Journal of Research in Pharmacy Practice最新文献

Acinetobacter baumannii is one of the primary pathogens responsible for healthcare-associated infections. It is related to high rates of morbidity and mortality globally, mainly because of its high capacity to develop resistance to antimicrobials. Nowadays, carbapenem-resistant A. baumannii (CRAB) has increased and represents a significant concern among carbapenem-resistant organisms. It is also a key pathogen associated with ventilator-associated pneumonia. CRAB was placed on the critical group of the universal priority list of the World Health Organization for antibiotic-resistant bacteria, to mention the importance of research development and the urgency of new antibiotics. Patients with severe CRAB infections currently face significant treatment challenges. Some approaches have been taken to deal with CRAB, such as combination therapy and the synergistic effect of certain antibiotics, but the best antibiotic regimen is still unknown. In this narrative review, we attempt to clarify the issues, including epidemiology, risk factors, and current treatment options for CRAB.

Objective: Most of the patients who are admitted to the intensive care unit (ICU) are forced to feed and use nutrition and medicine through an implanted tube. When administering medication through enteral feeding tubes, it is essential to be cautious, as some drugs may not be suitable due to interactions with feeding formulas or adverse effects when crushed. Some errors during drug gavage can lead to feeding tube blockage, reduced drug effectiveness, or drug toxicity. This study aimed to assess medication errors (MEs) in ICU patients using enteral feeding tubes and identify factors that affect ME incidents.

Methods: This descriptive and analytical study was conducted for 9 months in the special care department of hospitals affiliated with Isfahan University of Medical Sciences. It involved 257 patients in the ICU receiving oral medication through an implanted gastric tube. The study assessed the method of oral drug administration, verified the correctness of drug prescriptions, investigated errors in drug provision and administration, and monitored patients for possible side effects of these errors. Demographic information and details about the prescribing physician and relevant nurses were also recorded.

Findings: Our findings show that not washing the tube before gavage was the most frequent error (99.6%). However, different factors, whether the patient or the nurse, did not affect them. The other most common errors included mixing drugs simultaneously (75.6%) and not cleaning the tube after administering medication (78.6%). These errors were influenced by factors such as the number of drugs received by the patient, the hospital, and specific shifts.

Conclusion: In this study, we found that polypharmacy, the multiplicity of underlying diseases, and nurses' gender are the most critical factors that increase the number of MEs during the gavage of drugs in patients hospitalized in ICUs.

Objective: Given the prevalence of methadone poisoning, this study was conducted to compare the cardiovascular complications following acute methadone poisoning in patients with and without a history of long-term methadone use.

Methods: In this retrospective study, information related to patients with acute methadone poisoning hospitalized at Al-Zahra and Khorshid hospitals in Isfahan-Iran was collected from hospital archives and analyzed. Patients were divided into two groups with and without a history of long-term methadone use.

Findings: The mean of corrected QT interval (QTc), QRS, and heart rate showed no significant differences between the two groups at three-time points: baseline (upon admission), 12 h, and 24 h after admission (P > 0.05). The mean QT dispersion upon admission and 12 h after admission did not differ significantly between the groups (P > 0.05). However, the observation at 24 h postadmission indicated a significant increase in QT dispersion in the group with a history of long-term methadone use, showing a mean of 47.53 ± 10.62 ms compared to the without a history of long-term use group, with a mean of 26.78 ± 6.75 ms (P = 0.041).

Conclusion: The results indicate that among the cardiovascular findings when analyzing the electrocardiograms of patients with acute methadone poisoning, only QT dispersion differed between patients with and without a history of long-term methadone use. Cardiovascular events resulting from methadone poisoning are the significant factors contributing to patient mortality, highlighting the need for the careful management of methadone use in these patients.

Objective: This study investigates the impact of omeprazole on urinary magnesium (Mg) excretion in children undergoing treatment for peptic disease. Specifically, it examines how omeprazole influences the fractional excretion of Mg.

Methods: This single-arm clinical trial was conducted from 2020 to 2021. With 44 children diagnosed with acid peptic disease who received omeprazole (1-2 mg/kg/day) for 3 months at the Gastroenterology Clinic of Imam Hossein Hospital, Isfahan, Iran. Serum and urine levels of Mg and creatinine were measured before and after the intervention using the Pars Azmoon Kit, following the kits guidelines. The fractional excretion of Mg was then calculated using standard formulas.

Findings: The mean urinary Mg levels decreased significantly from 4.96 ± 2.48 mg/dL before treatment to 1.46 ± 0.63 mg/dL after treatment (P < 0.001). Serum Mg levels also significantly declined from 1.90 ± 0.20 mg/dL before treatment to 1.37 ± 0.03 mg/dL after treatment (P < 0.01). The mean fractional excretion of Mg decreased from 5.2% ± 1.2% before therapy to 1.7% ± 0.63% after treatment (P < 0.01). Serum creatinine levels showed a slight increase from 0.62 ± 0.19 mg/dL to 0.67 ± 0.13 mg/dL (P = 0.053), whereas urinary creatinine levels increased by 20.80 ± 18.77 mg/dL (P < 0.001).

Conclusion: The observed hypomagnesemia is not attributable to increased urinary Mg loss. Instead, the kidneys appear to compensate for the reduced serum Mg levels by decreasing urinary Mg excretion, thereby conserving Mg in the body following omeprazole treatment.

Objective: Due to high workloads and insufficient counseling time in ambulatory care pharmacy, outpatient pharmacists for pediatric patients in China proposed a mobile health application (mHealth app) that they considered could provide patient counseling more efficiently. To improve it accordingly, we need to design a more specific and multi-dimensional evaluation method to obtain pediatric caregivers' evaluations of a mHealth app.

Methods: A cross-sectional survey on five dimensions (transmission, accuracy, accessibility, completeness, and experience) of the mHealth app was conducted using a random questionnaire among outpatient caregivers at a children's hospital.

Findings: We received 478 valid questionnaires from 500 caregivers. The Item-Level Content Validity Index (I-CVI) indicated the content validity of the questions (I-CVI =1.000). The Content Validity Index for Scales (S-CVI) confirmed their content validity (S-CVI =1.000). The intraclass correlation coefficients (ICCs) of test-retest reliability were acceptable (0.806≤ ICC ≤0.869). The mean scores for transmission, accuracy, accessibility, and completeness were more than 3.5 when the experience was 2.1. Caregivers of different ages agreed that their accuracy was satisfactory; however, their experience was not. Caregivers aged over 50 years did not recognize its transmission and accessibility, whereas caregivers aged under 29 years and over 50 years were not satisfied with its completeness.

Conclusion: The accuracy of the mHealth app is excellent; the transmission and accessibility need to give the silver generation time to accept and adapt, and experience and completeness should be improved. The five-dimensional assessment model can also be used to evaluate other mHealth apps for patient counseling.

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.