Journal of Pharmaceutical Care

Digital Therapeutics: Catalyzing Personalized Medicine and the Pursuit of Equitable Healthcare

Chetan Choudhary — Sat, 29 Jun 2024 06:45:28 +0430

The evolution of digital therapeutics reflects a transformative shift in personalized healthcare, propelled by software-driven interventions aimed at preventing, managing, and treating a plethora of medical conditions with evidence-based approaches. This editorial articulates the burgeoning role of DTx as an integral component of modern healthcare, distinct from traditional therapy methods through its direct delivery of therapeutic measures via software. The importance of a digital therapeutic alliance is emphasized for enhancing patient engagement and adherence, with a nod to the literature suggesting promising outcomes in various domains including neurology, psychiatry, and general medicine. The paper reviews the promising applications of DTx, such as game-based interventions for younger patients and strategies targeting chronic conditions like Parkinson’s disease, which have seen a surge in relevance amidst the pandemic stressors. It also highlights the response from regulatory bodies, particularly the FDA, in recognizing and promoting the safe integration of DTx into clinical practice. The editorial further discusses the pivotal challenges and opportunities ahead, emphasizing the need for continued innovation, regulation, and collaboration between stakeholders to ensure not only the expansion but also the efficacy and safety of DTx. As the medical community seeks to harness these advancements, this editorial underscores the transformative potential of DTx to democratize and enhance health outcomes, setting the stage for a new era in medicine.

Assessment of Community Pharmacists’ Knowledge and Perception of Pharmaceutical Care in South Africa: A Cross-sectional Survey

Gezahegn Samuel Lorato, Velisha Ann Perumal-Pillay, Fatima Suleman — Sat, 29 Jun 2024 06:47:23 +0430

Background: Medicines are intended to cure, prevent, or diagnose diseases, alleviate signs, or symptoms, but improper use can cause patient morbidity and even mortality. Pharmacists assume direct responsibility for all the patient’s drug-related needs. Hence, pharmacists’ knowledge and attitudes regarding pharmaceutical care (PC) and their perceived barriers to PC provision are imperative to treatment success. The aim of the study was to explore community pharmacists’ knowledge and perception towards pharmaceutical care and identifying perceived barriers towards its implementation in South Africa.

Methods: A quantitative study was undertaken, using a descriptive cross-sectional design. The data were collected by means of an online questionnaire completed by community pharmacists across South Africa. The data were analyzed using descriptive statistics, through Microsoft Excel and the Statistical Package for the Social Sciences (SPSS).

Results: Out of 250 online questionnaires sent, a total of 181 responded, which delivered an 72.4% response rate. The vast majority (n=166; 91.7%) of the respondents were knowledgeable about PC though a few (n=15; 8.3%) of the respondents had a poor understanding of PC. A high number of respondents (n=173;95.5%) agreed that providing PC would increase the patients’ conﬁdence in the pharmacy profession (n=173; 95.5%); and about 87.2% responded that all pharmacists should provide PC services. Lack of compensation for PC provision was perceived as the main barrier (83.9%).

Conclusion: South African community pharmacists have good knowledge of PC, but a lack of remuneration and time were perceived as the main barriers to PC provision. Relevant stake holders like policymakers in pharmaceutical service, health care financial managers, and pharmacy managers should intervene to overcome these barriers.

Antibiotics Utilization Pattern in a Children’s Medical Center in North of Iran

Sat, 29 Jun 2024 06:48:26 +0430

Background: The development of a system for rational use of antimicrobials seems mandatory. Furthermore, since hospitals do not share the same bacterial flora and have different patterns of antibiotic therapy the purpose of the present study is to perform a Drug Utilization Evaluation (DUE) on the pattern of antibiotic administration in patients hospitalized in 17 Shahrivar Pediatric Hospital, RASHT, Iran.

Methods: In this descriptive cross-sectional study that was conducted in a one-year period (2021-2022), 560 patients were randomly selected and their medication data were collected based on the gender and age as well as the type, dose, duration of antibiotic therapy and the results of bacterial cultures and also susceptibility of the infectious microorganisms.

Results: The average age of patients was 53.56 months with 46.9% of them being less than 24 months old. The highest rate of antibiotics administration belonged to the infectious diseases ward (30%) and 33% of antibiotics were prescribed by pediatric infectious diseases specialists. The result of most of the cultures was reported as negative (98.38%), the most prevalent microorganism was Escherichia Coli from urine cultures (2.38%) and Staphylococcus Aureus from sputum cultures (14.28%). The highest prescribed antibiotics were ceftriaxone (51.2%) and vancomycin (45.6%). It was determined the antibiotic stipend was 15.6% of the whole budget for purchasing medicine.

Conclusions: It is necessary to develop a guideline regarding the prescription of antibiotics in children's departments, which reduces empiric treatment and the requirement to adjust the drug after a negative culture.

Severity and Risk Rating of Drug-Drug Interaction Potency in Chronic Kidney Disease in Public Health Hospital

Okta Muthia Sari, Aditya Maulana Perdana Putra — Sat, 29 Jun 2024 06:58:38 +0430

Background: Chronic kidney disease has emerged as a prominent cause of mortality worldwide in the last two decades. Drug interactions are a significant problem in individuals with chronic kidney disease, as they often receive numerous concurrent treatments. The aim is to examine the frequency of drug-drug interactions in outpatient treatment for chronic renal disease, classified according to their severity and risk level. Furthermore, the study aims to demonstrate the combined effect of the most common drug-drug interactions potency and associated risk factors. Methods: This study is a retrospective cross-sectional analysis of outpatients diagnosed with chronic kidney disease at Ansari Saleh Public Hospital in Banjarmasin, Indonesia. Medical records from 2022 were obtained retrospectively from computerised sources. The evaluation of potential interactions between drugs was conducted using Lexicomp®. The categorical data were displayed as percentages, and the continuous variables were depicted as means. Results: The study found that most drug interactions fell into the moderate severity (77.1%) and category C (75.5%) for the risk assessment. The prevalence of drug-drug interactions was 83.6% and the average number of potential drug interactions per patient was 3.34 ± 3.481. The concurrent use of candesartan and furosemide was the most prevalent drug-drug interaction (5.1%). The number of prescribed medications was a notable determinant for probable drug-drug interactions (p < 0.05). Conclusion: Identifying and averting potential drug-drug interactions is crucial to guarantee patient safety.

WHO/INRUD Drug Prescribing Indicators in the Emergency Ward of a Teaching Hospital, South East of Iran

Mandana Moradi, Alireza Rafighdous, Soudabeh Hamedi-Shahraki — Sat, 29 Jun 2024 00:00:00 +0430

Background: Rational drug use is an important issue in all healthcare settings. Core drug use indicators have been developed by World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD). The prescribing indicators measure healthcare providers’ performance in five key areas of drug usage. The aim of this study was to evaluate WHO/INRUD indicators of prescribing in emergency ward of a teaching hospital. Methods: This descriptive cross-sectional study was carried out in Emergency Ward of teaching hospital from March 2022 – March 2023. A standard prescribing indicators form was utilized to collect the required data using WHO drug prescribing indicators. Besides the rate of intravenous fluids and narcotic analgesics administration was evaluated. Index of rational drug prescribing (IRDP) was also calculated for each month and the mean of 12 IRDPs represent the emergency ward IRDP. Descriptive statistics were used for analysis. Results: Antibiotics were prescribed in 34% of studied prescriptions and ceftriaxone was the most widely used antibiotic (33.8%). Index of rational drug prescribing (IRDP) was 0.73 for polypharmacy, 0.93 for generic name prescribing, 0.88 for antibiotic prescribing, 0.1 for injectable drug use and 1 for formulary-based drug prescription. Total IRDP for the emergency ward was 3.64 (from optimal value of 5). IV fluids and narcotics were prescribed in 61.1% and 8.3% of studied prescription respectively. Conclusion: We concluded that although our overall IRDP value is below the WHO standard but it is about other neighbor countries. Our condition regarding IV drug administration showed a huge difference with WHO standards. It shows we need more input and regulations in this regard.

Impact of Statin or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker on the In-Hospital Mortality of COVID-19 Patients

Mohsen Gholinataj Jelodar, Samaneh Mirzaei, Majid Hajimaghsoudi — Sat, 29 Jun 2024 00:00:00 +0430

Background: It is important to determine the risk factors that contribute to the mortality of a disease and take measures to prevent or alleviate it. In the case of COVID-19, old age, male gender, and comorbidities such as diabetes (DM) and hypertension (HTN) have been identified as potential risk factors. However, there is conflicting information on the effects of statins and ACEI/ARB in COVID-19 patients admitted to the ICU, particularly those with diabetes or hypertension. This study aims to investigate the effects of these drugs on the in-hospital prognosis of ICU COVID-19 patients, with a focus on patients with DM or HTN.

Methods: During 18 months, we conducted a descriptive-analytical observational analysis on 391 patients who were admitted to the ICU. The study focused on COVID-19 patients and aimed to identify mortality risk factors by assessing their demographic, clinical, pharmaceutical, laboratory, and imaging data. We statistically analyzed the data to achieve this goal.

Results: Out of 391 patients, 83 received statins and 89 received ACEI/ARBs. The research has revealed that the use of ACEI/ARBs in COVID-19 patients admitted to the ICU may increase the risk of endotracheal intubation (P<0.0001) and mortality (P<0.0001). Additionally, patients treated with these drugs are more likely to experience secondary bacterial infections (P=0.007) and venous thromboembolism events (P=0.015). The results of a recent study analyzing diabetic and hypertensive patients hospitalized in ICU showed that there is no significant difference in clinical outcomes between COVID-19 patients who used ACEI/ARB and those who did not. Our study has found that the use of statins in diabetic patients is linked to a reduction in mortality rate (0.008) and secondary bacterial infections (P=0.035) of COVID-19 patients admitted to the ICU. In multivariate logistic regression, the use of statin or ACE/ARB was not identified as the mortality prediction factor.

Conclusion: Statins can help reduce mortality rates among COVID-19 patients, especially in diabetic patients, hospitalized in the ICU. So, they should be used to manage cardiovascular risk factors and lower the mortality risk. Statins and ACEI/ARB drugs were not predictors of mortality and did not decrease survival rates during ICU hospitalization.

Assessment of Knowledge and Practice Regarding Disposal of Unused and Expired Drugs in Medical Professionals in a Tertiary Care Teaching Hospital in Eastern India: A Cross- Sectional, Questionnaire-based Study

Sat, 29 Jun 2024 07:04:48 +0430

Background: Despite the effect of drugs on human body getting wide attention worldwide the effect of disposed drugs on the environment is largely neglected. Since the doctors working in a teaching hospital are the major stakeholder in ensuring proper and safe disposal of drugs their knowledge, attitude and practice regarding drug disposal was assessed in this study.
Methods: A pre-validated questionnaire was given to the doctors working in a tertiary care teaching hospital through Google form from 1st June,2023 to 31st July 2023. Their responses were recorded in a Microsoft excel form and analyzed.

Results: It was observed that while buying medicines 87.5% of physicians check the date of expiry but only 78.9% do that while receiving physician’s sample from the medical representatives. Among the participants in this study 97.2% declared that medicines remain unused in their homes. In case of unused drugs, 45.8% donate them to patients or hospitals, and 29.2% throw them away with household garbage whereas in case of expired medicines majority (56.9%) throw them away. Among the participants 38.9% had never instructed their patients about the proper disposal methods.

Conclusion: To ensure proper drug disposal programs should be initiated to increase awareness about the danger of improper drug disposal not only in general population but in medical community also.

Epidemiologic Analysis of Drug and Poison Information Center (DPIC) Inquiries: A Four-Year Cross-Sectional Study in Hamadan, Iran (2019-2023)

Nasibeh Ghalandari, Shahaboddin Emami — Sat, 29 Jun 2024 07:05:41 +0430

Background: Drug and Poison Information Centers (DPIC) play a pivotal role in pharmacovigilance, public education, and preventing adverse drug reactions, medication errors, and poisoning incidents.

Methods: This study presents an epidemiologic analysis of inquiries received by the DPIC at Hamadan University of Medical Sciences in Iran over four years (2019-2023). A descriptive cross-sectional analysis of recorded phone calls to the DPIC at Hamadan University of Medical Sciences from October 2019 to November 2023. The demographic distribution of inquirers, types of inquiries, and sources used to answer questions were considered in the analysis.

Results: The study reports a total of 3904 recorded calls over the four-year period, with an average of 78.08 calls per month. The majority of callers were female (61%). The top three questions focused on coronavirus, side effects, and drug-drug reactions. Psychiatric agents, gastrointestinal agents, and antibiotics were the top three drug families inquired about. The data were collected from various references, with UptoDate® being the most frequently used (43.3%).

Conclusion: This study provides a comprehensive epidemiologic analysis of inquiries received by the DPIC at Hamadan University of Medical Sciences. The findings underscore the importance of DPICs in providing evidence-based information, contributing to pharmacovigilance, and enhancing patient safety.

5-Lipoxygenase: The Therapeutically Unexplored Target for Bone Health

Jignesh Kansagra, Vishal Dubey, Dharmeshkumar Kheni, Varun Sureja — Sat, 29 Jun 2024 07:06:29 +0430

Bone fracture is a common orthopedic condition that represents a significant health concern. Bone fracture repair process is a complex process that involves the harmonic and synchronized activity of bone cells. 5-lipoxygenase (5-LOX) is an enzyme responsible for the conversion of arachidonic acid to form leukotrienes. While leukotrienes have an empirical inflammatory role, various evidence suggests that these 5-LOX mediators, by switching the inflammatory environment and altering the activity of bone cells, have a detrimental effect on the bone fracture healing process. Additionally, various evidence suggests that 5-LOX inhibition shows improvement in the overall bone healing process and improves overall bone health. Despite this evidence, the clinical use of 5-LOX inhibitors in bone fracture healing is largely unexplored. The current review aimed to summarize the available evidence and pave the way for future large scale pre-clinical and clinical studies to evaluate the effectiveness of selective 5-LOX inhibitors in bone fracture healing.

Challenges of the Intellectual Property System in Pharmaceutical Innovations Resulting from Artificial Intelligence

Babak Sabet, Shahriar Eslamitabar, Ehsan Lame, Fatemeh Anvar — Sat, 29 Jun 2024 07:19:05 +0430

The patent system has long been criticized for limiting access to medicines. Dramatic advances in artificial intelligence and machine learning technology present a revolutionary opportunity in drug discovery, formulation and testing of dosage forms. The pharmaceutical industry claims that patenting is necessary to encourage innovation in the risky, lengthy, and costly research and development (R&D) process. But it still does not provide logical evidence about the actual effects of patents on innovation. The increasing use of artificial intelligence in research is intensifying the debate about pharmaceutical patents. Inventions created or enabled by artificial intelligence raise questions about patentability and patent policy in general. Faster and more efficient research and development weakens the justification for pharmaceutical patents. Research findings suggest that despite the necessity of continuing incentives for drug research and development, lawmakers should consider alternative systems that prioritize access alongside incentives to advance healthcare as a human right.

Self-Medication “Boon or Bane!!”: A Cross-Sectional Survey of Undergraduate Medical Students

Fehmi Mushtak Mukadam, Ujwala Pramod Gawali — Sat, 29 Jun 2024 07:09:41 +0430

Background: Self-medication can be a boon as well as curse to mankind whose proper application can reduce the unnecessary pressure on the health care system. The focus of this study was to assess the knowledge, attitude, and self-medication practices among undergraduate (UG) medical students, who are more likely to self-medicate themselves due to their limited knowledge and easy drug availability.

Methods: The study involved distributing questionnaires among undergraduate medical students at Government Medical College, using a cross-sectional approach. The data was collected in June 2022, with 360 responses analyzed. The questionnaire, consisting of 17 close-ended questions, included demographics, prevalence, indications for self-medication, commonly self-medicated drugs, patterns of self-medication, and knowledge about safety and consequences.

Results: 327 students willingly participated in the study of which 164 were females and 163 were males belonging to the age group of 18-25 years. The prevalence of self-medication was found to be 75.5%. Most common indication was cold, cough & sore throat (70.4%) followed by headache (66%). Antipyretics (71.2%) and analgesics (62.3%) were most commonly used class of drugs. 84.5% students are aware about adverse effects of drugs. 74% opine that self-medication is not a good practice.

Conclusion: Due to rising incidence of self-medication amongst the undergraduate medical students there is an increased risk of adverse drug effects. Thus, it is crucial to undertake measures that emphasize education and awareness, aiming to discourage self-medication among them.