No Abstract ###

Background: Warfarin is an effective oral anticoagulant which exert its effect by blocking the utilization of vitamin K. Warfarin therapy requires ongoing monitoring using the international normalized ratio (INR). In this study, effect of modest increase in vitamin K intake from vegetables on INR values was evaluated in warfarin treated patients.
Methods: A single-center study involving 24 outpatients (mean age, 62 years) with two last INR in therapeutic range in which INR variations was less than 0.5. Patients were selected based on their VKORC1 1639G→A polymorphism so that 8 patients from each of GG, AA or GA genotypes were recruited. Patients were asked to consume a vegetable mix (including lettuce, peeled cucumber and tomato) containing approximately 100 µg vitamin K (divided in two meals, lunch and dinner) daily for one week when INR response was measured.
Results: Daily consumption of vegetable mix decreased patient’s INR from 2.43±0.51 to 2.08± 0.46 (P<0.001). INR value had a significant decrease in each VKORC1 genotypes (from 2.55± 0.55 to 2.21± 0.54 in GG, 2.35± 0.33 to 2.00± 0.25 in AA, and  2.39± 0.65 to 2.00± 0.25 in GA) but the values did not differ between genotypes.
Conclusions: Daily increase in vegetable salad containing approximately 100 µg, decreased INR of patients. Therefore, avoiding variation in consumption of foods with even moderate content of vitamin K could help to prevent INR fluctuations in warfarin treated patients.

Background: Proton pump inhibitors (PPIs) are currently the most effective agents for acid related disorders. However, studies show that 25-75% of patients receiving intravenous Pantoprazole had no appropriate justification, indicating high rate of inappropriate prescribing in hospitals. The aim of this study is to examine the appropriate use of intravenous Pantoprazole in accordance with guidelines at Shahid Sadoughi hospital.
Methods: From January to April 2015, sample of 100 prescriptions who received Intravenous (IV) Pantoprazole were collected with observational and sectional model in Intensive care unit (ICU) and general wards of “Shahid Sadoughi” Hospital of Yazd, Iran. Clinical data from patient records are obtained and these data were mapped to establish clinical criteria and appropriate use of Intravenous Pantoprazole.
Results: The majority (63%) of Intravenous Pantoprazole prescriptions were deemed inappropriate in terms of either indication for use, dose or duration of therapy. 51.5% of the patients were above 55 years old. Endoscopy did not performed in most of the Non UGIB (Non upper gastrointestinal bleeding) cases. Most Intravenous Pantoprazole prescriptions were ordered by junior doctors (Intern), and again this group were significantly less likely to prescribe the drug for appropriate reasons when compared with more experienced clinicians.
Conclusion: This study suggests that the majority of IV PPI prescriptions in our hospital are inappropriate. Awareness of the result of this article through medical staff could result in more judicious use of intravenous pantoprazole and dose optimization. Physicians and pharmacists can work together to create solutions to inappropriate drug use.

Background: Inherent toxicity of cytotoxic drugs is the basis for their potential adverse risks from occupational exposure to the nursing staff. In Iran, chemotherapy regimens are prescribed and administered according to the world updated protocols. But little is done regarding the protective standards in this field.
Methods: An observational cross-sectional survey was conducted among nurses who work in three tertiary care teaching hospitals in Tehran, Iran in 2012. All participants worked in one of the hospital wards handling cytotoxic drugs (preparation and administration). A questionnaire was used for interviewing all subjects, and observing them preparing and administering the drugs. We examined all adverse effects associated with handling of antineoplastic drugs.
Results: Totally 270 adverse reactions were reported. The most frequently reported adverse effects included headache and vertigo (40 cases), hair loss (36 cases), skin rashes and itching (31 cases), and burning sensation in eyes (31 cases). In all hospital wards, the standards were met in not more than 50% of the items.
Conclusion: Monitoring the personnel who are directly involved in handling of cytotoxic drugs is of great importance. Furthermore, educating the personnel in the field of standards of cytotoxic drugs handling could increase the nursing staff’s knowledge regarding these drugs’ adverse reactions.

Background: Opioid drugs are the most effective drugs for the treatment of moderate to severe pain. Rates of opioid use are influenced by a variety of factors. The aim of this study was to determine the pattern of use of parenteral opioid drugs in hospitalized patients in a referral teaching hospital.
Methods: In a retrospective study, required data were extracted from medical records of adult patients who had received any parenteral opioid analgesic in the 6-month period from March 2013 to September 2013. The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system method was used for evaluation of opioid analgesic use in patients.
Results: The overall usage of parenteral opioid analgesics was 730.51 DDDs with meperidine (Pethidine) having the most amounts of use (588.69 DDDs and 33.23 DDDs/100 bed-days). Overall, the male surgery ward and emergency department had the most amounts of use based on the number of DDDs (445.8 DDDs) and per 100 bed-days (1046 DDDs/100 bed-days), respectively. Methadone use was most in the infectious diseases ward.
Conclusion: The trend of parenteral opioid analgesics consumption is increasing in this hospital. Therefore, better adherence to pain treatment guidelines by medical staff is necessary for rational use of these drugs.

Background: Stress is an important element of organization ineffectiveness and since it leads to sickness, eventually it reduces quality and quantity of health care, lead to expansion of it costs and low job satisfaction. Stress comes along with consequences, one of this reactions which comes along with horrible effects is job burnout. Health care are more exposed for job burnout. We examined the relationship between job stress and job burnout in Iranian clinical pharmacist.
Methods: Sample was 50 of men and women of clinical pharmacist. Parker and De cotiis  scale (1983) and Maslach Burnout Inventory (MBI, 1981) were used to asses clinical pharmacist stress and burnout. Data were analyzed by applying regression method.
Results: Results indicated that there is strong relationship between stress and burnout and its three dimensions. The result also indicated that stress have the highest impact on emotional exhaustion and the least on the depersonalization.
Conclusion: Burnout is a result of stress in human services career. Human service needs are vary from other professions since in these jobs in order to fulfill the clients’ needs, employees should use themselves as the required technology, and in return they do not receive gratitude or appreciation.

According to the vital role of pharmaceutical industry in health care system, pharmaceutical supply chain security, standard production and distribution of the pharmaceutical products are of great importance for pharmaceutical companies. Therefore, applying technology, especially Radio Frequency Identification (RFID), is essential to achieve these goals. Moreover, due to the importance of security in production and distribution and also the quality of pharmaceutical products, international pharmaceutical Institutes such as Food and Drug Administration (FDA) and huge pharmaceutical companies apply RFID to increase their success and improve their efficiency and effectiveness. The present study explains the concept of RFID, its application and importance in pharmaceutical industry, and its role in struggling against counterfeit medicines in addition to presenting a framework of RFID in struggling against counterfeit medicines. It is discussed that RFID has various applications in pharmaceutical industry such as inventory and property management system, access control and machines’ performances, producing sterile pharmaceutical products, anti-thieving mechanism, preventing medicines’ diversion.
Counterfeit medicines and recognition of counterfeit medicines. As a conclusion RFID can be suggested to make the pharmaceutical industry and health system smart. Therefore, it is suggested to establish this technology in pharmaceutical supply chain by the use of Information Technology and create a team of related specialists in order to successful application of this technology and gain the positive related results.