Pharmacists known as chemists or druggists, are health professionals who practice in pharmacy, the field of chemical sciences and health sciences focusing on safe and effective medication use. Pharmacists undergo university or graduate-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, monitoring parameters; this is mated to anatomy and pathophysiology. Pharmacists interpret and communicate this specialized knowledge to patients and other health care providers. Among other licensing requirements, different countries require pharmacists to hold either a Bachelor of Pharmacy, Master of Pharmacy, or Doctor of Pharmacy degree; the most common pharmacist positions are that of a community pharmacist, or a hospital pharmacist, where they instruct and counsel on the proper use and adverse effects of medically prescribed drugs and medicines. In most countries, the profession is subject to professional regulation.
Depending on the legal scope of practice, pharmacists may contribute to prescribing and administering certain medications in some jurisdictions. Pharmacists may practice in a variety of other settings, including industry, research, formulary management and government; the fundamental role of pharmacists as a healthcare practitioner was to check and distribute drugs to doctors for medication, prescribed to patients. In more modern times, pharmacists advise patients and health care providers on the selection, dosages and side effects of medications, act as a learned intermediary between a prescriber and a patient. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Pharmacists may practice compounding. In some jurisdictions, pharmacists have prescriptive authority to either independently prescribe under their own authority or in collaboration with a primary care physician through an agreed upon protocol called a collaborative practice agreement.
Increased numbers of drug therapies, aging but more knowledgeable and demanding populations, deficiencies in other areas of the health care system seem to be driving increased demand for the clinical counseling skills of the pharmacist. One of the most important roles that pharmacists are taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states and management of each to improve outcomes. Pharmaceutical care has many benefits that may include but are not limited to: decreased medication errors. Pharmacists are the first point-of-contact for patients with health inquiries, thus pharmacists have a significant role in assessing medication management in patients, in referring patients to physicians. These roles may include, but are not limited to: clinical medication management, including reviewing and monitoring of medication regimens assessment of patients with undiagnosed or diagnosed conditions, ascertaining clinical medication management needs specialized monitoring of disease states, such as dosing drugs in kidney and liver failure compounding medicines providing pharmaceutical information providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states supervising pharmacy technicians and other staff oversight of dispensing medicines on prescription provision of and counseling about non-prescription or over-the-counter drugs education and counseling for patients and other health care providers on optimal use of medicines referrals to other health professionals if necessary pharmacokinetic evaluation promoting public health by administering immunizations constructing drug formularies designing clinical trials for drug development working with federal, state, or local regulatory agencies to develop safe drug policies ensuring correctness of all medication labels including auxiliary labels member of interprofessional care team for critical care patients symptom assessment leading to medication provision and lifestyle advice for community-based health concerns staged dosing supply The role of pharmacy education, pharmacist licensing, continuing education vary from country to country and between regions/localities within countries.
In most countries, pharmacists must obtain a university degree at a pharmacy school or related institution, and/or satisfy other national/local credentialing requirements. In many contexts, students must first complete pre-professional coursework, followed by about four years of professional academic studies to obtain a degree in pharmacy. Pharmacists are educated in pharmacology, chemistry, organic chemistry, pharmaceutical chemistry, pharmacy practice, pharmacy law, physiology, pharmacokinetics, drug delivery, pharmaceutical care, nephrology
Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed; this instability increases the likelihood of joint injury leading to a degenerative process in which tissues break down and no longer function well. Shoulder pain may be referred to areas around the shoulder or down the arm. Other regions within the body may generate pain that the brain may interpret as arising from the shoulder; the shoulder joint is composed of three bones: the clavicle, the scapula, the humerus. Two joints facilitate shoulder movement; the acromioclavicular joint is located between the clavicle. The glenohumeral joint, to which the term "shoulder joint" refers, is a ball-and-socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body; the "ball" is the rounded portion of the upper arm bone or humerus.
Arm movement is further facilitated by the ability of the scapula itself to slide along the rib cage. The capsule is a soft tissue envelope, it is lined by a smooth synovial membrane. The bones of the shoulder are held in place by muscles and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach shoulder bones to each other. For example, the front of the joint capsule is anchored by three glenohumeral ligaments; the rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint. Four filmy sac-like structures called bursa permit smooth gliding between bone and tendon, they protect the rotator cuff from the bony arch of the acromion. Following are some of the ways doctors diagnose shoulder problems: Medical history. For shoulder problems the medical history includes the patient's age, dominant hand, if injury affects normal work/activities as well as details on the actual shoulder problem including acute versus chronic and the presence of shoulder catching, locking, paresthesias, stiffness and weakness.
Other salutary information includes OPQRST and a history of issues that could lead to referred pain including cervical spine disorders, heart attacks, peptic ulcer disease, pneumonia. Standardized questionnaires like the Penn Shoulder Score that assess shoulder pain and function can aid in eliciting the required history to make a diagnosis and monitor condition progression. Physical examination of the shoulder to feel for injury and discover the limits of movement, location of pain, extent of joint instability; the steps to elicit this information are inspection, testing range of motion, performing special maneuvers. Information collected on inspection are asymmetry, ecchymosis, scars and venous distention. Palpation can help find pain and deformities, should include the anterior glenohumeral joint, acromioclavicular joint, biceps tendon, cervical spine, coracoid process and sternoclavicular joint. Range of motion tests external and internal rotation and adduction, passive and active weakness, true weakness versus weakness due to pain.
The Apley scratch test is the most useful: touch opposite scapular by reaching behind the head for adduction and external rotation and behind the back for abduction and internal rotation. There are more specific maneuvers that can home in on a diagnosis, however their accuracy is limited. Tests to confirm the diagnosis of certain conditions; some of these tests include: X-ray Arthrogram—Diagnostic record that can be seen on an X-ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there is an opening. MRI --A non-invasive procedure in which a machine produces a series of cross-sectional images of the shoulder. Other diagnostic tests, such as injection of an anesthetic into and around the shoulder joint; the shoulder joint is the most dislocated major joint of the body.
In a typical case of a dislocated shoulder, a strong force that pulls the shoulder outward or extreme rotation of the joint pops the ball of the humerus out of the shoulder socket. Dislocation occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles; when a shoulder dislocates the condition is referred to as shoulder instability. A partial dislocation where the upper arm bone is in and out of the socket is called a subluxation. In the medical community, dislocation is referred to as luxation. All shoulder dislocations are downwards and of these, 95 percent are in a forward direction. Clinically this is
"Bless the Broken Road" is a song, recorded by several American country music artists. Co-written by Marcus Hummon, Bobby Boyd, Jeff Hanna in 1994, it tells how the journey through relationship heartbreak and disappointment was an important series of lessons along the broken road to finding one’s true love, it was first recorded by the Nitty Gritty Dirt Band in 1994, followed by Hummon on his 1995 album All in Good Time. Since many artists have recorded the song with Rascal Flatts' version being the highest-charting, becoming a number 1 hit on the Billboard country music charts in 2005 and earning the songwriters a Grammy Award for Best Country Song. Singer-songwriter Marcus Hummon co-wrote the song with Bobby Boyd. Nitty Gritty Dirt Band recorded it for the 1994 album Acoustic. One year Hummon covered the song for his debut album All in Good Time for Columbia Records, his rendition includes backing vocals from Matraca Berg. Michael McCall of New Country magazine thought that Hummon's rendition was the best track on the album.
Sons of the Desert recorded its own version of the song, for a planned second album on Epic Records that would have been released in 1998. This album was not released, due to a dispute between its label. Since many artists have recorded the song including Melodie Crittenden, Geoff Moore, Jamie Slocum, Carrie Underwood, Buddy Greene, Rascal Flatts. In 1998, Melodie Crittenden recorded the song under the title "Broken Road," and included it on her self-titled debut album for Asylum Records. Released as the first of two singles from it, this version was a number 42 single on the Billboard Hot Country Singles & Tracks charts; this version was featured on an episode of Dawson's Creek. Billboard gave Crittenden's version a positive review in the January 17, 1998, calling it "sheer poetry with a moving message." The highest-charting rendition is by the country music group Rascal Flatts, who cut the song for the Feels Like Today album. Released in November 2004, this version spent five weeks at number one on the Hot Country Singles & Tracks charts.
It won a Grammy Award for Best Country Song and earned a platinum certification from the Recording Industry Association of America. The song topped the 2 million mark in paid downloads on September 18, 2010. It's Rascal Flatts' third song to reach that mark, following "Life Is a Highway" and "What Hurts the Most"; as of January 2020, the song has sold 3,719,000 copies in the US. On May 25, 2005, during a live performance on American Idol by Carrie Underwood and Rascal Flatts, an additional version was recorded. While not in wide release, never included on an album, the version received enough radio airplay to enter the country music charts at number 50. In 2009, an acoustic version recorded by Rascal Flatts was included in the soundtrack of Hannah Montana: The Movie. On May 19, 2012, "Bless the Broken Road" debuted at number 76 and went to number 41 next week on the UK Singles chart, the band's first and only appearance on the chart. Rascal Flatts' version of the song is set in the key of C major, with a vocal range from C3 to A4.
Selah, a contemporary Christian music band, covered the song in 2006 on the album Bless the Broken Road: The Duets Album featuring a duet vocal from Crittenden. Released as a single, Selah's version peaked at number five on the Hot Christian Songs charts. In 2007, this version of the song was nominated for a Dove Award for Song of the Year at the 38th GMA Dove Awards. A feature film based on the song, titled God Bless the Broken Road, began filming in 2015, was announced to release in 2016; the actual release was September 7, 2018