofua established the Owan Women Empowerment Project, a not-for-profit organisation headquartered in Afuze, Edo State. The organisation was handed to the local community in 2008, with a handover grant of $100,000 from the Ford Foundation.
Professor Okonofua attended the University of Ife (Obafemi Awolowo University) where he obtained his bachelor’s degree in Health Science in 1978. He began his career in 1978 at University of Benin Teaching Hospital as a medical intern. After his internship in 1979, he was mobilised for the compulsory one year national youth service programme and was deployed to Ipokia District Hospital, Ogun State as a medical officer. He completed his youth service in 1980, the same year he became a senior house officer at the Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital. In 1983, he became a Senior Registrar in the department and in 1984 he was promoted as Chief Resident Officer.
In 1981, Okonofua enrolled for his fellowship at the National Postgraduate Medical College of Nigeria and the West African College of Surgeons. He became a fellow of the West African College of Surgeons in 1984 and a fellow of the National Postgraduate Medical College of Nigeria in 1985. Between 1984 and 1985, he was a clinical research fellow at the Department of Chemical pathology of Royal Free Hospital, the teaching hospital of the University of London. In 2005, he received his PhD in International Health from the Karolinska Institute in Stockholm, Sweden.
Professor Okonofua commenced his academic career as Lecturer 1 in the Department of Obstetrics and Gynaecology at the Obafemi Awolowo University in 1986. He served as the Acting Head of Department between 1987 and 1992, and rose to the post of Professor in 1992. He transferred his services to the University of Benin in 1996, where he served as the Head of Department, Dean, Provost, of the college of medicine and member of the University’s Governing Council.
Special recognitions:
Professor Okonofua is a recipient of several honours, including the Distinguished Alumnus Award of the Obafemi Awolowo University, Special Achievers Award by the Nigerian Television Authority, Distinguished Services Award by the Society of Gynaecology and Obstetrics of Nigeria.
Professor Okonofua was a Takemi Fellow in International health at School of Public Health, Harvard University between 1991 and 1992. In 2004, he became a fellow of the International College of Surgeons. He is also a Fellow of both the Nigerian Academy of Science (FAS) as well as the New York Academy of Science. He has also authored and co-authored several books, scholarly articles, monographs and technical reports on women’s sexual and reproductive health.
You are what your deep driving desire is. As your deep driving desire, so is your will; as your will is, so is your deed; and as your deed is, so is your destiny.
In my profession, Pharmacy, there is what is called pharmaceutical index of a drug.
This is the range within which drugs are optimally effective to produce pharmacological response required of the drug. Any alteration (increase or decrease) in this therapeutic index will not and cannot produce optimal response.
In a similar vein, each individual has his own therapeutic index, an optimal functioning area where he can and will function at its best. This is a point where he can function optimally and this is where the greatness of his destiny lies.
Every individual must endeavour to study himself and find out his optimal functioning zone. English philosopher and writer G.K. Chesterton remarked, “One may understand the cosmos, but never the ego, the self is more distant than any star”.
You must find ways to be an active force in your life. You must take the total advantage of your destiny, design a life of substance and truly begin to live your dreams. If your therapeutic index is a fashion designer and you are a medical practitioner, you might not find fulfilment. If your optimal functioning zone is entertainment and you are in security, you may not grab your destiny.
One of the most important factors that determine your destiny is your ability to determine your niche in order to perform optimally. Imagine if Isaac Newton had ventured into business without discovering his ability to observe things minutely, which is a major pre-requisite in science, he probably would not have been known. Discovery made him a great scientist.
Michael Dell, Bill Gates, Christiana Ronaldo, Usain Bolt, Jeff Bezos, Strive Masiyiwa, Tony Robbins and Ben Carson are great men of the world because they discovered themselves. There is always a worthy price for discovery. “No one remains quite what he was,” said Thomas Man “when he recognises himself.”
Robert Kelly, popularly known as R. Kelly, discovered his music talent at an early age. This is what makes him a superstar among the stars. David Beckham’s parents discovered his football skill in his early life and this was what brought him fame and fortune. For you to reach the zenith of success, you must discover who you are, your abilities, strengths, weaknesses, potentials, talents, skills and personality. Those who have learnt early in life to look inward, study themselves and follow their native gifts are those who conquer the world and grab their destiny.
Many people have travelled through the wrong path in life and this has affected their destinies. Here is the good news; it is never too late to rediscover yourself. Your age, status, gender, condition or position in life does not limit you in rediscovering yourself. You must cast your mind back to the past, link it with the present to determine your future.
Self-awareness is of importance in discovering who you are. Self-awareness allows you to connect with your emotions, thoughts and actions. You must learn to be aware of your actions. One way to do this is by examining how you make appraisals. Appraisals are all of the different impressions, interpretations, evaluations and expectations you have about yourself, others and situations. These appraisals are largely influenced by your conscience. It takes everything you gather as information already stored in your mind.
Taking cognizance of your thoughts influences your self-awareness, actions and reactions, thus allowing you to alter them, if they are not right.
Discovering your strength involves knowing your passion. What do you engage in that brings you happiness and fulfilment? What do you consciously or unconsciously always find yourself engaging in? It may even be that friends and family members have acknowledged you for this ability. Then I’m convinced, that is your therapeutic index, your optimal functioning zone, your strength and where the greatness of your destiny lies.
Humorously, I always put it like this. “If you want an hour of happiness have a nap; if you want a day of happiness go for a picnic; if you want a week of happiness go for a vacation; if you want months of happiness marry your beautiful spouse; if you want years of happiness, inherit wealth; but, if you want a lifetime of happiness discover your passion and follow it.”
Neil Somerville said, “You are the master of your destiny, use your strength well. They are the keys to your destiny and your success in life. Once you know yourself and take action to realise your dreams, you can unlock the doors to your own potential”. You must be faithful in discovering yourself for you to be fruitful in life.
ACTION PLAN: Take 30 minutes and write an article with the title, “Who Am I?” Reflect back on your past experiences, connect them with the present and link them to the future as you write.
AFFIRMATION: I operate within my therapeutic index. I am blessed and highly favoured.
Taking a multitude of prescription medications at a time is described as polypharmacy. More than five drugs administered by any route constitute too many drugs in a prescription, according to the World Health Organisation (WHO). This is a massive burde
n on patients, as it leads to a myriad of drug interactions, adverse drug events, medication non-adherence, reduced functional capacity, cognitive impairment, falls, urinary incontinence and poor nutrition, which all invariably lead to bad therapeutic outcome.
Polypharmacy is most prevalent amongst the elderly, hospital in-patients, and nursing home patients. The best interventions involve an inter-professional approach that often includes a clinical pharmacist.
Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported that 39 percent of those over age 65 now use five or more medications, a 70 percent increase in polypharmacy over 12 years. It is therefore imperative that the pharmacist enlightens other members of the healthcare team, as well as the patients, on medicines and the complexities of prescribing and taking too many drugs.
Community pharmacists on the other hand, must not coerce patients into buying drugs with the aim of making sales alone. This leads us to an alternative definition of polypharmacy, which is the use of more medications than are medically necessary. For this definition, medications that are not indicated, not effective, or which constitute a therapeutic duplication would be considered polypharmacy. It is therefore imperative for pharmacists in the community practice to balance professionalism with business ethics by selling and dispensing only prescription medicines necessary for a patient’s condition.
Patients and families must ask their pharmacists for medicine use review services, where they bring all the drugs they use to discuss whether to change or continue certain drug regimens. I remember the case of a patient taking four different supplements, all containing calcium, without knowing. My timely intervention saved her from complications such as hardening of arteries which could be fatal.
Some drug combinations can spell trouble when prescribed, especially in the elderly. For instance, using aspirin as a painkiller, while using clopidogrel, could lead to severe bleeding through the blood-thinning effect. A combination of simvastatin and amlodipine should also be avoided in any prescription, as statins, along with their cholesterol-lowering properties, can cause muscle pain and weakness; amlodipine heightens that risk. A different blood pressure, drugs such as Lisinopril would be a safer choice.
One of the complications that arise as a result of polypharmacy includes devastating falls, leading to broken hips and head injuries, many of which account for preventable visits to emergency care, causing higher mortality risks overall.
Polypharmacy can be addressed on two fronts, which involve engaging healthcare providers and patients themselves. In meetings or gatherings involving any association of healthcare workers, discussions should be tailored towards weaning patients off dubious medications and educating them on the risks and benefits of the drugs being prescribed and dispensed by the doctor and pharmacist respectively. Information on how to manage multiple prescriptions should be discussed with patients.
The patient, or any caregiver close to the patient taking multiple medications, can combat potentially dangerous problems by keeping a list of all medications, including vitamins and over-the-counter items. On every hospital visit, ask the pharmacist to help check your list for any complications and remember to report all adverse drug reactions.
Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to healthcare. Team effort will bring about a radical change in overcoming polypharmacy as physicians, pharmacists and nurses must work together to reduce drug wastage, adverse drug reactions and bad therapeutic outcome.
By Ayodeji Oni
(Freelancing for Advantage Health Africa)
Pharm. Ajibola Nojeem Lawal is the founder and chief executive officer of Nokadiz Pharmaceuticals Limited, a giant wholesale and retail pharmaceutical enterprise in Bauchi, Bauchi State.
Lawal, whose pharmacy career spans over 30 years, covering hospital practice, public health and community practice, is a University of Washington trained expert in leadership and health management.
A holder of a B.Pharm from University of Ibadan (1987), Lawal also holds a PGD in Management (2000), an MBA in Marketing (2004) and another PGD in Public Health (2007) all from Abubakar Tafawa Balewa University, Bauchi.
A specialist in procurement and logistics management of ARV drugs and capacity building of health service providers, his rich career has seen him work with government, international non-governmental organisations and local communities. He has continued to demonstrate extensive knowledge of resource management, programmatic and technical support on HIV/AIDS, malaria and nutrition activities.
Lawal has been a pharmacy specialist for the Howard University Global Initiative in Yobe State since July 2013. He has worked as a consultant on several health projects across the northern and southern states for several years. These included Bauchi State government and organisations such as Society for Family Health, Global Fund, and World Bank.
The Abeokuta, Ogun State born pharmacist was the chairman, Transport and Security Committee (LOC), PSN national conference, Yankari 2004, Bauchi; vice chairman, National Association of General Practice Pharmacists (NAGPP), Bauchi, 1995 to 1997; and secretary, Association of Community Pharmacists of Nigeria (ACPN), Bauchi State, 2008 to 2013.
He is happily married to Mrs Khalimat Omayoza Lawal and blessed with four children.
By Comrade Nurse Abdrafiu Alani Adeniji (National President, National Association of Nigeria Nurses and Midwives)
Nursing profession is perhaps one of the most underrated and misunderstood professions in the Nigerian society. Despite constituting the largest number of global health care professionals and being the most predominant component of any hospital personnel infrastructure (in the United States, the number of registered nurses is more than four times the number of practicing physicians), the truth remains that very few people understand the myriad roles and responsibilities of nurses until they are in need of nursing care themselves.
Nurses and their contributions are vital components of any reliable healthcare organisation striving for zero patient harm and quality care. It has been suggested that hospitals promoting better nursing environments with above-average staffing ratios experience lower patient mortality, particularly for patients considered “high-risk.”
According to Terry Fulmer, president of the John A. Hartford foundation, “whether people know it or not, they come into hospitals for nursing care.” For example, if a patient comes in for surgery, that operation may last hours, but subsequent nursing care may be required for days, weeks, and even months, depending on the patient’s trajectory.
Surgery is one thing, but it is the nursing care post-surgery that will determine how quickly patients recover, the success or failure of the intended surgical outcomes, and the quality of life recovered during a tenuous post-operative phase. In essence, the success and failure of the surgical, gynaecological, obstetrical, ophthalmological, dental, oncological, psychiatric and various medical cases are determined by the quality of nursing care services.
The Nigerian situation
Unfortunately in Nigeria, there are times when nurses, whose services are critical to patients’ treatment outcome, are not involved in patient care plan and management. Over here, the understanding of the public on who a nurse is so confusing because of the infiltration of the divine professional jurisdiction of nursing practices by quacks. The knowledge deficit is so massive that any female or anybody seen in white is called a nurse; thus, whatever misdemeanour coming from such a person is anchored on the image of the noble profession of nursing.
It is rather unfortunate however, that this lack of a deep understanding of the importance of the nursing profession and the resultant underrating of nurses is having adverse effects not only on healthcare systems but also on economies of the nation, continent and the world at large. There is no gainsaying that the nursing profession forms the pivot around which all other health professions revolve and as such is a determinant of the health care system in the society.
It has been recognised that the health system of any country is a reflection of how its nursing professionals are regarded and treated. The former ICN president aptly captures this in the following statement; “The wealth of our nations depends on the health of our populations, and the health of our populations depends on nursing” (Judith Shamian, Former ICN president, 2017).
What is nursing?
A classic definition of nursing has been given by Virginia Henderson, a distinguished American nurse educator and writer. She defined nursing as: “the art and science of caring, aimed at assisting the individual sick or well in the performance of those activities contributing to health or its recovery (or peaceful death) that he would have performed unaided if he has the strength, will or knowledge, and to do this in such a way as to help him gain independence, rapidly as possible.” She further stated that “this aspect of her work, this part of her functions, she initiates and controls; of this, she is master.”
The American Nurses’ Association defines nursing as the protection, promotion, and optimisation of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
The International Council of Nursing (ICN) while expatiating these two definitions stated as follows; “Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual, family, and group “responses to actual or potential health problems” (ANA, 1980, P.9).
These human responses range broadly from health restoring reactions to an individual episode of illness, to the development of policy in promoting the long-term health of a population. The unique function of nurses in caring for individuals, sick or well, is to assess their responses to their health status and to assist them in the performance of those activities contributing to health or recovery or to dignified death that they would perform unaided if they had the necessary strength, will, or knowledge and to do this in such a way as to help them gain full of partial independence as rapidly as possible (Henderson, 1977, p.4).
Within the total health care environment, nurses share with other health professionals and those in other sectors of public service the functions of planning, implementation, and evaluation to ensure the adequacy of the health system for promoting health, preventing illness, and caring for ill and disabled people.
ICN summarised the essence of nursing in this definition: “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”
Who is a nurse?
The nurse has been defined by the ICN as “a person who has completed a programme of basic, generalised nursing education and is authorised by the appropriate regulatory authority to practise nursing in his/her country.” It adds: “Basic nursing education is a formally recognised programme of study providing a broad and sound foundation in the behavioural, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post-basic education for specialty or advanced nursing practice.”
According to the ICN, the nurse is prepared and authorised:
(1) to engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all health care and other community settings;
(2) to carry out health care teaching;
(3) to participate fully as a member of the health care team;
(4) to supervise and train nursing and health care auxiliaries; and
(5) to be involved in research. .
The above definitions obviously leave no doubt that the scope of nursing is not limited to the hospital or a clinical setting; it cuts across all facets of our society. It will interest the society at large to know that there are over 100 specialties in nursing – underscoring the fact that the nursing professional is a polyvalent entity who has a wide variety of functions in the healthcare system and the society at large.
Duties of the nurse
The functions of a professional nurse are multifaceted and can be categorised basically into three levels of competencies, namely: independent, interdependent and dependent roles. The independent roles are those ones that the nurse is able to perform without the supervision or assistance of anyone. And as Virginia Henderson stated in her definition, this aspect the nurse initiates, controls and is a master of.
The nurse has his or her professional jurisdiction especially in the nurses’ core competences wherein the nurse is trained, certified, and legally covered, recognised, registered and licensed to practise in and outside the country. These are the autonomous duties and responsibilities.
The interdependent roles of the nurse are those that he or she performs in collaboration with other professionals within and without the health profession. While a nurse needs the input of other healthcare professionals, these other professionals also need the input of nurses to be able to carry out their professional duties. The medical/surgical teams need information from firm/ward/ unit charge nurses about the patient to take an informed professional decision.
The nurse is trained to understand the importance of intersectoral/professional collaboration to the achievement and maintenance of good health and therefore works in conjunction with others in the pursuance of activities leading to health promotion and illness recovery
The third tier of the nurse’s functions comprises the dependent roles which are functions the nurse relies on other professionals to perform. This discussion will briefly consider a few of the polyvalent functions of the nurse the hospital/clinical setting and in the community setting.
(Continues in next edition)
By Ihekoronye, Romanus Maduabuchi
A community pharmacy is a healthcare facility, under the legal supervision of a registered pharmacist that provides professional pharmacy services in a local community.
The World Health Organisation (WHO) affirms the community pharmacist as the health professional most accessible to the public (WHO, 1997). According to the International Pharmaceutical Federation (FIP), the community pharmacist is an expert in pharmaceutical care, health promotion and pharmacotherapy. He is a professional communicator with patients, other healthcare professionals and decision makers. He delivers high quality products, services and communication. The community pharmacist equally documents his actions and communicates outcomes with professional colleagues (FIP, 2014).
Community pharmacists have also earned themselves the reputation of the most trusted healthcare professionals (APHA, 2009). These global reputations stem from the fact that community pharmacies are located close to where the people live, work and play, stay open for long hours and require no previous appointment bookings to see the pharmacist. However, operating and managing retail pharmacies in a developing economy like Nigeria is fraught with a myriad of challenges, from over-regulation, chaotic distribution channels and unpredictable policy environment, to hyper-competition and deficient public infrastructure. Yet, the activities of community pharmacies are so vital to the lives of the communities that they are classified as essential services by most governments. Most retail pharmacies provide not just essential, safe, quality and efficacious medicines but also sound professional services by the pharmacists.
In Nigeria, there are about 4500 retail pharmacies serving over 170 million citizens. This means almost 40,000 individuals being served by one community pharmacy. Moreover, in view of the poor economic indices with the attendant high prevalence of diseases, one could be tempted to assume that every community pharmacist would have his hands full with the sick in need of good health and that retail pharmacy business in Nigeria would easily flourish. However, this assumption has never found a place in the operations of many retail pharmacies in Nigeria.
Business success requires an entirely different set of dynamics. Studies have shown that many pharmacy graduates have an enormous array of technical skills but do not necessarily have the business skills to leverage them for competitive advantage and business success (Alston and Waitzman, 2013). The critical building blocks for a flourishing business are essentially the same across different sectors of human endeavor. These business practices are not usually part of the academic curricula of the conventional educational institutions. They are taught in a different kind of school, the school of the real world, the University of the Streets.
Business success happens on the streets. The best business modules from all the business schools in the world cannot guarantee business success till the time-tested principles are translated from paper to the real world. However, a consistent application of these principles will guarantee business success, always. This explains why many non-pharmacists in Nigeria have managed to contrive very successful pharmaceutical business empires while the real pharmacists only tend to hang onto the crumbs that occasionally fall from the tables of the masters. The present article addresses itself to some of these salient determinants of business success as taught in the University of the Streets.
My dear pharmacist, the Pharmacists Council of Nigeria (PCN) may have told you that your license to practice empowers you to run a retail pharmacy business. That is the truth, but not the whole truth. The PCN forgot to tell you that success in retail pharmacy business requires passion for community pharmacy, so strong that it drives you to take personal responsibility for doing whatever is necessary for the business to thrive.
If you cannot work for long hours, answer many ‘stupid’ questions from customers, listen patiently to endless complaints, manage relationships with staff, landlords, regulatory agencies, suppliers and still keep your personal and family life together, all at the same time, you may find retail pharmacy business a nightmare.
While pharmacists may retire into community practice from other practice settings such as hospital, industrial, academic, social and administrative pharmacy, it must be noted that our emphasis here is on full-time endeavour in retail pharmacy. So the first strategy for a flourishing retail pharmacy business is not about what you do. It is to think. Think to find if you have the mindset, the passion, the energy, the drive to play in the retail pharmacy field.
To vision, add passion.
Every retail pharmacy business should be founded on a vision by the business owner. This vision should be so clear and compelling it can be captured in words. It is called a vision statement. It encapsulates the reason for the pharmacy business. How this compelling reason is to be achieved should be articulated in a mission statement.
However, the pursuit of the vision and mission must be guided by a set of values. So the retail pharmacy should have on display (much like the pharmacist’s and premises licenses), a statement of the vision, mission and core values.
These are not mere clichés but driving forces and guiding lights. They must flow from the top. The ownership and management must so believe in these guiding lights that their passion exudes and infects the staff and even customers. This contagion in most cases gives birth to a mantra, a by-word that creates a positive culture and climate at the pharmacy. So we have a team made up of ownership, management and staff, chasing a common passion (not cash), having fun and making everybody happy.
The question is, what are the vision, mission and values of your retail pharmacy business?
To vision and passion, add a plan.
A detailed business plan is necessary for a successful retail pharmacy business. Even existing businesses need periodic plans in the form of annual budgets. These plans help assess performance and measure progress. Many pharmacists who managed to pass the course on pharmaceutical calculations during training are scared stiff in real life whenever the conversation gets to spreadsheets, profit and loss accounts, return on investments, balance sheets and cash flow analysis. Yet, cash remains the lifeblood of business and if the pharmacy business runs out of cash, it simply expires.
For the business to flourish, it may require the injection of ‘other peoples’ money ’. This may come from partners, equity investors, bank loans, venture capitalists, family and friends and so on. These investors will need to see the numbers in order to be convinced that the business is profitable.
Even if the funds come entirely from the savings of the business owner, it is important to have an understanding of financial analysis. How long will it take for the business to recover cost? How does the pharmacist know it’s time to expand? How many employees are ideal for the size of business? Which customer segments should the pharmacy focus on? How does the business owner separate family expenses from business spending? What level of savings is tolerable? Which suppliers should qualify for which categories of transactions, how does the business get out of debt, and what debt-equity ratio is tolerable before the business gets over-leveraged?
These are some of the questions that financial intelligence on the part of the pharmacist seeks to answer. While experts may be invited to guide the pharmacist, some basic rules may suffice: sales minus costs equals profit; savings culture always wins despite the level of practice; separating family and friends from business always helps; more employees should only be hired when current hands are so overloaded that they may snap if more workload is added.
So my dear pharmacist, get money-wise, get street-wise, do the math, and do it yourself.
(Continues next edition)
There abound massive opportunities in the Nigerian pharmaceutical industry. Finding them is however, very expedient. The ever-evolving nature of disease pattern, the dynamics of the pharmaceutical market and the increasing need for technological innovations to improve healthcare delivery, are a few of the situational factors that influence service delivery in this industry. To stay informed and make strategically relevant decisions, it is needful that the industry understands the market situation per season vis-à-vis prescriber’s preference, cost influence and competitive landscape, hence the importance of market research. Investment in research is a proven path that enable companies to increase their market shares and stay up-to-date with current trends in the industry, here is where we offer our services:
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No matter how talented you may be, you need persistence to maximise the use of the talent. Persistence is doing something despite difficulty. You need tenacity, determination or staying power to achieve any form of success. Thomas Edison said, “Many of life’s failures are people who did not realise how close they were to success when they gave up.” You must carry on despite challenges, opposition or even failure. This is what makes you a champion or winner and a person of influence. A winner never quits and a quitter never wins. But you are born to be a winner. Lou Holtz said, “You aren’t going to find anybody that’s going to be successful without making a sacrifice and without perseverance.”
Perseverance brings you to the conclusion of your project or aspiration. Apostle Paul said, “I have fought the good fight, I have finished the race, and I have remained faithful” (2 Timothy 4:7). Persevere to cross the finish line and win your prize. When God gives an assignment, it usually takes longer than imagined. You come across some problems you never anticipated but God equips and gives you the strength and grace to overcome them. You must, therefore, focus on the completion of your task. If you are actually obeying and doing the will of God, you must finish your work. In John 4:34, Jesus said, “My food is to do the will of him who sent me and to finish his work.” I love what Jesus said when he had successfully completed His work. He said, “It is finished” (John 19:30).
Some people do not realise that as God gave Jesus work to do and to finish it, He has also given all of us something to do and finish. Right from birth, all the talents and abilities to accomplish your life assignment have been released to you. It is left for you to know what to do and then apply the God-given resources to accomplish it.
You need to develop persistence with little tasks. When you have a little work before you, put all your might into it to complete it. Ecclesiastes 9:10 says, “Whatever your hand finds to do, do it with all your might… “It says, “Whatever.” That means that even little tasks must be handled with diligence, determination and perseverance. Don’t allow fatigue or distraction to stop you from completing your task. Don’t misplace your priority. Determine to stop the work only when it is finished.
Don’t accumulate abandoned projects. They are results of wrong planning and execution. If you form the habit of focusing on small tasks with all your strength, intellect, spirit, and emotion, you will succeed with big tasks. But if you fail in small tasks, how can you succeed in big tasks? Luke 25:14-30 has the parable of the talents. The servants who handled their master’s business profitably were given more talents to trade with but the servant who could not manage the little one given to him was punished and even the little he had was withdrawn.
If you desire to be successful and make maximum use of your talent, you must not be complacent. Complacency will prevent you from striving. The day you start thinking in your heart that you have arrived, that is the day you start declining. In your business, your competitors will start overtaking you. Don’t take success as a destination but a process, a journey. You must keep on succeeding to be a success. It may be necessary to take a break but that break should be to gather momentum for the long marathon race.
Complacency is a great enemy of success. To avoid this, don’t dwell on past successes but focus on the height to reach. Complacency may harbour the spirit of pride. The moment you start beating your chest to demonstrate how wonderfully you have performed, you are in danger of appropriating the glory that belongs to God. Watch it before your wall of defence starts cracking. Proverbs 16:18 says, “Pride goes before destruction, a haughty spirit before a fall.”
Vision of the big picture will nourish perseverance. The vision of where you want to be and what you want to achieve will create the desire and resilience in you. Misuse or even abuse of your God-given talent is an evidence of lack of the knowledge of who you are and God’s purpose for your life. Ignorance of this will make you not fulfil your destiny.
1 ❏ Natrilix
2 ❏ Nizoral
3 ❏ Zyloric
For the question above, ONE or MORE of the
responses is (are) correct. Decide which of the responses is
(are) correct. Then choose:
A ❏ if 1, 2 and 3 are correct
B ❏ if 1 and 2 only are correct
C ❏ if 2 and 3 only are correct
D ❏ if 1 only is correct
E ❏ if 3 only is correct