Journal of Research in Pharmacy Practice最新文献

Objective: Sleep is critical for good health and quality of life, but many people struggle with sleep disorders. Pharmacists are on the front lines, helping patients manage these problems. However, there is growing concern that some pharmacists are dispensing benzodiazepines over-the-counter and failing to provide proper counseling. This study examined how pharmacists in Iran performed in these areas.

Methods: Between January and April 2022, we conducted a cross-sectional study in three major Iranian cities, using a "simulated patient" to observe how pharmacists interacted with them. In total, 431 pharmacies participated, and we used detailed forms to record the pharmacists' behavior. We then analyzed the data using descriptive statistics and the Chi-square tests.

Findings: Of 549 visits, 78.5% were managed by pharmacists, whereas the remainder were managed by other pharmacy staff. 79.7% of pharmacists evaluated the patient before deciding whether or not to prescribe the medication and 58.9% provided a kind of counseling for their offered medication, but just 10.6% of pharmacies had a private counseling area. Despite regulations that require a valid prescription for benzodiazepines, 9.2% of pharmacies dispensed diazepam, and 13.2% dispensed alprazolam without requesting one, and when counseling was offered, it often lacked critical details.

Conclusion: These findings raise serious concerns. There are deficiencies in how pharmacists and patients interact, with many pharmacists spending minimal time assessing patient needs. The high rates of benzodiazepine dispensing without valid prescriptions and inadequate counseling point to a need for stricter protocols and more training. To address these issues, health-care professionals and policymakers must collaborate to improve the quality and safety of sleep disorder treatment in community pharmacies.

Due to the high morbidity and mortality of the coronavirus disease 2019 (COVID-19) in patients with malignancy, the necessity of vaccination in this group of patients became particularly important. Although a large number of studies have reported the safety of COVID-19 vaccination in multiple myeloma (MM) patients, the effect of the COVID-19 vaccine on MM relapse has not yet been reported. Here, we report a case of a possible association between relapse of MM and COVID-19 vaccination with Sinopharm^®, an inactivated virus vaccine, in a patient with MM who has remained in complete remission for about 4 years. The MM relapse in the patient was diagnosed by both clinical findings and laboratory workup including serum protein electrophoresis, bone marrow aspiration, and biopsy. Despite this possible association between COVID-19 vaccination and MM relapse in the patient, given its importance in reducing mortality and having an acceptable safety profile, the COVID-19 vaccine should be administered to all cancer patients. However, careful monitoring and follow-up are recommended in patients with MM after COVID-19 vaccination.

Objective: The objective of the study was to evaluate the efficacy and safety of topical 1% medroxyprogesterone in corneal epithelial healing after photorefractive keratectomy (PRK).

Methods: In this placebo-controlled double-masked randomized contralateral eye study, 66 eyes of 33 patients with myopia and myopia-astigmatism were assigned into two groups to receive either 1% topical medroxyprogesterone (intervention) or artificial tear (placebo) at the end of PRK surgery. The patients were followed up daily for 5 days until epithelial healing was achieved. The time taken for epithelial healing was the main outcome measure.

Findings: The mean age of the subjects was 32.97 ± 7.6 years and 46 individuals were female (69.7%). All baseline refractive characteristics were comparable between the groups. There was no significant difference between the two groups in terms of epithelial defect size on Day 1 (P: 0.67). Both groups exhibited a consistent pattern of decreasing epithelial defect size from Day 1 to Day 5, with the control group having slightly worse initial values. There were no significant differences between the groups in the following days. Both groups showed substantial reductions in the epithelial defect size, but the intervention group showed a more prominent decrease on Day 2. The intervention did not show a significant statistical difference compared to the control group, and both groups ended up with a similar outcome.

Conclusion: These findings suggest that the topical 1% medroxyprogesterone does not significantly affect the healing of corneal epithelium after PRK.

Objective: Medical errors are the third leading cause of death in the U. S., with medication mistakes being a common issue. Medication reconciliation (MR) involves comparing patients' orders with their existing medications to prevent errors. Pharmacists are ideally suited for MR tasks. Effective MR can reduce drug-related rehospitalizations. This study aimed to investigate medication errors among hospitalized patients and to evaluate the impact of ward-based and satellite pharmacists on the quality of drug administration services.

Methods: A descriptive cross-sectional study was conducted at Nikan General Hospitals in Tehran, Iran, over 6 months. We assessed the performance of ward-based and satellite pharmacists in various wards. All patient medication activities were meticulously monitored and recorded. Adjusted drug-related problem (DRP) codes were then used to identify medication errors and the corresponding interventions.

Findings: The study included 1682 patients, each experiencing at least one DRP. The data revealed a DRP prevalence of 6.44% (95% confidence interval: 6.15%-6.75%). A total of 2173 DRPs were identified, with 650 originating from intensive care units and the remaining 1523 from other wards. Notably, DRPs attributed to nurses (labeled as S2) constituted 18.36%, and those due to drug interactions (classified as D7) accounted for 13.48%. Following intervention, the most common pharmacist recommendations were initiating a medication (14.04%), discontinuing a medication (13.12%), changing a medication (11.38%), and reducing doses (11.09%).

Conclusion: Effective MR, supported by comprehensive training of medical staff such as physicians and nurses, can significantly reduce DRPs in hospitalized patients. Clinical pharmacists play a vital role in this context.

Objective: The goal of this study is to investigate the potential association between gestational anemia and antenatal depression in pregnant women.

Methods: It is a case-control study consisting of 684 pregnant women under 18 years recruited in different tertiary care hospitals, in Lahore, between June 2023 and December 2023. Utilizing an online questionnaire, data collection encompassed demographics, dietary habits, and the Edinburgh Postnatal Depression Scale (EPDS). Pregnant women with antenatal hemoglobin (Hb) levels above and below 11.0 g/dL were categorized as a nonanemic and anemic group. Statistical analysis involved Chi-square tests to explore the relationships between gestational parameters and maternal factors.

Findings: The depression scores of anemic and nonanemic pregnant women compare two groups of pregnant women based on their Hb levels: those with Hb <110 g/l during pregnancy (anemic) and those with Hb ≥110 g/l (nonanemic). The anemic group had higher depression scores than the nonanemic group, both for those with EPDS <12 points and those with EPDS ≥12 points. However, P = 0.077 indicates that this difference was not statistically significant at a typical alpha level of 0.05.

Conclusion: No significant association was found between gestational anemia and antenatal depression in pregnant women. These findings prompt further research to unravel the intricacies of the association between gestational anemia and depression. The outcomes thus urge the researchers and health-care professionals to consider the diverse factors that may contribute to mental health outcomes during pregnancy and refine strategies for maternal care.

Objective: Pregnancy outcomes are an important factor in women's quality of life, and negative experiences have adverse effects on the overall health of the mother and the family. This study was designed and implemented to compare the effects of two drugs, hyoscine and dexamethasone, on cervical ripening and effacement during childbirth.

Methods: This study was a double-blind randomized clinical trial of 150 patients divided into three groups. The researchers, in the early stage (latent) of labor, gave 8 mg of dexamethasone intravenously to the first group, 20 mg of hyoscine butyl bromide to the second group, and 8 mg of dexamethasone along with 20 mg of hyoscine butyl bromide to the third group.

Findings: Among the quantitative variables studied (length of labor induction, duration of active stage, first stage and second stage of labor, placental expulsion time, 5- and 10-min Apgar and Bishop score), active stage duration (P = 0.000) and 5-min Apgar (P = 0.042) had statistical differences among the three groups. In addition, the type of delivery (P = 0.003) and the percentage of fetal distress (P = 0.001) in the studied groups had a statistically significant difference, and also, in the third group, the cesarean rate was less than the other two groups.

Conclusion: Simultaneous injection of hyoscine and dexamethasone in primiparous women can reduce the duration of the active stage of labor without obstetric complications, so its use in the latent stage is suggested.

Objective: Laryngoscopy induces potent noxious stimuli causing reflex autonomic activation manifested by an increase in blood pressure and heart rate (HR). Various drugs with different routes have been tried to prevent this response. The literature comparing inhalational dexmedetomidine with intravenous (IV) dexmedetomidine to prevent laryngoscopy response is limited.

Methods: A total of 150 American Society of Anesthesiologists Physical Status Class I/II, undergoing elective surgery requiring laryngoscopy and intubation, were included and randomized into two groups. Patients in Group D_INH received nebulized dexmedetomidine (1 μg/kg) and in Group D_IV received IV dexmedetomidine (0.5 μg/kg), 15 min before anesthesia induction. For blinding, nebulized or IV saline was used simultaneously. The primary outcome was to compare the mean arterial pressure (MAP) and HR at laryngoscopy, intubation, and 1, 5, and 10 min after intubation. The secondary outcome was to compare sedation, following the administration of dexmedetomidine, propofol consumption during induction, and any side effects.

Findings: There was no significant difference in MAP (mmHg) postlaryngoscopy and intubation (immediate after intubation 78.5 ± 11.3 vs. 82.3 ± 16.0, P = 0.093). The mean HR was clinically similar in both groups postlaryngoscopy and intubation (immediate after intubation, 80.9 ± 12.5 vs. 76.3 ± 10.9). Patients in the D_IV group were more sedated than the D_INH (Ramsay Sedation Scale 3-4 vs. 1-2, P < 0.001). Bradycardia was seen in eight patients of the D_IV group only.

Conclusion: Preoperative nebulized dexmedetomidine is as effective as and safer than IV dexmedetomidine in preventing laryngoscopic response among adults.

Objective: This cross-sectional study aimed to assess the frequency of potential drug-drug interactions (DDIs) and demographic correlates of moderate and major DDIs among patients with hematologic cancer at a referral hematology hospital in Iran.

Methods: In this study, for 6 months, all patients suffering from hematologic cancers admitted to the tertiary oncology hospital, Omid, Isfahan, were considered. Data from all medications prescribed to patients during hospitalization were analyzed using the online Lexicomp^® drug interaction checker, recording all interactions classified by risk level: C, D, or X.

Findings: A total of 674 DDIs were detected in 109 patients. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 57.9% for those at level C and 31.5% for levels D and X. According to the frequency, the main interaction was between aprepitant and corticosteroids, followed by the interaction between aprepitant and vincristine. The most common interaction between antineoplastic agents was between doxorubicin and cyclophosphamide. In terms of mechanism, most of DDIs (54.9%) were pharmacodynamics. Only the number of administered medications was associated with DDI occurrence.

Conclusion: Potential DDIs of moderate to major severity are common among patients with hematologic malignancies. This underscores the importance of implementing different strategies to mitigate this clinically significant risk.

Objective: There is no definitive pharmacological strategy for COVID-19; thus, medicinal herbs can be an appropriate option for COVID-19 management. We investigated the efficacy of a D-reglis^® tablet (root extract of licorice) as adjuvant therapy in critically ill patients with COVID-19 at intensive care units (ICUs) of Alzahra Teaching Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

Methods: In the present double-blind, randomized, placebo-controlled clinical trial, critically ill cases with COVID-19 (n = 52) received a D-reglis^® tablet (760 mg) or a placebo tablet for 5 days. The ICU stay length was the primary outcome. The secondary outcome included the changes in oxygen saturation, duration of mechanical ventilation, mortality rate, and Sequential Organ Failure Assessment (SOFA) Score during the study period.

Findings: The ICU stay was significantly lower in the licorice group than in the placebo group (P = 0.015). No significant difference was detected between the groups regarding oxygen saturation, SOFA score, duration of mechanical ventilation, and mortality rate.

Conclusion: The licorice tablet (D-reglis^®) as an adjuvant treatment showed promising results regarding the ICU stay length in critically ill COVID-19 patients. However, further clinical trials with larger sample sizes, further duration of intervention, measurement of inflammatory markers, and further study about the molecular mechanism of the effect of licorice on COVID-19 should be done to obtain more conclusive findings.

Objective: According to the importance of evaluating the antimicrobial resistance pattern in the management of nosocomial infections (NIs), we decided to investigate the prevalence of antimicrobial resistance in Chamran Heart Hospital.

Methods: This retrospective cross-sectional observational study was performed for 6 months from February to July 2022 at Shahid Chamran Hospital of Isfahan, Iran. All hospitalized patients with any NIs were eligible for the study. Clinical specimens were obtained from patients with NIs. All specimens underwent microbial culture, and if bacterial growth developed, differential tests were performed. Antibiotic susceptibility testing also was performed per the standards of Clinical and Laboratory Standards Institute, 2022.

Findings: Out of 201 examined samples, urinary infection (34.83%), pneumonia (27.86%), and sepsis (13.43%) were reported to be the most prevalent infections. Among Gram-negatives (76.12%), Citrobacter spp. (26.37%), Escherichia coli (24.87%), and Klebsiella spp. (11.44%) were the most common pathogens. About 54.9% of Citrobacter spp., 33.3% of E. coli, and 45.45% of Klebsiella spp. were resistant to carbapenems. About 1.88% and 15% of Citrobacter spp. were identified as pan-drug-resistant bacteria and extensively drug-resistant (XDR), respectively. In addition, 4.34% of Klebsiella spp. were identified as XDR. Among Gram-positives (23.88%), Enterococcus spp. (8.95%) was identified as the most common pathogen, and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) was 11.11% and 61.11%, respectively.

Conclusion: In our study, carbapenem-resistant Enterobacteriaceae accounts for about 50% of all NIs. Moreover, despite the low prevalence of MRSA, VRE was reported to be high in our center when compared with other studies.