MONU044 Alchemy FA Internals.indd

36 Pages·2016·6.35 MB·English

MONASH
PHARMACY AND
PHARMACEUTICAL
SCIENCES
SPECIAL EDITION
Moulding the
pharmacists
of the future

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Fast Facts
THOMSON REUTERS HIGHLY CITED
RESEARCHERS 2003 – 2013
No.1 worldwide in Pharmacology and Toxicology
QS WORLD UNIVERSITY RANKINGS,
PHARMACY AND PHARMACOLOGY
No.1 in Australia and Asia-Pacifi c 2016
No.4 worldwide 2016
Top 10 worldwide (average 2011 – 2016)
Excellence in Research for Australia 2015
Top rating of 5 in all sectors (well above world standard)
PharmAlliance
with University of North Carolina at Chapel Hill, USA,
and University College London, UK
National Alliance for Pharmacy Education
with University of Queensland, University of Sydney,
University of South Australia
NEW IN 2017:
Australia’s fi rst integrated MPharm
Enhanced Doctoral Program in Pharmaceutical Science
MONASH
PHARMACY AND
PHARMACEUTICAL
SCIENCES
Contents
02 Caroline Le and Erica Sloan – mind over metastasis Alchemy is produced
by the Development Offi ce,
04 Moulding the pharmacists of the future – designing education Faculty of Pharmacy a nd
for a rapidly changing world Pharmaceutical Sciences,
Monash University.
04 Pharmacy education with initiative Managing Editor: John Palmer
Writers: Iliana Findikakis, Alan James,
07 The crest of the change – advanced-practice pharmacists Jessica Rostas and John Palmer
Design: Strategy, Brand and Marketing
08 Keeping the powder dry – careers in antimicrobial stewardship
Communications, Monash University
Photography: Paul Philipson
09 Student profi le: Rachael Raleigh
Contact us:
10 Practice-based PhDs John Palmer
Marketing Manager
12 Six of the best [email protected]
Disclaimer
16 Q&A with Traci Lourey Views expressed in Alchemy are those o f
the authors and persons quoted and are not
18 Too much of a good thing? Investigating polypharmacy necessarily those of the Monash Faculty of
Pharmacy and Pharmaceutical Sciences.
20 Pharmabridge helps Filipino pharmacy fl ourish Alchemy is printed on FSC Environmentally
Accredited paper. FSC tracks certifi ed material
21 Landmark study demonstrates importance of clinical medication reviews through the production process – from the forest
to the consumer, including all successive stages
22 Teacher practioners – dispensing better learning of processing, transformation, manufacturing
and distribution.
24 Broadening the mind, expanding the waistband: Student profi le, Nick Sourlos
26 Media studio, MyDispense, PharmAlliance, ARC, MIPS research
30 Where are they now? All detail images in this issue
are taken from the Sissons Mural
32 Remembering Brian Cossar in Cossar Hall.
Mind over metastasis
Our growing understanding of how stress
affects the spread of cancer
One morning early in 2014, while Caroline Le The pig lymph node that Nowell had brought to
was working in the lab on the fourth fl oor the lab had been used for tracking drug delivery.
of building 404 of Monash University’s Parkville It had been injected with nanospheres – microscopic
campus, Cameron Nowell walked in and laid a polystyrene balls that glow. It occurred to Le that this
pig’s lymph node on the bench in front of her. was exactly what she needed to track lymph fl ow.
Nowell is a research facilities manager at MIPS. By using this technology in mice with cancer, then
He is the “imaging guy” – the man responsible for all placing the mice under stressful conditions, she would
aspects of the microscopy and analysis upon which be able to see whether stress increased lymph fl ow
much of MIPS research rests. and whether the activated lymph fl ow carried greater
numbers of cancer cells out of the tumour.
As the two of them examined the lymph node, it began
to occur to Le that it might hold the key to a puzzle Caroline Le began her academic career investigating
she had been trying to solve for almost six months. not cancer, but Parkinson’s disease. She completed a
Bachelor of Science at Monash University’s Clayton
At the time, she was working towards her PhD under
campus, majoring in pharmacology and biotechnology,
the supervision of Dr Erica Sloan. In 2010 Dr Sloan
before coming to Parkville to study towards her
had published a seminal paper that established a link
honours. It was at Parkville that she fi rst encountered
between chronic stress and the spread of breast cancer,
Dr Sloan and her research.
setting in motion an ever-expanding stream of research
that sought not only to understand the relationship “I’ve always been interested in research that tries to
between stress and cancer in more depth, but to understand the infl uence the brain has on conditions
investigate the potential for new cancer treatments that affect the rest of the body,” she said. Towards the
that the relationship suggested. end of Le’s honours year, Sloan approached her about
doing a PhD. It was an easy decision.
Dr Le’s research focused on the means by which that
spread took place. “We expected the cells to spread to “I found it fascinating how little work had been done in
the lungs, which they did,” said Le. “But stress strongly this area. The connection between stress and disease
“Le and Sloan suspected
affected how many cells also appeared in the lymphatic was proposed almost a century ago by Walter Cannon,
that cancer cells were system, which we didn’t expect.” the researcher who coined the phrase ‘fi ght or fl ight’.
spreading through But it took until around 2005 for his insight to begin
The involvement of the lymphatic system shed an
to be applied to cancer. There was a study on stress
the lymphatic system, interesting light on research that Sloan had previously
and ovarian cancer released circa 2005, and before
conducted in collaboration with scientists at Peter
and that stress was this Erica’s post-doctoral mentor at UCLA, Steve Cole,
MacCallum Cancer Centre, which demonstrated that
accelerating the rate did some really interesting work on stress signalling
bigger lymphatic vessels were associated with more
in infection. But Erica really is one of the pioneers in
at which they did so.” rapid and extensive cancer spread. Le and Sloan
looking at how stress drives cancer spread.”
suspected that cancer cells were spreading through
the lymphatic system, and that stress was accelerating When Le injected nanospheres into the mice in which
the rate at which they did so. tumours had been cultivated, it worked. For the fi rst
time, researchers were not only able to see evidence
But their hunch was diffi cult to prove – lymph nodes
that cells were spreading via the lymph glands; they
are tiny and lymph fl uid is transparent, making the
were able to see the spread as it happened.
fl ow in its natural state effectively invisible to imaging
technology. Earlier researchers had added dyes, with They watched as high stress levels increased lymphatic
mixed success. Le herself had experimented with a fl ow, making the mouse’s lymphatic system a more
variety of different compounds, but none had done effi cient and networked distributor of cancer cells.
what she needed: allowed her to see the lymph fl ow In the stressed mice, the lymph network grew bigger,
as it happened. more cancer-carrying lymph fl owed, cancer spread
happened faster and metastatic tumours grew larger.

2
Dr Erica Sloan and Dr Caroline Le
On Wednesday, 2 March, Le’s paper, Chronic Like many signifi cant studies, Le’s work has “There are so many questions to answer
stress in mice remodels lymph vasculature raised more questions than it answers. One from here,” said Le. “Can we develop a new
to promote tumour cell dissemination, was focus of media attention has been the potential generation of beta-blockers that target only
published in the prestigious journal Nature for the development of new cancer therapies, the stress receptors found on immune cells
Communications. Media attention was swift most notably a trial currently being conducted and the vasculature? Can the type of
and voluminous. In addition to specialist by another of Dr Sloan’s collaborators, Dr anaesthetic used in the surgery to remove
media such as BTW Bioworld, Le and Sloan Jonathan Hiller. In an ongoing clinical study the tumour affect patient outcomes?
appeared on news reports for Channel Nine at Peter MacCallum Cancer Centre, Dr Hiller How do beta-blockers work with chemo
and Channel Ten, and the story was picked up is investigating whether beta-blockers, a class drugs? When is the best time to treat?”
by all the major Australian news publications. of drugs that have traditionally been used to
Media organisations from as far away as Turkey treat high blood pressure by blocking stress
covered the research. hormones, can slow the spread of breast cancer.
“I think it resonates with people for a few There is cause for optimism about the beta-
reasons. Everyone is scared of cancer and blocker research. Dr Le’s research has shown
most people have been touched by it. It makes that beta-blockers can prevent the spread of
intuitive sense – everybody feels like stress breast cancer in mice. And in human breast
is bad for them, even if they don’t necessarily cancer studies, better outcomes have been seen
know how,” Le said. “We’ve been really careful in patients who have breast cancer and have
to emphasise that our research isn’t saying been simultaneously treated for hypertension
that stress causes cancer, but that it with beta-blockers.
promotes its spread.”

ALCHEMY WINTER 2016 3

Moulding the pharmacists
of the future
Designing education for a rapidly changing world
Professor Carl Kirkpatrick Director, Pharmacy Education
Every February, dozens of idealistic might be conservative estimates of medication communication and problem-solving (see, for
school leavers step tentatively onto exposure in older people, with poly-pharmacy example, the article on Dr Safeera Hussainy
our campus for the fi rst time (if you’re now the norm rather than the exception. and the faculty’s implementation of Objective
reading this, there’s an odds-on chance you Structured Clinical Examinations, overleaf).
As a result, the demand for our skills as
were once one of them). At that moment,
medicines experts will increase. As a faculty that prides itself on research
they transform from bright young people
advancement across pharmaceutical, clinical
distinguished by their passions for science The second of these forces is the increasing
and practice sciences, and has a deep
and helping people into something else complexity of medicines, in particular some
understanding of the global environment
entirely: pharmacists in training. newer classes such as biologics – complex
through our strong international relationship,
large molecules that are often produced
The world they enter upon graduation will be it falls to us to lead the educational change
via recombinant technologies. It has been
markedly different from the one they lived that will ultimately produce this new breed
suggested that biologics now make up around
in when their studies commenced; by the of pharmacist. We are fortunate that we
40 per cent of new medicines coming to market.
time they retire, it will have changed beyond have in the faculty some of the world’s most
Biologics increasingly utilise diagnostic tests
recognition. The way health care is practised infl uential researchers (see ‘Six of the Best’
prior to or after treatment to determine whether
in Australia and across the Western world is on page 12). Because they are at the absolute
the patient might respond, to individualise the
shifting and developing dramatically. cutting edge of their fi elds, they are in a
dose, or as diagnostic test to evaluate response.
unique position to see the ways in which the
The question for pharmacy educators is how we
A new realm of personalised medicines fi eld will evolve over the next few decades.
best equip our graduates to lead that change
approaches will be required, and pharmacists This level of insight is invaluable in shaping
and seize the opportunities it will provide.
will need to be increasingly active contributors. our curriculum.
The answer to that question is complicated To do so, we will require ever-increasing levels
All of this has resulted in a decision to launch
because the oncoming wave of change is not of scientifi c knowledge. You can see evidence of
a new course, the BPharm (Hons)/MPharm,
monolithic. Instead it is a product of several this in some of the other articles in this edition,
which we announced in March this year
swells from different directions, all interacting from the pieces on careers in antimicrobial
and will progressively replace our existing
in ways that are diffi cult to predict. stewardship (page 8) and practice-based
course, the BPharm (Hons), from 2017.
PhDs (page 10), to the emergence of advanced
The fi rst and most obvious of those forces is The enhanced skills and knowledge with
practice credentialing (overleaf).
demographics. The baby boomers – whose which we will be equipping our students can
existence in many ways drove the creation of The fi nal force is an evolving understanding no longer fi t inside a bachelor-sized container.
the public health systems we now have across of best practice in health care that places a
the Western world – are retiring. growing emphasis on team-based integrated
health care. While this has traditionally been
An ageing population will pose signifi cant “The way health care is
the domain of hospital clinical pharmacy
challenges for health care. The greater practised in Australia
practice, there are now excellent examples
proportion of elderly people will produce
extending out of community pharmacies, within and across the Western
resource challenges for our health systems.
GP surgeries via practice pharmacists, and other
These patients will have multiple comorbidities world is shifting and
opportunities outside the bricks and mortar of
associated with ageing, resulting in increased developing dramatically.”
our current health care.
medication use: currently, 43 per cent of
people aged 50 years and older use fi ve or more The growth of integrated primary health care
medicines over a 24-hour period; 11 per cent teams will mean that our increased scientifi c
use 10 or more. Recent research from our Centre knowledge will need to be equally matched
for Medicine Use and Safety indicates these by a growth in soft skills such as teamwork,

ALCHEMY WINTER 2016 5
Continued from previous page
Importantly for the standing of the profession, positioning
a master’s-level qualifi cation (Level 9 in the Australian
Qualifi cations Framework) as standard signals, both
to those in the health professions and to the wider
community, that the role of the pharmacist has evolved
and will continue to do so.
We have been steadily working towards the new degree for
a number of years. Indeed, many of the innovations that
will be incorporated in the BPharm(Hons)/MPharm have
in fact been developed, refi ned and implemented as part
Pharmacy education
of our existing degree.
For example, in order to address the emerging need for
with initiative
pharmacists who can work more effectively in teams, the
faculty has collaboratively developed and then introduced
a range of screening tests that provide feedback to
students early in their degree about their professional
skills, non-cognitive skills via situational judgement Effective pharmacy education involves much more than clinical
scenarios, and oral and written communication via a knowledge and skills. It should also instil the soft skills and
Diagnostic English Language Assessment. These screening interpersonal capabilities required of a health professional. The faculty
processes will allow students to identify with a mentor has implemented several education initiatives to foster personal growth
their strengths and weaknesses in these areas, which will and professional development.
feed into a personalised learning plan to guide students
Dr Safeera Hussainy has extensive experience in educational theory and
in their personal and professional development across the
adult learning principles – developing the educational framework that
fi ve years of their new degree.
underpins the education. Safeera lectures in pharmacy practice and
Through all of this, engagement with the wider profession is stream leader for the BPharm education team.
is key. Throughout the development of the new course, we
Safeera is leading the faculty’s implementation of Objective Structured
have consulted with a cross-profession group of trusted
Clinical Examinations (OSCEs). “The OSCE is a performance-based
advisors. Their insights into the competencies that
assessment,” Safeera explains. “It tests students’ soft skills as well as
practising pharmacists need now and will need into
clinical knowledge – the things we look for in a health professional.
the future have proven invaluable.
We’d received feedback from the profession that some students weren’t
To achieve the desired modifi ed workforce capabilities communicating as well as they should. Their clinical knowledge was
for the profession, it is essential there be alignment of excellent, but some of their interpersonal skills needed development.”
timeline and expectations with changes in university
Introduced in 2011, OSCEs have now been implemented throughout the
curricula and graduate training programs. Education
degree. “It’s a huge initiative,” Safeera says, “and it’s delivering results.
that drives change in health care and health outcomes in
We’re hearing positive feedback from the profession. Graduates have the
Australia, and provides the future leaders of the profession,
confi dence and ability to effectively interact – all those skills that are
must be informed by partnership and collaboration with
valued by patients and other health professionals.”
all facets of the profession. Furthermore, it must be based
upon a deep understanding of the future workforce and As Safeera explains, these education initiatives are part of the bigger
health care needs of Australia. learning and development picture. “These initiatives align with the
learning objectives of the course and the Monash graduate attributes.”
Pharmacists have a clear and increasing role in improving
patient health and health outcomes. We are well-suited A Monash graduate herself, Safeera has worked in hospital and
to providing solutions to the challenge that will defi ne the community pharmacy. She completed her PhD in palliative care
next few decades. But to do so, we will require enhanced education, and is currently conducting research in women’s health.
knowledge and skills, and a different philosophy of practice. Safeera has recently left us temporarily – on maternity leave.
I am confi dent the new integrated degree will play a “It’s good research for my women’s health project! Everyone’s pregnancy
substantial role in meeting those requirements. But only is different, but it’s giving me valuable insight. No doubt it will give me a
by drawing upon the strengths in the wider pharmacy wealth of knowledge to share with students in the future. And everything
community – our alumni, our corporate partners, our else that comes with it.”
practitioners who teach into our programs – will we truly
be able to seize the opportunity presented to us.

6
The crest of the change
Kirstie Galbraith and the new Advanced Pharmacy Practice Framework
In 1617, after many years Following independent evaluation by a panel of trained
of lobbying, the Worshipful credentialing evaluators, candidates were recognised at one of the
Society of Apothecaries of three levels of advancement. The fi ndings for the pilot program are
London was granted its Royal informing the roll-out of a formal program of advanced-practice
Charter. The charter defi nitively recognition for Australia.
separated the apothecaries
Associate Professor Kirstie Galbraith, who is director of the
from the Worshipful Company
Postgraduate Studies and Professional Development Unit at Monash,
of Grocers, of which they had
is one of 29 pharmacists in Australia and New Zealand who has been
until then been a part.
independently evaluated by the APC and formally credentialed as an
From the vantage point of the early 21st century, knowing how the advanced-practice pharmacist.
pharmacy profession has become the custodian of quality use of
Associate Professor Galbraith says the pilot program is a strong
medicine, the fact that grocers and pharmacists were ever considered
and much-needed foundation for the future of formal professional
parts of the same profession seems bizarre.
development and recognition of Australian pharmacists.
Yet it provides a reminder that the structure of the profession is not
“I expect over time many pharmacists who are performing at a level
fi xed; that the demands that societies place upon their pharmacists
beyond that of initial registration will seek recognition of their more
change and the profession evolves accordingly.
advanced capabilities via this pathway.”
In contemporary Australia, with its increasing burden of chronic
There is an international trend towards a wide range of national
disease and ever-broadening range of increasingly complex
initiatives aimed at practitioner advancement. A recent report
medications, pharmacists are being asked to exhibit more
prepared by the International Pharmaceutical Federation (FIP),
sophisticated skills than ever before. The opportunities for
which Galbraith co-authored, shows that the use of national
specialisation and advancement are increasing, and the number of
frameworks such as the APPF is a key activity for the global
pharmacists who have high-level expertise in areas such as research,
development of the pharmacy workforce.
education or management is growing.
Benefi ts of developing and recognising advancement in pharmacy
The Australian Pharmacy Council has recently completed a pilot
practice include enhanced professional development pathways.
program for credentialing of advanced-practice pharmacists using
Credentialing also recognises pharmacists who are able to more
the Advanced Pharmacy Practice Framework (APPF) developed
effectively manage complexity in many areas of expert practice,
by the profession.
including research, education and management.
The Advanced Pharmacy Practice Framework describes 30 advanced
competencies across three levels of advancement, and can be used as a
tool for evaluating practitioner performance and guiding development. “I expect over time many pharmacists
who are performing at a level beyond
The 43 pharmacists who took part in the 2015 pilot program
demonstrated the impact of their practice via a portfolio of their that of initial registration will seek
training, achievements and experience.
recognition of their more advanced
capabilities via this pathway.”

ALCHEMY WINTER 2016 7
Keeping the powder dry
Careers in antimicrobial stewardship
The dangers of antimicrobial resistance have been recognised since the dawn
of the antibiotic age. In 1945, just a few years after penicillin entered broad
application, Alexander Fleming used his Nobel Prize lecture to sound a warning
about the consequences of irresponsible antibiotic use.
“AMS is a crucial Fast-forward 60 years and resistance is a growing For Sonia, mentoring is also valuable for refl ecting on
problem. Diseases that were previously thought to have her own practice. “Guiding others encourages you to
component of
been under control, such as staph, gonorrhoea and keep thinking about your own career. I really enjoy
health care and is
tuberculosis, have all developed multi drug-resistant the role and continuing to further my own knowledge
now mandatory in strains. A 2013 report commissioned by the UK and skills. My role with the National Centre has also
government estimates the global death toll resulting given me a broader perspective to help advance my
hospitals.”
from drug-resistant infections at 700,000 a year. practice, and enables me to work with a range of
different clinicians.”
With very limited new antibiotics on the horizon,
treatment options for many patients have become Kelly Cairns is lead pharmacist for antimicrobial
increasingly complicated. stewardship at the Alfred Hospital. Kelly sees great
career potential for pharmacists in AMS. “AMS
Two Monash University Master of Clinical Pharmacy
is a crucial component of health care and is now
graduates are on the front line of the struggle.
mandatory in hospitals. As such, many pharmacists
Sonia Koning and Kelly Cairns are working as AMS
around Australia are keen to develop skills in AMS.
(antimicrobial stewardship) pharmacists, seeking to
When I fi rst came to the Alfred, my role was
optimise the antibiotics we use today to improve patient
to work as a part of a multidisciplinary team
outcomes and prevent further antibiotic resistance.
to implement the AMS program, and to
They are also mentoring current master’s students optimise antibiotic use. Five years on, it’s
undertaking clinical fellowships in this important area. a well-established service.”
Sonia divides her time between Eastern Health A key part of Kelly’s role also is sharing her
as the senior AMS pharmacist, and Melbourne Health knowledge and experience. “I’m currently
with the National Centre for AMS. She also teaches supervising one of the Monash clinical fellows
into a number of the Monash graduate programs. completing her Master of Clinical Pharmacy in
Sonia says she has always had an interest in infectious AMS. The Alfred fellowship is a two-year structured
diseases and in education. Her current roles allow program linking coursework and clinical experience.
her to do both. Fellowships build valuable partnerships between
the University and the workplace, and they’re
“When I fi rst started at Eastern Health, I was the
invaluable for building knowledge and skills.
only AMS pharmacist for the entire network.
Teaching is a big part of my role – helping all
We’ve now expanded the AMS program across
clinicians improve their antimicrobial knowledge.”
Eastern Health, to include an AMS fellowship
position, which I’m supervising. Mentorship is key
to the success of this program.”

8