bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management
Authors: Boriani Giuseppe , Lee Geraldine , Parrini Iris , Lopez-Fernandez Teresa , Lyon Alexander R , Suter Thomas , Van der Meer Peter , Cardinale Daniela , Lancellotti Patrizio , Zamorano Jose Luis , Bax Jeroen J , Asteggiano Riccardo ,   for the Council of Cardio-Oncology of the European Society of Cardiology
Published: January 2021

Background

In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty.

Aim

We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians.

Methods and results

A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively.

Conclusion

This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF.
Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study
Authors: González-Salvado Violeta , Peña-Gil Carlos , Lado-Baleato Óscar , Cadarso-Suárez Carmen , Prada-Ramallal Guillermo , Prescott Eva , Wilhelm Matthias , Eser Prisca , Iliou Marie-Christine , Zeymer Uwe , Ardissino Diego , Bruins Wendy , van der Velde Astrid E , Van’t Hof Arnoud W J , de Kluiver Ed P , Kolkman Evelien K , Prins Leonie , González Juanatey José Ramón
Published: January 2021

Aims 

Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients.

Methods and results 

The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes.

Conclusion 

In this European cohort of elderly patients, older age and comorbidity tackled patients’ referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.
Both incidence and prevalence of ischaemic heart disease are declining in parallel: a national data-linkage study in New Zealand (ANZACS-QI 52)
Authors: Grey Corina , Jackson Rod , Wells Sue , Wu Billy , Pujades-Rodriguez Mar , Schmidt Morten , Selak Vanessa , Kerr Andrew J
Published: January 2021

Aims

To examine trends in ischaemic heart disease (IHD) incidence and prevalence in New Zealand from 2005 to 2016, using comprehensive linked national hospitalization and mortality data as proxy measures of all significant events.

Methods and results

Incident and prevalent cases of IHD in people aged ≥25 years were identified using individual patient-linkage of routinely collected ICD-10-coded hospitalization and mortality data. Incidence rates and prevalence proportions were calculated by sex and age group and then age-standardized to the 2016 New Zealand population. Ischaemic heart disease incidence and prevalence declined in men and women in all age groups. The average annual rate of decline in age-standardized IHD incidence was 3.3% for women and 2.7% for men, and the rate of decline in age-standardized IHD prevalence was 3.2% for women and 2.2% for men. Despite a 17% increase in the New Zealand population aged 25 years and over during the study period, the total number of people living with IHD also decreased, particularly in those aged 65 years and older.

Conclusion

In contrast to observations from other countries, where IHD incidence but not IHD prevalence has been falling, declining IHD incidence in New Zealand in recent decades is now mirrored by declining IHD prevalence.
Non-exercise estimated cardiorespiratory fitness and mortality from all-causes, cardiovascular disease, and cancer in the NIH-AARP diet and health study
Authors: Vainshelboim Baruch , Myers Jonathan , Matthews Charles E
Published: January 2021

Aims

Impractical methods and relatively small cohort have limited the applications of non-exercise estimated cardiorespiratory fitness (NEE-CRF). This study aimed to assess the association between a pragmatic NEE-CRF method and mortality outcomes in a large prospective cohort.

Methods and results

A total of 330 769 participants [men (n = 186 469) and women (n = 144 300)] aged 50–71 years from the NIH-AARP Diet and Health Study were assessed at baseline (1995–96) and prospectively followed until 31 December 2015 (14.9 ± 2.1 years). Non-exercise estimated cardiorespiratory fitness was estimated using pragmatic and previously validated equation, and Cox hazard analysis for mortality was conducted. Non-exercise estimated cardiorespiratory fitness was 9.9 ± 1.5 metabolic equivalents (METs) in men and 7.2 ± 1.6 METs in women. In total, 34 317 men and 20 295 women died during the follow-up. Higher NEE-CRF was associated with lower mortality risk from all-causes, cardiovascular disease, and cancer. Compared to the lowest quartile of NEE-CRF, the hazard ratios and 95% confidence interval for all-cause mortality in the second, third, and fourth quartiles were: 0.82 (0.79–0.84), 0.74 (0.72–0.77), and 0.70 (0.67–0.73) for men, and 0.84 (0.81–0.88), 0.78 (0.75–0.82), and 0.72 (0.68–0.77) for women (P trend <0.001 for all). For each 1-MET increase in NEE-CRF, risks for mortality due to cardiovascular disease and cancer were 0.85 (0.82–0.88) and 0.89 (0.87–0.91) in men, and 0.84 (0.81–0.88) and 0.89 (0.87–0.91) in women, respectively (P < 0.001 for all).

Conclusion

Higher NEE-CRF is independently associated with lower mortality risk in a large prospective cohort of men and women. These results support the utility of the applied NEE-CRF method for risk stratification, prevention, and rehabilitation programs and application in large epidemiological studies.
Frailty in cardiology: definition, assessment and clinical implications for general cardiology. A consensus document of the Council for Cardiology Practice (CCP), Association for Acute Cardio Vascular Care (ACVC), Association of Cardiovascular Nursing and Allied Professions (ACNAP), European Association of Preventive Cardiology (EAPC), European Heart Rhythm Association (EHRA), Council on Valvular Heart Diseases (VHD), Council on Hypertension (CHT), Council of Cardio-Oncology (CCO), Working Group (WG) Aorta and Peripheral Vascular Diseases, WG e-Cardiology, WG Thrombosis, of the European Society of Cardiology, European Primary Care Cardiology Society (EPCCS)
Authors: Richter Dimitri , Guasti Luigina , Walker David , Lambrinou Ekaterini , Lionis Christos , Abreu Ana , Savelieva Irina , Fumagalli Stefano , Bo Mario , Rocca Bianca , Jensen Magnus T , Pierard Luc , Sudano Isabella , Aboyans Victor , Asteggiano Riccardo
Published: January 2021

Frailty is a health condition leading to many adverse clinical outcomes. The relationship between frailty and advanced age, multimorbidity and disability has a significant impact on healthcare systems. Frailty increases cardiovascular (CV) morbidity and mortality both in patients with or without known CV disease. Though the recognition of this additional risk factor has become increasingly clinically relevant in CV diseases, uncertainty remains about operative definitions, screening, assessment, and management of frailty. Since the burdens of frailty components and domains may vary in the various CV diseases and clinical settings, the relevance of specific frailty-related aspects may be different. Understanding these issues may allow general cardiologists a clearer focus on frailty in CV diseases and thereby make more tailored clinical decisions and therapeutic choices in outpatients. Guidance on identification and management of frailty are sparse and an international consensus document on frailty in general cardiology is lacking. Moreover, new options linked with eHealth are going to better define and manage frailty. This consensus document on definition, assessment, clinical implications, and management of frailty provides an input to integrate strategies pre- and post-acute CV events with a comprehensive view including out of hospital, office-based diagnostic and therapeutic choices, and based on a multidisciplinary team approach (general cardiologists, nurses, and general practitioners).
The search for novel treatment strategies forStreptococcus pneumoniaeinfections
Authors: Cools F , Delputte P , Cos P
Published: January 2021

This review provides an overview of the most important novel treatment strategies against Streptococcus pneumoniae infections published over the past 10 years. The pneumococcus causes the majority of community-acquired bacterial pneumonia cases, and it is one of the prime pathogens in bacterial meningitis. Over the last 10 years, extensive research has been conducted to prevent severe pneumococcal infections, with a major focus on (i) boosting the host immune system and (ii) discovering novel antibacterials. Boosting the immune system can be done in two ways, either by actively modulating host immunity, mostly through administration of selective antibodies, or by interfering with pneumococcal virulence factors, thereby supporting the host immune system to effectively overcome an infection. While several of such experimental therapies are promising, few have evolved to clinical trials. The discovery of novel antibacterials is hampered by the high research and development costs versus the relatively low revenues for the pharmaceutical industry. Nevertheless, novel enzymatic assays and target-based drug design, allow the identification of targets and the development of novel molecules to effectively treat this life-threatening pathogen.
Clinical services in community pharmacies: a scoping review of policy and social implications
Authors: Campeau Calfat Alexandre , Duval Cécile , Laberge Maude , Savard Anne-Marie , Sirois Caroline
Published: January 2021

Objectives

Clinical services have allowed pharmacists to shift from product-oriented to patient-oriented services. However, the policy and social implications of clinical services in community pharmacies are not well described. The purpose of this scoping review was to identify these implications.

Key findings

We searched Pubmed and Embase, from inception to March 2019, as well as grey literature for publications that discussed policy (e.g. pharmacy model and pharmacist status) or social (e.g. role of pharmacists and interprofessional collaboration) implications of clinical services. Publications had to address clinical services provided by pharmacists in community settings that target the global long-term care of patients. We extracted data related to the implications and classified them into themes thereafter. The search process identified 73 relevant publications, of which 13 were included in regard to policy implications and 60 relative to social implications. Two themes emerged from policy implications: implementation and characteristics of policies, and professional status. Pharmacists’ independence from distribution, financial coverage of clinical services and innovative models of practice were addressed. Social implications involved three themes: roles and interprofessional collaboration, changes in practice and barriers and model of practices and services. Perceptions of pharmacists’ skills, organisational barriers, time constraints, lack of self-confidence and cultural shifts required to implement clinical services were included in these themes.

Our review demonstrates the changing role of community pharmacists in provision of clinical services within the healthcare system. The range of clinical services varies widely from one setting to another. The context of community pharmacy is not well suited to these changes in practice.
Analysis of the demographics and characteristics of the Australian pharmacist workforce 2013–2018: decreasing supply points to the need for a workforce strategy
Authors: Jackson John K , Liang Jenifer , Page Amy T
Published: January 2021

Objectives

An adequate workforce is necessary for health care delivery. The last official analysis of the Australian pharmacist workforce was in 2014 and the results of recent studies are contradictory. The objective of this work was to determine current demographic details and recent trends of the pharmacy workforce and assess the impact of changes in student numbers and migration policy.

Methods

Longitudinal and descriptive analysis was undertaken of National Health Workforce Datasets and registrant data available from the Australian Health Practitioner Regulation Agency and the Pharmacy Board of Australia from 2013 to 2018.

Key findings

There was an increase in females and a trend towards hospital practice but no change in the geographic distribution of pharmacists over the period. However, the pharmacist workforce grew more slowly than comparable health professions and while the youngest pharmacist cohort (20–34 years) remains the largest, the next oldest cohort increased at a greater rate. The youngest cohort reported a decrease in intention to remain working in pharmacy.

Conclusions

A fall in student numbers and changes to immigration policy have contributed to a low growth rate and ageing of the pharmacist workforce compared with other professions. Whether these factors along with the intentions of young pharmacists will result in a shortage is dependent on developments in demand for pharmacists and a workforce strategy is required to monitor these developments.
Antibiotics and toothache: a social media review
Authors: Emmott Rachel , Barber Sophy K , Thompson Wendy
Published: January 2021

Objectives

Antibiotics are inappropriate for the treatment of toothache, yet many seek them. Social media allows users to express their opinions, share experiences and offer support. This study used social media to investigate the public’s experiences of, and attitudes towards, antibiotics for toothache.

Methods

A systematic search of posts on Facebook and Twitter was undertaken. Eligibility criteria were applied to select relevant social media posts for thematic analysis of word content. An inductive descriptive coding system was developed from the data and exemplary quotes were identified to illustrate the themes and subthemes identified.

Key findings Searches identified 174 posts, of which 144 were selected for analysis. Five themes were identified: experience and expectations, self-care and professional treatment, access to dental care, quality of life and coping strategies. The belief that antibiotics are an appropriate treatment for a toothache was widespread. Antibiotic-seeking behaviour was related to access to professional dental care, including avoiding dental appointments due to dental anxiety and the perceived affordability of dentistry. A range of strategies to cope with the severe impact toothache was having on people’s quality of life were identified, from prayer to antibiotics.

Conclusions

Social media is used extensively to seek antibiotics, avoid dental treatment and provide support to people with toothache. A general belief that antibiotics are an appropriate and necessary treatment for toothache exists. This improved understanding about the factors driving antibiotic-seeking behaviour provides new targets for the development of approaches to tackling antibiotic resistance, by reducing unnecessary antibiotic use in dental clinics and beyond.
The Selectivity of Aesthetic Explanation
Authors: Song Moonyoung
Published: January 2021

It is widely agreed that an artwork having certain non-aesthetic properties explains its having a certain aesthetic property. One interesting feature of such an explanation is its selectivity—it cites only some of the non-aesthetic properties on which the presence of the aesthetic property depends. Hence a question arises as to what distinguishes the selected non-aesthetic properties from the unselected ones. I answer this question by proposing a selection principle modeled on Laura Franklin-Hall’s selection principle for causal explanation, according to which an explanation selects a package of factors that maximizes the ratio of delivery (the degree to which the factors cited in an explanation make what is explained modally robust) to cost (the amount of information an explanation contains).
Spectrophotometric Determination of Polyvinyl Pyrrolidone in Pure and Pharmaceutical Dosage Form
Authors: Al-Afify Nourhan Kh , Trabik Yossra A , El-Kosasy Amira M , Magdy N
Published: January 2021

Background

Recently, functional polymers have attracted significant attention in the areas of pharmaceuticals and biomedical applications, so it is important to develop simple techniques to analyze functional polymers in their pharmaceutical dosage forms.

Objective

Three simple, accurate, and sensitive UV spectrophotometric methods have been developed and validated for determination of polyvinyl pyrrolidone (PVP) in the presence of benzalkonium chloride (BZ) and sodium lactate in ternary mixtures.

Method

Method A is a derivative ratio spectra zero-crossing (DRSZ) method which measures PVP peak amplitude at 303.1 nm. Method B is a double divisor ratio derivative (DDRD), used for determination of both PVP and BZ in the presence of sodium lactate at 272.6 and 271.5 nm, respectively. Method C is a double divisor ratio derivative-ratio difference spectrophotometric method (DDRD-RDSM), a new and hybrid method of double divisor and ratio difference that hasn't been applied before. It measures peak amplitude difference of the ratio spectra at ΔP278 – 252.4 and ΔP260.9 – 213 for PVP and BZ, respectively.

Results

Linear ranges for PVP (5.00–35.00, 10.00–40.00, and 10.00–40.00 µg/mL) was obtained by using DRSZ, DDRD, and DDRD-RDSM, respectively. While the linear range for BZ (5.00–60 µg/mL) was obtained by using both DDRD and DDRD-RDSM.

Conclusions

All results were statistically compared with reported methods. No significant differences were observed. The developed methods were applied to the analysis of the investigated drugs in pure and pharmaceutical dosage forms.

Highlights

The proposed methods are of great value, improving the efficiency of routine analysis of PVP and BZ in their pharmaceutical dosage forms.
Prescribing patterns and cost-utility analysis of management of childhood asthma in Saudi Arabia: a retrospective cross-sectional study
Authors: Ali Mohammad Daud , Ahmad Ayaz , Banu Nuzhat , Patel Munfis , Ghosn Sherihan Ahmad , Eltrafi Zainab
Published: January 2021

Objective

This study is based on a retrospective cross-sectional study to assess the prescribing patterns and cost-utility analysis of management of childhood asthma in Saudi Arabia.

Methods

Prescription data were collected for 1 year from electronic records of pharmacy. The unit dose price was retrieved from pharmacy database and compared with daily price based on WHO Defined Daily Dose (DDD) and Saudi Initiative for Asthma (SINA). The cost of each drug is calculated from average prices of each unit dose of each prescription.

Key findings

In male children (57.98%), asthma was more common in comparison to female children (41.02%) at the studied hospital. Salbutamol (44.55%) was the most commonly prescribed medication followed by budesonide (30.97%) and montelukast (12.82%), whereas prednisolone (0.15%) was the least prescribed medication for the management of childhood asthma. It was found that fixed-dose combination of budesonide and formetrol prescribed for the longest duration of therapy (30 days) and imposed highest cost as well [197.10 SR (52.53 USD)] among all the prescribed medicine.

Conclusion

In this study, inhalation route is the most preferred one for management of asthma; this may be due to their fast therapeutic action. Salbutamol was the most popular drug for quick reliever therapy, while budesonide was the most favoured drug for childhood asthma management. Medication prescribed for the management of childhood asthma at the mentioned study centre adhere to SINA guideline.
Healthcare resource utilization and costs associated with hyperkalemia in a large managed care population
Authors: Sharma Ajay , Alvarez Paula J , Woods Steven D , Fogli Jeanene , Dai Dingwei
Published: January 2021

Background

Hyperkalemia is a serious metabolic condition and can lead to life-threatening cardiac arrhythmias and sudden death. Guideline-directed medications that affect the renin-angiotensin-aldosterone axis can increase serum potassium and may limit their use. Hyperkalemia has been shown to drive healthcare resource utilization (HRU) and costs for patients with cardiorenal conditions.

Objectives

To describe hyperkalemic patient characteristics and quantify patient HRU and costs relative to normokalemic patients from a large US health plan.

Methods

A retrospective cohort study that identified and evaluated a hyperkalemic patient population from a large administrative claims database. The observation period was 1 January 2015 to 31 May 2018, with a 1-year follow-up period after the index date (the earliest service/claim with evidence of hyperkalemia). Primary patient outcomes included inpatient admissions, emergency department (ED) visits, primary care physician (PCP)/specialist visits, length of stay (LOS) and associated medical and pharmacy costs. This hyperkalemic cohort was stratified by renin-angiotensin-aldosterone system inhibitor (RAASi) utilization and chronic kidney disease (CKD) stage for the economic analysis.

Key findings

86,129 adult patients with hyperkalemia were evaluated in the study cohort (median age: 69 years). There were more males [45,155 (52%)], with the majority of patients located in the Southern United States [45,541 (51%)] and a 70/30 split of Medicare to a commercial health plan. Most patients had CKD, hypertension and hyperlipidemia; ≥80% of the patients had ≥4 comorbidities. Over 40% of patients were not receiving RAASi therapy, and potassium binder use was low (<5%). Patients using optimal-dose RAASi with proportion of days covered ≥80% were observed to have the lowest HRU for inpatient admissions, ED and PCP visits and LOS days.

Conclusions

Hyperkalemia is associated with substantial HRU and costs. The development of a quality improvement program structured around the management of hyperkalemia in individuals with heart failure, diabetes and/or CKD may be necessary.
Attitudes and appropriateness of pain management in cancer patients using pain management index
Authors: Ayoub Nehad M , Nuseir Khawla Q , Al-Shamali Yasmeen A , Al-Zoubi Ahmad
Published: January 2021

Objectives

Inadequate management of cancer pain (CP) remains a global medical problem. In this study, the aim was to assess attitudes of cancer patients towards their CP treatment and to evaluate effectiveness of pain management.

Methods

A sample of 300 adult cancer patients admitted to a single hospital were face-to-face interviewed in a cross-sectional study design using a structured questionnaire. The short form of the Brief Pain Inventory was used to collect data on pain, and Pain Management Index (PMI) was calculated to assess adequacy of pain management.

Key findings

Median age of patients was 53 years (interquartile range, 43–63). Half of patients (50.5%) believed their pain therapy needs improvement. Almost half patients had severe pain at interview (49.8%). Pain interfered most with patient enjoyment of life with a mean interference score 6.13 ± 2.37. Majority of cancer patients (84.3%) received a non-opioid analgesic while a minority (15.7%) received opioid analgesic in which morphine was the most common drug. The use of non-opioid adjuvants was minimal. Mean PMI for patients was −1.15 ± 0.75 (range −2 to +1), and most patients (80.3%) had inadequate pain treatment. Gender and smoking status of patients were significantly associated with adequacy of pain management (P = 0.009 and P = 0.004, respectively). There were no associations between patient age, educational level or tumour characteristics and adequacy of pain management.

Conclusions

Cancer patients in this study present with severe pain and the rates of undertreatment are high. There is an urgent need to improve management plans to assure appropriate use of therapeutic modalities for treatment of cancer-related pain.
Examining community-managed drug outlets' failure in geographically isolated and disadvantaged areas: insights from the consumers' end
Authors: Collado Zaldy C , Rescober Angeli Ann S , Hipolito Imee G , Ulat Armand Patrick A , Tayfour Abubakr
Published: January 2021

Objectives

The article aimed to examine the impact of poor purchasing power, perceptions on the physical structure, and medicine demand to community-managed drug outlets or Botika ng Barangay (BnB) in the Philippines. The study investigated what contributes to program resiliency or failure in so far as the consumers in geographically isolated and disadvantaged area (GIDA) are concerned.

Methods

Findings were drawn from five sets of focus-group discussion (FGD) among residents, four in-depth interviews (IDIs) with former operators of BnB and three IDI with former members of the village council specifically assigned in health sector.

Key findings

The study found out that all our study variables namely; poor purchasing power, perceptions on BnBs' physical image, and limited medicines that do not match the consumers' medicine demand did not contribute to the failure of the program in their communities. However, the study found out that informal arrangements in the community which allowed people to just loan medicines without actually paying in return was intimately connected to BnBs' closure in the communities.

Conclusion

The study suggests that, in the context of GIDAs, the failure of community-managed drug outlets rests as well on financially unsustainable practices in the community. This, we believe, can be negated through provisions for medicine subsidy.
Perception and attitude of the public on vaccine practices and pharmacists as immunizers in Jordan
Authors: Batarseh Yazan S , Darwish ElHajji Feras W , Shammas Samira , Darwish Rula M , Fakhoury Rula , Al Haj Ahmad Maram , Al Rusasi Ahmed , Jarrar Laila
Published: January 2021

Objective

To assess general perception and attitude of the public on vaccines current practices and pharmacists as immunizers in Jordan

Methods

In this study, computer-assisted personal interviews technique was utilized using a quantitative approach of a structured questionnaire. The survey instrument was completed with random telephonic interviews covering different geographic areas in the country of Jordan with a total sample size of 366.

Key findings

Majority of respondents had a positive perception of vaccines in general. Regarding the respondents’ perception of current vaccination status, the majority felt it is good as is or requires some enhancements. Furthermore, 53% believe pharmacists should administer vaccines. Majority strongly agree (76%) that pharmacists should be trained and certified to do so. However, 57% strongly disagree that current pharmacies in Jordan have the facilities allowing them to administer vaccines. Finally, a significant increase of 26% in public willingness to have a pharmacist immunizer after certification was observed compared to without being certified (52%).

Conclusions

Respondents support the role of vaccination as a preventative tool. However, to their opinion, contrary to the high effectiveness in paediatric vaccination in Jordan, current adult vaccination systems need to be revised and improved to increase its adult coverage. Additionally, respondents highly support the idea of allowing pharmacists to become immunizers under certain conditions regarding proper training, accredited certification and licensed administration facilities.
Medical staff perspective on factors influencing their prescribing decisions: a cross-sectional study in Mekong Delta, Vietnam
Authors: Tran Van De , Cao Nguyen Thi Tai , Le Minh Hoang , Pham Duy Toan , Nguyen Kien Trung , Dorofeeva Valeria Valeryevna , Loskutova Ekaterina Efimovna
Published: January 2021

Objectives

Understanding medical staff’s prescription behaviors helps improve the quality of prescriptions and the rationality of medication use. Although factors affecting the prescribing decisions were discussed in various studies worldwide, limited knowledge of these issues has been reported in Vietnam. This paper aims to examine factors that influence prescribing behavior concerning medical staff’s demographics and characteristic differences.

Methods

Quantitative descriptive cross-sectional study, using adapted questionnaire consisting of 27 factors divided into 9 factor categories, was conducted with medical staff in Mekong Delta during June–July, 2019. Rasch analysis was performed to assess the questionnaire psychometric properties. Descriptive analysis, parametric tests and non-parametric tests were utilized to address the study objectives.

Key findings

A total of 201 participants completed the questionnaire. A majority of participants (>90%) agreed that their own decision to prescribe a drug was influenced by several factors such as drug safety and efficacy (92.5%), patient history (92.0%), patient income (92.0%) and patient disease status (91.0%). There were significant age differences in influences on prescribing decision. Medical staff aged under 30 appreciated the role of pharmacists higher than whose aged 31–40 (P-value = 0.010) and over 40 (P-value = 0.013). Additionally, they were more concerned with ‘patient characteristics’ including patient request, expectations, and disease status when making prescribing decisions compared with whose aged over 40 (P-value = 0.005).

Conclusions

The study revealed various factors influencing medical staff prescription decision-making processes. These findings could be useful for pharmaceutical companies in Vietnam in developing marketing strategies, and for policy-makers in timely improvement of prescription quality.
A comparison study between public and private healthcare sector medicine prices in South Africa
Authors: Thaver Tarryn , Padayachee Neelaveni , Bangalee Varsha
Published: January 2021

Objectives

The objectives of the study were to compare price trends, determine price differentials, and equate the average price index of a basket of medicines between the public and private healthcare sectors in South Africa.

Methods

A price list consisting of 32 essential medicines available in both the public and private healthcare systems of South Africa was chosen for this study. The price of medicines for the private sector were obtained from the Medicine Price Registry-Open Up website for the period 2014–2018. Public sector medicine prices were obtained from the Department of Health website for the corresponding period. Observations and price trends were identified and analyzed using Microsoft Excel version 2016.

Key findings

A total of 74 medicine brands were analyzed in the study. It was found that the prices across both sectors had increased over time, however, the majority of brands (87%) displayed higher prices in the private sector in comparison to the public sector. On average, the price differential between the private and public sector medicines were 395.47%.

Conclusions

The study found varying price differences between medicines in the public and private sectors because of the different methodologies used in each. The reasons for changes in medicine prices across the years in both sectors, could not always be clearly determined as both sectors lacked complete transparency in the processes applied to establish medicine prices. Therefore, more transparent medicine price systems need to be considered for the future of South Africa’s healthcare system as the country transitions toward universal health coverage.
Impact of pharmacist-led interventions on asthma patients’ knowledge, attitudes and self-efficacy: single-blind randomised controlled trial
Authors: Amorha Kosisochi C , Okonta Mathew J , Ukwe Chinwe V
Published: January 2021

Objectives

Asthma is a common chronic disease and education is a critical component of chronic disease management. This study assessed the impact of pharmacist-led educational interventions on asthma patients' knowledge, attitudes and self-efficacy.

Methods

This single-blind, three-arm, prospective, randomized, controlled and parallel group study was conducted in the Respiratory Units of University of Nigeria Teaching Hospital, Enugu State and the Lagos University Teaching Hospital, Lagos State between March 2016 and September 2017. The three arms, in a 1 : 1 : 1 ratio, were: Usual Care, Individual Intervention and Caregiver-assisted Intervention. The Intervention arms received education, to varying degrees, for six months. The Usual Care arm received no education. The Knowledge, Attitude and Self-Efficacy-Asthma Questionnaire was filled at baseline, three months and six months. Data were analysed using the IBM SPSS Version 25.0 with statistical significance set as P < 0.05.

Key findings

Seventy-eight (78) asthma patients participated; 39 per hospital; 13 in each arm. Patients in both Intervention arms possessed significantly better asthma knowledge compared to Usual Care at three months (13.73 versus 5.88, P < 0.001/12.81 versus 5.88, P < 0.001) and six months (14.31 versus 5.77, P < 0.001/13.23 versus 5.77, P < 0.001). Only the Individual Intervention arm demonstrated significantly better attitudes (84.92 versus 79.77; P = 0.047) and self-efficacy (86.12 versus 80.73, P = 0.006) compared to Usual Care at three months and six months, respectively.

Conclusions

These findings highlight the importance of educating patients directly, as much as possible.
Medication errors: a focus on nursing practice
Authors: Alrabadi Nasr , Shawagfeh Shaima , Haddad Razan , Mukattash Tareq , Abuhammad Sawsan , Al-rabadi Daher , Abu Farha Rana , AlRabadi Suzan , Al-Faouri Ibrahim
Published: January 2021

Objectives

Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.

Methods

A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.

Key findings

This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.

Conclusions

Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.
Effect of strategic purchasing of antiviral drugs and the clinical pathway for the treatment of Chronic Hepatitis C in Colombia (hepC-STRATEGY): study protocol for a quasi-experimental study
Authors: Ledezma-Morales Mónica , Amariles Pedro , Salazar-Ospina Andrea , Duque-Zapata Natalia , Gómez Cárdenas Julieth , Vargas-Peláez Claudia M , Rossi Francisco A
Published: January 2021

Objective

Describe a study protocol to establish the effect of DAA's strategic purchase and the clinical pathway in the clinical outcomes, general costs, and quality of healthcare of patients with CHC in Colombia.

Methods

A quasi-experimental study will be carried out to compare clinical outcomes (treatment effectiveness), healthcare quality (access to treatment, time to treatment, patient's satisfaction and barriers/facilitators perceived) and direct costs before/after the implementation of the mentioned strategies. Patients ≥18 years old initiating DAA treatment between January 2015 and December 2019 in an outpatient pharmacist-led center in Colombia will be included. In order to reduce selection bias, the propensity score method will be used. In the bivariate analysis, χ 2 tests and t student will be used to analyse the study outcomes. A regression analysis will be used to explain the association of multiple variables with access to treatment, time to treatment and effectiveness. Descriptive statistics will be used to analyse the patient's satisfaction and barriers/facilitators perceived.

Key findings

Implementing local government policies is necessary to improve access to medicines and decrease disease burden. The strategies adopted by the Colombian Ministry of Health to manage CHC needs to be evaluated. Therefore, studies are required to establish their effects on clinical outcomes, overall costs, and quality of care.

Conclusions

This study will provide evidence on the effect of Colombian strategies to address the problem of HCC. It will provide information to policymakers in low- and middle-income countries that could reduce disease burden.
Antimicrobial stewardship programs: perceptions and practices among Jordanian healthcare practitioners
Authors: Khasawneh Rawand A , Ababneh Mera A , Al-Azzam Sayer I
Published: January 2021

Objective

Antimicrobial stewardship programs are of paramount importance in containing antibiotic resistance and combat the acquisition of multi-drug resistance strains. Healthcare practitioners, specifically physicians and clinical pharmacists are the direct clinical antibiotic prescribing authorities. Therefore, this study aimed to assess Jordanian practitioners' perceptions and practices towards antimicrobial stewardship programs.

Methods

This was a cross-sectional study, in which physicians and clinical pharmacists were approached to fill out a previously validated study instrument. A close-ended structured questionnaire comprising 34 questions covering aspects related to antimicrobial stewardship program perceptions, practices and participants' demographic data were used to collect pertinent information.

Key findings

A total of 286 participants were enrolled in the study. There was an overall positive perception towards antimicrobial stewardship programs, while practices related to this element was still suboptimal. Additional comparison of the overall perception scores among different demographic characteristics showed that long years of practice, postgraduate studies and practice in academic sectors yielded higher perception scores (P = 0.0335, 0.0328 and 0.0007, respectively).

Conclusion

There is an imminent need to enhance Jordanian practitioners' knowledge about antimicrobial stewardship programs. Clear recognition of integral antimicrobial stewardship programs' components must be coupled with highlight changes in current practices related to antimicrobials usage and prescription.
Grape seed extract improved the fertility-enhancing effect of atorvastatin in high-fat diet-induced testicular injury in rats: involvement of antioxidant and anti-apoptotic effects
Authors: Abdulwahab Dalia K , Ibrahim Weam W , Abd El-Aal Rania A , Abdel-Latif Hekma A , Abdelkader Noha F
Published: January 2021

Objectives

Reduced male fertility is highly prevalent with hypercholesterolaemia. Though statins are drugs of choice for hypercholesterolaemia, their effect on male fertility is still controversial and dose-dependent. Grape seed extract (GSE) possess hypocholesterolemic and testicular protective effects. Thus, this study aimed to investigate the effects of low-dose atorvastatin (ATV) on male infertility in hypercholesterolaemic rats and assess the additional value of combining ATV with GSE.

Methods

Male rats were randomized into four groups. The normal group was fed a standard diet. The remaining groups were fed a high-fat diet (HFD) for 1 month to induce hypercholesterolaemia. Two HFD groups were administered either ATV (1 mg/kg) alone or combined with GSE (200 mg/kg) orally for 65 days, while the third group served as HFD control.

Key findings

Treatment with ATV or ATV/GSE attenuated dyslipidemia-induced alteration in serum HDL-cholesterol, LDL-cholesterol, and total cholesterol. ATV enhanced serum testosterone, sperm count and motility and fertility index. The effect on testosterone and sperm count was more pronounced by ATV/GSE. Moreover, ATV reduced testicular malondialdehyde, nitric oxide, caspase-9 and caspase-3 while elevated reduced glutathione and superoxide dismutase along with catalase activity. Noteworthy, GSE/ATV induced more powerful antioxidant and anti-apoptotic effects.

Conclusion

GSE enhanced ATV’s protective effect against hypercholesterolaemia-induced infertility via antioxidant and anti-apoptotic mechanisms.
Improvement of the pharmacokinetic characteristics of liposomal doxorubicin using CD47 biomimickry
Authors: Gheibihayat Seyed Mohammad , Jaafari Mahmoud R , Hatamipour Mahdi , Sahebkar Amirhossein
Published: January 2021

Objectives

In view of their biodegradability, biocompatibility, encapsulation efficiency and targeted release, as well as low toxicity, liposomes are being widely used in the context of drug delivery. However, the efficiency of such drug delivery systems might face limitations by macrophage-mediated clearance (CL), which reduces circulation half-life (T½). This problem can be resolved through surface functionalization via poly (ethylene glycol) (PEG) in the process of PEGylation. However, the use of PEG might have its own disadvantages. Accordingly, the main purpose of this study was to produce novel stealth nanoliposomes using CD47 mimicry peptide [namely self-peptide (SP)] as an alternative to PEG for minimizing macrophage-mediated CL and enhancing circulation T½.

Methods

At first, doxorubicin (Dox)-containing liposomes [i.e.liposomal Dox (LD)] were coated with different concentrations of SP (viz. SP-LD) (0.5%, 1% and 2%). In addition, PEG-functionalized LD (i.e. PLD) was fabricated as a standard control group. Then, various types of liposomal formulae were injected into a population of mice, assigned to six groups (four mice per group) for biodistribution. After sacrificing these animals in prespecified time points (namely 0.5, 6, 12, 24, 48, 72, 96 and 168 h), serum, liver, spleen, heart, kidney and lung samples were collected to estimate the encapsulated drug content in different groups through measuring intrinsic autofluorescence signal of Dox.

Key findings

The tissue distribution results in the liver, spleen, heart, kidney and lung samples indicated a significant difference between the SP-LD and the PLD groups. Furthermore, the examination of Dox content, 6 h after administration, showed a growth rate of 28% in Dox content in the SP group compared with the PLD one. Subsequently, these values were, respectively, 63% and 75% at 24 and 48 h.

Conclusions

The results of tissue distribution and serum kinetic analysis correspondingly revealed that the use of the SP could augment the circulation time of Dox in comparison with PEG, and it could additionally minimize the tissue accumulation of the drug, which is normally the cause of drug-induced toxicity. The use of the SP on nanoliposomes could prolong the circulation of T½ and diminish the tissue accumulation of LD. These findings are relevant for improving therapeutic efficacy and reducing the toxicity of liposomal drugs.
Combining combretastatin A4 phosphate with ginsenoside Rd synergistically inhibited hepatocellular carcinoma by reducing HIF-1α via PI3K/AKT/mTOR signalling pathway
Authors: Yang Xinxiu , Gao Meng , Miao Mengqi , Jiang Cuihua , Zhang Dongjian , Yin Zhiqi , Ni Yicheng , Chen Jing , Zhang Jian
Published: January 2021

Objectives

Combretastatin A4 phosphate (CA4P), a vascular disrupting agent (VDA), can cause rapid tumour vessel occlusion. Subsequently, extensive necrosis is discovered in the tumour center, which induces widespread hypoxia and the rise of the α subunit of hypoxia-inducible factor-1 (HIF-1α). The aim of this study was to evaluate the inhibition of hepatocellular carcinoma growth by combining CA4P with HIF-1 α inhibitor and investigate the mechanism of this combination.

Methods

Ginsenoside Rd (Rd) was used in combination with CA4P to estimate the inhibition effect in HepG2 cells and HepG2 xenograft mouse model. The efficacy of anti-tumour was evaluated by tumour growth curve. The protein expression of HIF-1α and PI3K/AKT/mTOR signalling pathway were analysed by western blot.

Key findings

Combination of CA4P and Rd inhibited HepG2 cell proliferation and induced apoptosis in vivo and in vitro. It also increased the necrotic area of the tumour and delayed the tumour growth. Moreover, Rd down-regulated HIF-1α protein expression by inhibiting PI3K/AKT/mTOR signalling pathway.

Conclusions

Combination of CA4P and Rd had synergistic anti-tumour effects. The mechanism may be related to the inhibition of HIF-1α by PI3K/AKT/mTOR signalling pathway. This strategy provides a new thought for the combinative therapy of VDAs.