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The hydration of prototype-radiopacified tricalcium silicate cement, Biodentine and Bioaggregate resulted in the formation of calcium silicate hydrate and calcium hydroxide, which was leached in solution. The hydrated materials were composed of a cementitous phase that was rich in calcium and silicon and a radiopacifying material. Biodentine included calcium carbonate, and Bioaggregate included silica and calcium phosphate in the powders. IRM was composed of zinc oxide interspersed in a matrix of organic material.

Dry storage of Biodentine resulted in changes in the material microstructure and cracks at the root dentine to Biodentine interface. Furthermore, the gaps resulting from material shrinkage allowed the passage of the fluorescent microspheres thus indicating that these gaps are significant and can potentially allow the passage of micro-organisms.

BackgroundThe concept of biosimilar presents a myriad of issues such as patient safety, efficacy and financial aspects to clinicians, pharmacists and policy makers. The introduction of biosimilar infliximab, the first biosimilar on the local national health system in Malta, put clinicians at the forefront of these challenges.ObjectivesThe objective of the study was to assess the perception and awareness of Maltese clinicians working within the National Health System on the concept of biosimilars.MethodsThe questionnaire developed by the Alliance for Safe Biologics Medicines and which was previously run in 5 European countries was shortlisted to be used in the study1. Permission from the Alliance for Safe Biologics Medicines was sought to use the questionnaire. The questionnaire was sent online to prescribing clinicians working within the Maltese National Health System. The clinicians were given one month to answer the questionnaire during which time three reminders were forwarded.ResultsA total of 132 prescribers participated in the study giving a 14% response rate. Approximately 34% prescribed biologics within their practice whereas 40% treated patients prescribed biologics by another specialist. Out of the total respondents 6% consider themselves very familiar with the concept of biosimilars, 35% had a basic understanding of biosimilars whereas 59% could not define biosimilars or had never heard of them. Less than half of the respondents (36%) believe that patients can safely receive either originator or biosimilar and expect the same result. Only 27% agree that patients can safely be switched between products during the course of treatment and 46% state that is is very important or critical for them to have the sole authority to decide whether to prescribed the biosimilar or originator. Around 27% answered that they prescribe by generic name irrespective of whether the drug is a biologic or not.ConclusionsThe awareness (6%) on biosimilars in Malta is much less than that achieved in 5 European countries where an average of 22% of prescribers considered themselves very familiar with the concept of biosimilars1. Although prescribing of biologic medicines is regulated by Subsidiary Legislation 458.59 “Prescribing and Dispensing requirement rules”, Maltese prescribers are unaware that biosimilars should be prescribed by brand name. Switchability is an aspect where Maltese clinicians are not comfortable since only 27% believe that patients can be safely switched between products during treatment. This however correlates to results of the ASBM European survey where only 39% agree with switchability. Increased awareness on biosimilars together with more robust data on switchability will help Maltese clinicians adopt biosimilars in their practice without having concerns on patient safety and efficacy.ReferencesO'Dolinar M, Reilly MS. Biosimilars naming, label transparency and authority of choice - survey findings amongst European physicians. GaBI Journal. 2014;3(2):58–62.AcknowledgementMr Michael Reilly, Executive Direc...

Objectives The implementation of individualised pharmaceutical care plans based on the identification of pharmaceutical care issues for rheumatoid arthritis patients presenting at outpatient clinic service has been proven to be effective in improving the quality of life of these patients. However, the identification and classification of pharmaceutical care issues into drug therapy problems does not give room to assessment of prescribing trends and adherence to international guidelines. The novel concept of medication assessment tools, is a concept which integrates pharmaceutical care issues within a larger context, that of evaluating the prescribing trends. The objective of this research was to design, and validate medication assessment tools specifically for rheumatoid arthritis patients. Methods A thorough literature review was carried out to identify the latest evidence‐based guidelines on rheumatoid arthritis pharmacotherapy. The rheumatoid arthritis medication assessment tool (RhMAT) was compiled and validated. Key findings The RhMAT consists of 11 general sections with a total of 54 criteria. For every criteria given, the researcher has an option of four responses ranging from criterion not applicable (N/A), criterion adherence (yes), criterion non‐adherence (no) and insufficient data to comment on the criterion. In cases where the criterion is not adhered to this can be justified adherence or unjustified and insufficient data for the researcher to be able to tick appropriately. The expert panel agreed with the final version of the RhMAT. Conclusion The innovative RhMAT was designed to act as a tool used by pharmacists to be able to detect gaps within patients' pharmacotherapy against evidence‐based guidelines thereby improving the quality of service offered to patients.