Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 37 38 Maryam Taghizadeh-Ghehi Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran 2019 06 26 2019 06 27 Professional Interventions to Improve Rational Prescribing and Drug Utilization: Role of Pharmacists https://jpc.tums.ac.ir/index.php/jpc/article/view/272

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 39 43 Elahe Laali Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences Soheila Manifar Department of Radiation-Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran Ali Kazemian Department of Oral and Dental Diseases, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Zahra Jahangard-Rafsanjani Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Kheirollah Gholami Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences . AND Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran 2018 12 18 2018 12 25 Background: Radiotherapy as an important treatment modality in head and neck cancer diminishes reactive oxygen system which causes damages to the normal cell/tissue function and cell cycle regulation. Selenium involve in both antioxidant and anti-inflammatory systems. In this study, we aimed to investigate whether there is a difference between selenium levels before and after radiotherapy and the effects of serum selenium levels on radiotherapy oral mucositis (OM) patients undergoing radiation for head and neck cancer. Methods:This prospective study includes 42 head and neck cancer patients treated by external beam radiotherapy at the Cancer Institution of Imam Khomeini Hospital, Tehran University of Medical Sciences. Plasma selenium concentrations were determined before and after RT. The grade of OM was evaluated weekly by the WHO oral toxicity scale. Results: The mean patient age was 54.74 (range=18-81) years. For most of the patients, the histopathological diagnosis of cancer was squamous cell carcinoma (n=28 (66.7%)).  There was no significant difference in serum Se levels before and after RT (85.38±30.63 before radiation and 90.32±33.26 after radiation, p-value >0.05). ). Moreover, there was no significant difference between levels of Se after RT in patients who developed severe OM and who did not. Conclusion: In our study, we couldn’t find any significant difference in the levels of Selenium before and after radiotherapy and also there was no association between Selenium levels and oral mucositis developing.     https://jpc.tums.ac.ir/index.php/jpc/article/view/246

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 44 51 Tsegaye Melaku Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Ethiopia Yordanos Solomon Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Ethiopia Legese Chelkeba Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Ethiopia 2019 02 04 2019 03 11 Background: Cardiovascular disease is a leading cause of morbidity and mortality among type 2 diabetes mellitus (T2DM) patients. It has been proved & recommended by most guidelines that statins are effective for primary or secondary cardiovascular diseases prophylaxis. The aim of the study was to assess the pattern of statin use among T2DM patients with high risk of cardiovascular diseases. Methods: Hospital-based cross-sectional study was conducted among T2DM patients from February to April 2018 at Jimma University Medical Center. Patient-specific data including clinical characteristics, laboratory work ups and medication records were collected using a structured data collection tool. Results: Mrom a total of 150 study participants, 93(62%) of them were males. Majority of the patient, 112(74.7%), were between age of 40-64 years (mean ± SD of 46.65±19.61 years). About 55(36.67%) of participants were on statin therapy for treatment & prophylaxis. Age between 65 to 74 years (AOR = 3.006; 95% CI: 1.440–6.277; P=0.003), disease co-morbidity (AOR 4.486; 95% CI: 2.080–9.673; P<0.001) & elevated blood cholesterol (AOR = 1. 422; 95% CI: 1.244–1.622; P=0.033), living with diabetes mellitus for more than 10 years (AOR=2.45; 95% CI: 1.524- 3.891; P=0.027) & uncontrolled blood sugar (AOR=2.127; 95% CI: 1.833–2.457; P=0.0241) were independent predictor of statin use. Conclusion: The majority of patients with type 2 diabetes were not receiving statins. Further interventions to improve statin use should be considered for these high-risk patients   https://jpc.tums.ac.ir/index.php/jpc/article/view/249 https://jpc.tums.ac.ir/index.php/jpc/article/download/249/191

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 52 57 Elham Hosseini 1Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran Lida Shojaei Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran. AND Pharmaceutical Sciences Research Center, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran Hassanali Karimpour Department of Anesthesiology and Critical Care, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran Foroud Shahbazi Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran. AND Pharmaceutical Sciences Research Center, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran 2018 12 11 2019 01 02 Background:  Drug interaction commonly occurred in critically ill patients and may increase hospital lengths of stay and total cost. The aim of the present study is to evaluate potential drug-drug interaction in critically ill patients. Methods: In this cross-sectional study, medical records of critically ill patients admitted to the 16-bed intensive-care units of a teaching hospital were assessed according to the Micromedex® drug interaction and drug interaction fact®. The identified drug-drug interactions were categorized by level of severity. The agreement between two resources was assessed. Results: Our survey found 915 and 564 paired DDIs according to the Micromedex® and drug interaction fact®, respectively, amongst 120 patients.  The prevalence of potential DDIs (pDDIs) was 87.7% and 91.7% with drug interaction Fact® and Micromedex®, respectively. Approximately, 80% of recruited patients, had at least three pDDIs based on Micromedex®. A significant moderate agreement between two drug interaction compendia was reported. (kappa= 0.41, 95% CI: 0.167-0.649, p<0.001). The serotonin syndrome, increasing the risk of bleeding and hyperkalemia were the major possible consequence of potential DDIs; but none of them occurred. Conclusions: Most of the observed interactions were mild to moderate in nature. However, major and contraindicated interactions are possible in critically ill patients. Therefore, monitoring of patients with possible major or contraindicated drug interaction is recommended.   https://jpc.tums.ac.ir/index.php/jpc/article/view/243

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 58 61 Mitra Momken 1Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran Amir Hooshang Mohammadpour Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. AND Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Hanie Elahifard Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Atlas Haddadi Avva Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Behnaz Rohani Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Farideh Rezaei Student Research Committee, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran Fatemeh Nazemian Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran Sepideh Elyasi Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran 2019 02 08 2019 04 27 Background: Intravenous fluid therapy is frequently used for hospitalized patients but it is overused in many cases. This can lead to economic burden in addition to complications. Few studies have investigated fluid therapy cost-related errors. Drug Use Evaluation (DUE) can be used to evaluate these errors. The aim of our research is to evaluate fluid therapy errors in surgery ward of Imam Reza Hospital, Mashhad, Iran. Methods: During this cross-sectional study, patients selected by simple randomization method from surgical ward of a teaching hospital in Mashhad, Iran. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations by clinical pharmacists. The data related to patients’ fluid therapy were compared with this protocol. Main outcome measure of this study was any mistake in the selection of fluid type, content, volume and rate of administration. Results: One hundred patients were observed during study. Errors in the rate of fluid administration (85%), incorrect fluid volume calculation (83%) and incorrect type of fluid selection (1%) were the most common types of errors. Conclusion: Our result showed that intravenous fluid therapy errors occurred commonly in the hospitalized patients especially in the medical wards. Improvement in knowledge and attention of health-care workers about these errors are essential for preventing of medication errors in aspect of fluid therapy. https://jpc.tums.ac.ir/index.php/jpc/article/view/250

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 62 67 Fariba Lookian Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran Elliyeh Ghadrdan Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Maryam Mousavi Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran 2019 04 17 2019 06 13 Background: Patients’ knowledge, attitude, and practice are essential factors for hypertension management. Therefore, the information that reflects the level of public awareness can affect health policies. The aim of this study is to assess the knowledge, attitude, and practice of the general population about different aspects of hypertension. Method: In this pilot study, we totally include 198 adults with or without hypertension who came to the main teaching hospital in Mashhad city. Patients were randomly selected, and they filled a KAP questionnaire. Results: Most of the participants were younger than 30 years old. The gender distribution consisted of 53.7% males and 45.8% females. The educational levels of participants were 13.8% primary or less, 33% secondary-tertiary and 53.2% academic. Severe headache and dizziness were the principal hypertension symptoms in participant perspectives. Most of the people had reported that salt intake and fatty foods may cause hypertension more than others. Majority of the responders considered low salt-fat diet and regular exercise were the main hypertension prevention. In the present study, participants believed that all the population can be at risk of hypertension, except primary or less educated who said low exercise and positive family history are the main causes.  All groups believed that hypertension risks are threatening both individual and society. In the presence of hypertension symptoms, referring to the nephrologist for initial evaluation was a priority for thirty percent of responders. Conclusions: Our study concluded that the majority of the general population had good knowledge about hypertension. We found that attitude was satisfied, although the inappropriate practice was seen in participants. https://jpc.tums.ac.ir/index.php/jpc/article/view/257

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 6 3-4 2019 07 16 68 71 Niusha Didehvar Pharm D Candidate, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Leila Sabetnia Department of Nephrology, School of Medicine, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran Heshmatolah Shahbazian Department of Nephrology, School of Medicine, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran Kaveh Eslami Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran Leila Kouti Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran 2018 12 15 2018 12 15 Geriatric patients are at greater risk of drug related problems due to increased prevalence of chronic diseases and drug consumption. But at the same time, an important issue in the collaboration of pharmacists and physicians, is the acceptance of the pharmacist’s recommendations by other specialties. The present review summarizes the acceptance rate of nephrologists towards pharmacist recommendations. PubMed and google scholar were searched from 1979 to 2016. The key terms were: physician-pharmacist, physician acceptance, pharmacist intervention, elderly patients, nephrology, renal disorder, pharmacist assessment, geriatrics, physician pharmacist collaboration. The search for kas been documented.  We reviewed some of the clinical trials and observations regarding vitamin D deficiency and supplementation. It has been shown that vitamin D deficiency is associated with more acute respiratory tract infections and acute pharyngitis resulting in more days off from training, more bone stress fractures, poor physical performance, and increased risk for suicide. Clinical trials that utilized supplemental vitamin D shows decreased incidence of stress fractures in female navy recruits, lower incidence of influenza A and lower risk of acute respiratory tract infections, and improved bone density during initial military training, although one systematic review found conflicting data in supplementation with vitamin D for the prevention of acute respiratory infection. These data opens a window for supplementation with vitamin D in populated military bases to decrease rate of respiratory infection and to minimize stress fractures for better performances; doses used for these purposes ranges from 300 to 1200 IU per day. Further clinical trials of vitamin D supplementation or dietary fortification for these military purposes should be conducted to determine the optimum dose and duration. https://jpc.tums.ac.ir/index.php/jpc/article/view/99 https://jpc.tums.ac.ir/index.php/jpc/article/download/99/98

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 4 1-2 2017 09 18 37 39 EN Leila Kouti PharmD, PhD, Assistant professor, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Asghar Davoodi Pharmacy student, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Kaveh Eslami PharmD, PhD, Assistant professor, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Maryam Aghakoochakzadeh PharmD, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2016 11 06 2017 05 07 Background: Medication discrepancies occur at the time of medicine prescription in inpatient and outpatient settings, especially at patient transfer and discharge. Pharmacists can prevent these medication errors by reconciliation of the patients’ medications. In this study, medication discrepancies of the only hospital of a small town are assessed by a pharmacist. Methods: A medication reconciliation form was designed to fully record all patients’ drug history and current therapies. All admitted patients during a six month interval were evaluated by a pharmacist and their medical records were compared to the detailed data form. Results: 150 admitted patients were evaluated in this study from September 2015 to February 2016. 51% of the patients were male and 49% female. 56% of the patients had medication discrepancies when discharged. Interestingly none of the patients had documented drug history in their medical records. Conclusion: More than half of the patients developed a medication discrepancy at the time of discharge. We think that a drug review of the patients at the time of admission and discharge and establishing medication reconciliation processes may be helpful in improvement of health care. https://jpc.tums.ac.ir/index.php/jpc/article/view/127 https://jpc.tums.ac.ir/index.php/jpc/article/download/127/99

Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 4 1-2 2017 09 18 40 43 EN Mahin Jamshidi Makiani Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran Maryam Farasatinasab Assistant Professor, Endocrine Research Center,institute of Endocrinology and metabolism, Iran university of Medical Sciences,Firoozgar Hospital,Teharan, Iran Somayyeh Nasiripour Assistant Professor, Colorectal Research Center, Iran university of Medical Sciences, Rasool-e-Akram Hospital,Teharan,Iran 2017 04 26 2017 05 30 Background: Antibiotic-resistant pathogens are problem in many geographic areas. The selection of appropriate antibiotics to treat Gram-negative bacteremia may be life-saving. The aim of this study was to evaluate the incidence of decreased antibiotic susceptibility among aerobic gram-negative bacilli isolated from hospitalized patients of Bandar Abbas general hospital. Methods: Consecutive specimens collected on clinical indications from hospitalized patients were cultured. The minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by the agar dilution method according to the National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Results: In this study 494 positive samples during one year were evaluated. The most common site of isolation was urinary system. The most frequently isolated organisms were E.coli (%47.3), Kelebsiella pneumonia (%19.9) and Pseudomonas aeruginosa (%16.2). Resistance to ceftriaxone, ceftazidime and cefepime was more than %50. MIC results revealed that E.coli was sensitive to amikacin, ciprofloxacin and meropenem more than %75; whereas sensitivity to ceftriaxone, ceftazidime and cefepime wasless than %30. Klebsiella showed sensitivity to amikacin %77.1; however sensitivity to ceftriaxone, ceftazidime and cefepime less than %25. In addition, sensitivity of Pseudomonas aeruginosa to amikacin, ciprofloxacin and imipenem was more than %65; while sensitivity to ceftriaxone, ceftazidime and cefepime was %25 or less. Conclusions: The high incidence of reduced antibiotic susceptibility among gramnegative bacteria in this hospital suggests that more effective strategies are needed to control the selection and spread of resistant organisms. https://jpc.tums.ac.ir/index.php/jpc/article/view/153 https://jpc.tums.ac.ir/index.php/jpc/article/download/153/100

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