In order to assess the significance of drug/substance levels measured in intensive care medicine and clinical and forensic toxicology as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. We revisited and expanded our 2012 compilation of therapeutic and toxic plasma concentration ranges as well as half-lives of now more than 1100 drugs and other xenobiotics.Data have been abstracted from original papers, text books, and previous compilations and have been completed with data collected in our own forensic and clinical toxicology laboratories. We compiled the data presented in the table and the corresponding annotations over the past 30+ years. A previous compilation was completely double-checked, revised, and updated, if necessary. In addition, more than 200 substances, especially drugs who have been introduced since 2012 to the market as well as illegal drugs and other xenobiotics which became known to cause intoxications were added. We carefully referenced all data. Moreover, the annotations providing details were updated and revised, when necessary.For more than 1100 drugs and other xenobiotics, therapeutic (“normal”) and, if data was available, toxic, and comatose-fatal plasma/blood concentrations as well as elimination half-lives were compiled in a table.In case of intoxications, the blood concentration of the substance and/or metabolite better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications as well as to support forensic and clinical expert opinions.

Objectives: To investigate a new method for evaluating counselling performance of staff in community pharmacies and to assess the quality of patient counselling. Method: Trained pseudo customers, instructed to play their role according to two different self‐medication scenarios, visited voluntarily participating community pharmacies in Berlin. After documenting the counselling process, immediately after each visit, outside the pharmacy on an assessment form, the pseudo customer re‐entered the pharmacy and gave detailed performance feedback to the counsellor and the pharmacist in charge in order to provide support for improving counselling skills and practice behaviour, when appropriate. This was followed with a written summary of the general performance of all participating pharmacies and additional individual feedback and suggestions for improvement. Educational needs were identified for subsequent performance‐based educational strategies such as group‐workshops, team‐training and on‐site team‐coaching. Results: Forty‐nine community pharmacies in Berlin volunteered to participate in this pilot study. Ninety‐eight per cent of the participating pharmacies offered advice. However, in 36% of the cases, advice was only given on request. The different types of scenarios – presentation of a symptom or request for a specific product – made a great difference to the spontaneity of questions and advice. At least one question to check on accuracy of self‐diagnosis was asked in 95% of the cases of symptom presentation but in only 47% of the cases of specific product request. Information on appropriate self‐medication was provided on at least one item in 74% of pseudo customer visits, but most of the time the information was not sufficient. Communication skills (nonverbal elements, comprehensibility etc.) were very good or good in 54% of the visits. Potential for improvement was mainly in relation to the use of open‐ended questions to gain more information and on counselling about appropriate self‐medication. Direct feedback was given in 96% of the pharmacies (one person refused to accept feedback and one feedback had to be postponed because of time shortage). All of the participants regarded counselling as an important subject in pharmacy practice. Conclusion: The pseudo customer method was successfully used in this study of German community pharmacies. It was shown that pseudo customer visits and performance feedback following the counselling process, were feasible in daily practice and well accepted by the participants. A training program, focussing on areas in most need of improvement, has been developed. The promising results have led to the Federal Chamber of Pharmacists in Germany adopting this method as part of a continuous quality improvement program in community pharmacies.

Aims Medication non‐adherence is frequent and is associated with high morbidity and mortality in patients with chronic heart failure (CHF). We investigated whether an interdisciplinary intervention improves adherence in elderly CHF patients. Methods and results The study population (mean age 74 years, 62% male, mean LVEF 47%, 52% in NYHA class III) consisted of 110 patients randomized into the pharmacy care and 127 into the usual care group. The median follow‐up was 2.0 years (IQR 1.2–2.7). The pharmacy care group received a medication review followed by regular dose dispensing and counselling. The control patients received usual care. The primary endpoint was medication adherence as proportion of days covered (PDC) within 365 days for 3 classes of HF medications (beta‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists). Main secondary outcome was the proportion of adherent patients (PDC ≥80%). The primary safety endpoint was days lost due to unplanned cardiovascular hospitalizations (blindly adjudicated) or death. Pharmacy care compared with usual care resulted in an absolute increase in mean adherence to 3 HF medications for 365 days (adjusted difference, 5.7% [95% CI, 1.6–9.8], P = 0.007). The proportion of patients classified as adherent increased, odds ratio 2.9 (1.4–5.9), P = 0.005. Pharmacy care improved quality of life after 2 years (adjusted difference in MLHFQ scores ‐7.8 points [‐14.5 to ‐1.1]; P=0.02), compared to usual care. Pharmacy care did not affect the safety endpoints of hospitalizations or deaths. Conclusion Pharmacy care safely improved adherence to heart failure medications and quality of life.

Background: A drug-related problem (DRP) is defined as an event or circumstance that actually or potentially interferes with desired health outcomes. DRPs can lead to ineffective pharmacotherapy and may cause drug-related morbidity and mortality. Most DRPs are avoidable and community pharmacies are assuming an active role in preventing and solving DRPs. Objective: To identify the spectrum of DRPs encountered in community pharmacies. Methods: In 2005. a nationwide survey in Germany was conducted in community pharmacies to record all identified DRPs. Participating community pharmacies were free to select one week within the designated study period (February–May) and were instructed to record basic statistics (eg, number of patient interactions. number of prescriptions filled/nonprescription [over-the-counter; OTC] drugs dispensed per week), as well as patient-, problem-, and intervention-related data (eg, patient age and sex, whether a prescription-only or OTC drug was involved in the DRP, the time needed for problem resolution). DRPs were categorized using a modified version of the PI-Doc (problem–intervention–documentation) classification system. Results: Community pharmacies that participated in the study (N = 1146) documented 10,427 DRPs (9.1 DRP per pharmacy per week). A broad spectrum of DRPs was identified, with 9 of 10 cases involving prescribed medicines. DRPs arose on 3 primary levels: the prescription-, the patient-, and the delivery level. Overall, drug–drug interactions were the most frequently reported DRP (8.6%) and, according to community pharmacies, more than 80% of identified DRPs could be resolved completely. The prescribing physician was contacted in 60.5% of all such cases. Median time needed for solving a DRP was 5 minutes. Conclusions: Pharmacists in the community pharmacy setting are well suited to identify and resolve DRPs. Ensuring the proper use of both prescription and OTC drugs is one of the basic responsibilities of pharmacists. This specific role of pharmacists within the healthcare system needs to be more fully recognized