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Journal of Pharmacy Practice Jun 2024Statins are a highly effective lipid-lowering therapy associated with significant reductions in atherosclerotic cardiovascular disease (ASCVD) events and death. Despite...
Statins are a highly effective lipid-lowering therapy associated with significant reductions in atherosclerotic cardiovascular disease (ASCVD) events and death. Despite these benefits, statins are underutilized. Pharmacist-led interventions to increase statin prescribing are effective. To our knowledge, no prior studies implemented a comprehensive cardiovascular risk assessment utilizing point-of-care (POC) testing in community pharmacies. The primary objective was to determine if community pharmacists can be utilized to identify gaps in care regarding appropriate use of statin therapy for prevention of ASCVD events in HPSAs. Secondary objectives were to assess public interest in ASCVD risk assessment and statin prescribing by the pharmacist, and to identify factors associated with statin gaps in care. A cross-sectional study was conducted at three independent community pharmacies. Participants were identified based on age and medication history and were scheduled at their pharmacy to receive a comprehensive ASCVD risk screening consisting of POC measurement of a complete lipid panel, blood glucose or A1C, and blood pressure. Participants were informed of their statin candidacy at the screening. Participants completed a survey regarding perceptions of the services provided and opinions of statin prescribing by pharmacists. Of the 57 participants, 43 (75.4%) were possible statin candidates. Most indicated trusting their pharmacist to prescribe a cholesterol-lowering medication and felt insurance should pay for these screenings. ASCVD risk assessment conducted within the community pharmacy setting for can be utilized to identify treatment gaps in status use. Participants indicated trusting pharmacists to provide this service and found the service valuable.
PubMed: 38914018
DOI: 10.1177/08971900241262362 -
SAGE Open Medicine 2024Health hazards such as adverse drug reactions and prolonged morbidity are fallouts of self-medication among young people in sub-Saharan Africa. The aim of this study was...
Prevalence, practice, determinants and adverse effects of self-medication among young people living in a suburban community of Ekiti, Nigeria: A community-based cross-sectional study.
OBJECTIVES
Health hazards such as adverse drug reactions and prolonged morbidity are fallouts of self-medication among young people in sub-Saharan Africa. The aim of this study was to assess the prevalence, practice, determinants, and adverse effects of self-medication among young people living in a suburban community of Ekiti, Nigeria.
METHODS
This survey was a descriptive, cross-sectional study of 602 young people aged 16-24 years., who were randomly selected in the community. A predesigned self-administered questionnaire was used for data collection. The study was conducted from 1st March to 31st May 2023. The independent variables measured include the sociodemographic characteristics, while the dependent variables are the practice of self-medication and factors that predisposes to self-medication. The general characteristics of the participants were analyzed using descriptive statistics. The categorical variables were reported as frequency distribution and proportions with 95% confidence intervals and were compared using the Chi-square test or Fisher's exact test. A -value of <0.05 was considered statistically significant.
RESULTS
Over 30% (31.7%) of the participants engage in self-medication. A larger proportion of the people who practiced self-medication lived a trekking distance of less than 1 km from the nearest health facility with a doctor ( = 0.044). The practice of self-medication was statistically related with being a student when compared with gainfully employed and unemployed people ( = 0.006). Fever (39.8%), abdominal pain (17.3%) and headaches (16.2%) were the topmost three ailments that necessitated self-medication. Antimalarials (44.0%), antibiotics (25.1%), and antipyretics (16.8%) were high on the list of drugs used for self-medication. Headache (34.0%) was the most common adverse reaction from self-medication among the participants studied.
CONCLUSION
Adverse reactions and drug addiction were negative fallouts of self-medication, which can affect the health of young people as they grow into adulthood. Therefore, monitoring of drug outlets must be taken seriously by government agencies to prevent the worsening of the negative effects of self-medication.
PubMed: 38911442
DOI: 10.1177/20503121241261002 -
Cureus May 2024The relative contribution of factors responsible for the environmental exposure of active pharmaceutical ingredients (APIs) is of interest for appropriate remedial...
The relative contribution of factors responsible for the environmental exposure of active pharmaceutical ingredients (APIs) is of interest for appropriate remedial measures. This study was carried out to evaluate the post-lockdown levels of APIs in water resources, in comparison to our previously published study from 2016. The environmental levels of 28 drugs from different classes were analyzed in surface water (Yamuna River), aquifers, and leachate samples collected from 26 locations in Delhi-NCR using the previously validated liquid chromatography-mass spectrometry (LC-MS/MS) methods. In addition, the prevalence of antimicrobial resistance in coliforms isolated from targeted surface water samples was also studied. This study revealed that more than 90% of APIs, including antibiotics, decreased drastically in both surface water and aquifers compared to our previous data. Selected samples subjected to antimicrobial resistance (AMR) analysis revealed the presence of cephalosporin-resistant coliform bacteria. Tracing cephalosporins in the surface and drain water samples revealed the presence of ceftriaxone in the drain and water samples from Yamuna River. Higher levels of ceftriaxone in landfill leachate were also found, which were found to be associated with coliform resistance and indicate the un-segregated disposal of medical waste into landfills. Social restrictions enforced due to COVID-19 resulted in a drastic decrease in antimicrobials and other APIs in aquatic water resources. Increased ceftriaxone and cephalosporin resistance was seen in coliform from surface water and drain, indicating the possibility of hospital waste and treatment-related drugs entering Yamuna River. Enforcement of the regulations for the safe disposal of antibiotics at hospitals and preliminary disinfection of hospital sewage before its inflow into common drains might help minimize the spread of antibiotic resistance in the environment.
PubMed: 38910720
DOI: 10.7759/cureus.60835 -
The British Journal of General Practice... Jun 2024Long-term antidepressant (AD) use, much longer than recommended by guidelines, may cause harms and generate unnecessary costs. Community pharmacists have frequent...
BACKGROUND
Long-term antidepressant (AD) use, much longer than recommended by guidelines, may cause harms and generate unnecessary costs. Community pharmacists have frequent contact with AD users and advise them on appropriate and safe medication use. GPs recognised pharmacists as potential sources of additional support for the AD discontinuation process, but there is a lack of knowledge about pharmacists' views.
AIM
To explore pharmacists' perspectives on discontinuing long-term use of ADs and supporting patients during the discontinuation process and their barriers and facilitators.
METHOD
Qualitative study in Belgian pharmacists. The authors conducted 14 semi-structured face-to-face interviews. Interviews were analysed thematically.
RESULTS
The first theme 'Antidepressants at the pharmacy: a persistent taboo' described the challenges pharmacists encounter in initiating discussions with patients about their ADs and mental health, and the persistent taboo around ADs at pharmacies. Second, pharmacists were concerned about the risks associated with AD discontinuation but recognise that harm from continuing ADs may outweigh concerns. Third, although pharmacists can be a starting point for discontinuation, they hesitate to do this and question if this is their role. They prefer that GPs have this responsibility.
CONCLUSION
Deprescribing long-term ADs is a challenging concept for pharmacists, especially when there is no patient request. The taboo around ADs and the fear of relapse of symptoms in a stable patient are important barriers for pharmacists when considering discontinuation. Pharmacist education and confidence-building is essential to involve the pharmacist in the discontinuation process. Findings also highlight a strong need for multidisciplinary collaboration and agreements with GPs to reduce unnecessary antidepressant treatment.
Topics: Humans; Antidepressive Agents; Qualitative Research; Pharmacists; Male; Female; Attitude of Health Personnel; Belgium; Community Pharmacy Services; Adult; Deprescriptions; Middle Aged; Professional Role; Interviews as Topic
PubMed: 38902099
DOI: 10.3399/bjgp24X737781 -
MMWR. Morbidity and Mortality Weekly... Jun 2024Tecovirimat is the first-line antiviral treatment recommended for severe mpox or for persons with mpox who are at risk for severe disease; tecovirimat is available in...
Tecovirimat is the first-line antiviral treatment recommended for severe mpox or for persons with mpox who are at risk for severe disease; tecovirimat is available in the United States under an expanded access investigational new drug (IND) protocol. During the 2022-2023 mpox outbreak, local U.S. health jurisdictions facilitated access to tecovirimat. In June 2022, Los Angeles County (LAC) rapidly developed strategies for tecovirimat distribution using existing medical countermeasure distribution networks established by the Public Health Emergency Preparedness Program and the Hospital Preparedness Program, creating a hub and spoke distribution network consisting of 44 hub facilities serving 456 satellite sites across LAC. IND patient intake forms were analyzed to describe mpox patients treated with tecovirimat. Tecovirimat treatment data were matched with case surveillance data to calculate time from specimen collection to patients receiving tecovirimat. Among 2,281 patients with mpox in LAC, 735 (32%) received tecovirimat during June 2022-January 2023. Among treated patients, approximately two thirds (508; 69%) received treatment through community clinics and pharmacies. The median interval from specimen collection to treatment was 2 days (IQR = 0-5 days). Local data collection and analysis helped to minimize gaps in treatment access and facilitated network performance monitoring. During public health emergencies, medical countermeasures can be rapidly deployed across a large jurisdiction using existing distribution networks, including clinics and pharmacies.
Topics: Humans; Disease Outbreaks; Los Angeles; Middle Aged; Adult; Adolescent; Female; Male; Young Adult; Aged; Antiviral Agents; Child; Mpox (monkeypox); Child, Preschool; Infant; Pyrrolidines; Benzamides; Aged, 80 and over; Phthalimides
PubMed: 38900699
DOI: 10.15585/mmwr,mm7324a2 -
Air Medical Journal 2024This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad,... (Observational Study)
Observational Study
Flight to Recovery: Impact of a Rooftop Helipad Air Ambulance Service at the Emergency University Hospital of Bucharest-A Caseload Analysis of the First 3 Years After Its Implementation.
OBJECTIVE
This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad, established in April 2019, is the only rooftop medical helipad in Bucharest authorized for day and night flights. Its influence extends beyond the local region, enabling the hospital to receive patients from various cities across Romania. The helipad has particularly strengthened the hospital's capabilities in cardiology, neurovascular emergencies, and neonatal care. Patients with acute myocardial infarctions or strokes can now be swiftly transported to the hospital for immediate intervention, whereas critically ill newborns can receive specialized care at the earliest stages of their lives. The objective of this article was to present a comprehensive timeline of the helipad's implementation and to demonstrate its transformative role in improving patient transportation, enhancing medical interventions, and elevating the overall efficiency of the health care facility.
METHODS
The study is a retrospective regional caseload analysis based on data gathered from the Emergency Department of the University Emergency Hospital of Bucharest database. We included all 215 air transfer missions registered between December 2019 and December 2022, exactly 3 years apart from the beginning of the program.
RESULTS
The findings provide valuable insights into patient demographics, case distribution, and trends, highlighting the importance of specialized medical interventions at the University Emergency Hospital of Bucharest. In particular, the mean age of patients treated at the hospital was 55.9 years, with a higher representation of males (156) than females (59). The average duration of hospitalization was 10.68 days. The study also examined transportation statistics, showing a decrease in the average number of transports per month over the years. Cardiologic cases accounted for the highest frequency (62.8%) among the analyzed categories followed by neurosurgery (8.8%) and neurologic cases (8.4%).
CONCLUSION
The analysis provides important insights into patient demographics, case distribution, and trends. The findings highlight the significance of specialized medical interventions, particularly in cardiology and neurosurgery, which accounted for the majority of the cases. The implementation of the helipad has greatly improved patient transportation and facilitated timely medical assistance.
Topics: Air Ambulances; Humans; Hospitals, University; Retrospective Studies; Female; Male; Emergency Service, Hospital; Middle Aged; Adult; Aged; Transportation of Patients; Infant, Newborn
PubMed: 38897695
DOI: 10.1016/j.amj.2024.03.002 -
Journal of Clinical Medicine May 2024: Catecholamines are among those agents that are indispensable in modern intensive care medicine. The rapid availability of hygienically impeccable and correctly...
: Catecholamines are among those agents that are indispensable in modern intensive care medicine. The rapid availability of hygienically impeccable and correctly concentrated injectable solutions, e.g., for syringe pumps, is becoming more and more important. However, little research has been conducted regarding how the use of catecholamines is distributed in different wards and what options can be used to achieve optimal availability. : In a retrospective monocentric study from 2019 to 2022, all continuously applied catecholamines in intensive care units (ICU) and intermediate care units (IMC) were investigated. The focus was on potential optimization by utilizing manufactured ready-to-administer solutions in the context of the economization of patient care. Norepinephrine syringes represented 81% of all syringes administered, appearing to be the most frequently used on all wards. Production by the in-house pharmacy showed both financial advantages and an increase in patient safety compared to syringes produced at the bedside. Increasing numbers of critically ill patients coupled with growing staff shortages and an increased awareness of safety requirements are driving the move towards ready-to-use and ready-to-administer solutions in critical care medicine. In-house manufacturing by hospital pharmacies can be a promising option to optimize processes and improve the economics of patient care. Individual calculations of the required catecholamine preparations with regard to possible economic advantages should be carried out in hospitals. In particular, in-house production of ready-to-use and ready-to-administer preparations could significantly increase patient safety and seems to be economically viable.
PubMed: 38892781
DOI: 10.3390/jcm13113070 -
Journal of Clinical Medicine May 2024: Cadaveric models have traditionally been a mainstay of dental and medical education worldwide since their inception. In Australia, educators at dental schools were...
: Cadaveric models have traditionally been a mainstay of dental and medical education worldwide since their inception. In Australia, educators at dental schools were among the first to use cadaveric porcine heads in formal teaching in oral surgery. This practice has since fallen out of favour in most modern dental curricula. The aim of this pilot study was to determine the utility of cadaveric porcine models for oral surgery training from a student perspective (Griffith University, Gold Coast, Australia). : Thirty participants who were all third-year dental students attended a two-hour session comprising a 30 min lecture followed by a 90 min practical workshop. The lecture outlined the steps and supervision of students during the practical and was provided by a consultant maxillofacial surgeon. At the conclusion of the workshop, participants were asked to anonymously complete a printed questionnaire with eight questions related to their experience. : Prior to the workshop, two-thirds (61%) of participants felt that they had been taught the surgical procedure for raising mucoperiosteal flaps adequately in their dental school curriculum during their third year, although only 43% of students had assisted specialty residents in raising a mucoperiosteal flap and 14% reported having performed the procedure themselves. Almost all students (96%) agreed that the porcine model was useful for their dental education and that they would practice the exercise using the model again if provided with the opportunity. The questionnaire had a 93.33% completion rate. : This pilot study indicates that porcine heads present a useful, low-cost adjunct in the learning of basic oral surgical procedures.
PubMed: 38892742
DOI: 10.3390/jcm13113032 -
Healthcare (Basel, Switzerland) Jun 2024Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists... (Review)
Review
Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists' role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination.
PubMed: 38891212
DOI: 10.3390/healthcare12111137 -
Healthcare (Basel, Switzerland) May 2024A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of...
BACKGROUND AND OBJECTIVES
A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability.
MATERIALS AND METHODS
We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world.
RESULTS
We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement-importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram.
CONCLUSIONS
Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.
PubMed: 38891155
DOI: 10.3390/healthcare12111080