Journal of Research in Pharmacy Practice最新文献

Objective: Methadone treatment is effective for managing opioid use disorder (OUD) but raises concerns about its impact on cardiac function. This study aimed to assess the prevalence of cardiac dysfunction among individuals under methadone treatment.

Methods: This cross-sectional study involved 200 OUD patients admitted to addiction treatment centers of Kerman, Iran, who were at least 1 year under methadone maintenance therapy. Participants were enrolled using a convenience sampling method. Exclusion criteria included concurrent alcohol or nonopioid drug abuse, underlying diseases affecting cardiac function (diabetes, hypertension, and chronic renal failure), hepatic diseases, or use of drugs affecting methadone metabolism. Data on methadone dose, treatment duration, and cardiac parameters assessed through echocardiography and electrocardiography were collected.

Findings: A total of 200 OUD patients aged 46.34 ± 13.93 years (72% male) were included. The average duration of methadone use was 2.17 ± 1.34 years, and the average dose was 52.10 ± 27.46 mg/day. 38% of subjects had QT prolongation, while echocardiographic assessment revealed various cardiac abnormalities: 17.5% with systolic dysfunction, 12.5% with abnormal left ventricular end-diastolic diameter, 66.5% with diastolic dysfunction, and 15.5% with increased systolic pulmonary artery pressure. Significant correlations were observed between methadone dose and duration with all measured cardiac parameters.

Conclusion: This study demonstrated an association between methadone treatment characteristics (higher dose and longer duration) and cardiac dysfunction. These findings suggest dose- and time-dependent cardiotoxic effects of methadone. Clinicians should implement cardiac monitoring, dose minimization, and risk-reduction strategies for patients on long-term methadone therapy.

Objective: This study investigated the impact of soft skills on the performance of medical representatives (MRs), aimed to identify key competencies deemed essential for success, and explored effective training methods to develop these skills.

Methods: A cross-sectional survey was designed to gather insights from leaders across various departments in Saudi pharmaceutical companies, including sales, marketing, medical affairs, and human resources (HR). Using purposive non-probability sampling, the survey was distributed to 80 potential participants through email and LinkedIn. Data were analyzed using descriptive statistics and thematic analysis of open-ended responses.

Findings: Fifty-five leaders responded (69% response rate), representing diverse departments and geographic locations. Communication skills and emotional intelligence were ranked as the most critical soft skills (mean ratings: 4.8 ± 0.4 and 4.7 ± 0.5 out of 5, respectively), followed by negotiation (4.6 ± 0.6), problem-solving (4.5 ± 0.5), and time management (4.4 ± 0.6). The majority (96.4% [n = 53]) of respondents agreed that MRs with strong soft skills perform better, particularly in client interaction (mean impact: 4.9 ± 0.3) and relationship building (4.8 ± 0.4). Managerial performance reviews (74.1%, n = 40) and sales growth (70.4%, n = 38) were identified as the primary metrics for evaluating soft skills. Communication workshops (83.6%, n = 46) and role-playing sessions (72.7%, n = 40) were deemed the most effective training methods. However, challenges such as time constraints (50.9%, n = 28), lack of employee interest (43.6%, n = 24), and resistance to change (41.8%, n = 23) were identified as significant barriers to skill development.

Conclusion: This study underscores the pivotal role of soft skills in enhancing employee performance and driving business success in Saudi Arabia's pharmaceutical industry. It highlights the need for structured training programs during onboarding and continuous development to equip MRs with essential soft skills. The findings offer actionable insights for leaders and HR professionals, paving the way for further research in this domain.

Objective: The services of pharmacists in the hospital go beyond the distribution of medicine, and today, it means the role of pharmacists in the optimal use of medicines by patients and improving their health outcomes. The purpose of this research is to monitor pharmaceutical services in the inpatient departments of Imam Hossein Hospital using a standardized authoring tool.

Methods: In this research, two questionnaires were compiled and validated, and different departments of Imam Hossein Hospital in Tehran, which is the largest tertiary hospital in Iran, were monitored in terms of pharmaceutical services. Correct answers below 50% were classified as "Inappropriate," between 50% and 70% as "Relatively Appropriate" and above 70% as "Appropriate."

Findings: The findings indicate that the highest risk points included absence of drug combination at the beginning of the patient's hospitalization in all departments, absence of drug calculation tables in 90%, absence of control protocol for the abuse of narcotic drugs and their prescription in 90%, absence of quick preparation guide and how to use injectable medicines in 80%, absence of stock list in 75%, and the absence of a control protocol for controlled medicines in 60% of inpatient departments.

Conclusion: The study conducted is the first comprehensive study of monitoring pharmaceutical services in hospital wards. The unique features of this study, such as the breadth, comprehensiveness and selection of the largest medical, educational and therapeutic center, and the largest tertiary hospital in Iran, can be generalized to all hospitals and benefit from it.

Objective: This study evaluated pharmacists' and pharmacy technicians' knowledge, attitudes, and practices (KAPs) regarding pharmacovigilance and adverse drug reaction (ADR) reporting at a tertiary care facility in Saudi Arabia. It also sought to identify the barriers to ADR reporting and propose strategies to improve pharmacovigilance practices. This study is timely given recent initiatives by the Saudi Vision 2030 to strengthen medication safety practices nationwide.

Methods: A cross-sectional survey was conducted among pharmacists and pharmacy technicians at a tertiary care hospital in Saudi Arabia. A structured, self-administered questionnaire collected data on participants' KAPs regarding pharmacovigilance. Descriptive and inferential statistical analyses were conducted to identify the trends and associations between demographic variables and KAP scores.

Findings: A total of 200 healthcare professionals participated in the study. While 87% of participants were aware of pharmacovigilance and 91% were familiar with ADRs, only 47.5% had ever reported an ADR. Positive attitudes were observed, with 94% agreeing that ADR reporting is an essential role of pharmacists and 90% supporting its inclusion in pharmacy curricula. However, key barriers to ADR reporting included lack of time (65%), insufficient training (58%), and uncertainty about reporting procedures (49%). Significant associations were found between knowledge levels, age, gender, and educational qualifications (P < 0.05).

Conclusion: Despite high levels of knowledge and positive attitudes, ADR reporting practices remain suboptimal due to structural and procedural barriers. To enhance pharmacovigilance practices in Saudi Arabia, targeted training programs, simplified reporting systems, and mandatory reporting policies are recommended.

Objective: Medication Decision Support Systems (MDSS) are increasingly integrated into hospital information systems to reduce prescribing errors and enhance evidence-based clinical decision-making. This study evaluates the effect of MDSS implementation on albumin prescribing in two intensive care units (ICUs) at Imam Reza Hospital, Mashhad, Iran.

Methods: A quasi-experimental pre-post design was applied. Albumin prescription data were collected over two 3-month phases, before and after MDSS implementation. Total population sampling was used. Statistical analyses included Chi-square and independent-sample t-tests to assess differences in guideline adherence, alert responsiveness, and patient safety. P < 0.05 was considered significant, and 95% confidence intervals were reported where applicable.

Findings: A total of 311 albumin prescription requests were reviewed. Following MDSS implementation, 60.15% of alerts led to prescription modification. Guideline adherence improved significantly (from 47.64% to 68.26%, P = 0.014), and patient safety rates increased (63.33% to 82.61%, P = 0.009). Alert responsiveness was highest in critical conditions such as acute respiratory distress syndrome and lowest in elective scenarios such as paracentesis.

Conclusion: MDSS significantly improved guideline adherence and prescribing quality in ICU settings. However, system limitations such as alert fatigue and physician override in specific scenarios remain. Further research is warranted to evaluate MDSS scalability, long-term clinical impact, and application to broader drug categories.

Objective: Paclitaxel-induced peripheral neuropathy (PIPN) is a disabling condition that leads to discontinuation or dose reduction of chemotherapy and reduces the patient's quality of life (QOL). We investigated the effect of N-acetylcysteine (NAC) in preventing PIPN.

Methods: This study was a randomized, double-blind, and placebo-controlled clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences. Breast cancer patients receiving the Adriamycin/Cyclophosphamide-Taxol regimen were enrolled. All patients received 1200 mg NAC or placebo in two doses before each cycle of paclitaxel. Response to treatment was assessed based on improvements in the Numeric Pain Rating Scale (NRS), NCI-CTCAE, NPS, FACT/GOG-Ntx, and EORTC-QLQ. Two blood samples were taken at baseline and last cycle to determine the oxidative factors.

Findings: Sixty patients were enrolled. At the last cycle, changes in NRS were decreasing in the NAC group but increasing in the placebo group. Thirteen patients (44.8%) in the NAC group and only one patient (3.4%) in the placebo group still reported no neuropathy in the end. A significant difference was observed between the two groups in the Ntx subscale and the Fact-G total score at the last cycle (P < 0.001). The QOL increased in the NAC and decreased in the placebo group. Glutathione levels, MDA, and TAC differed significantly between the two groups (P < 0.001, <0.001, and 0.04, respectively), but no significant difference in NO levels (P = 0.5).

Conclusion: Oral NAC at a dose of 1200 mg daily for two doses can reduce the incidence and severity of PIPN and improve patients' QOL.

The effectiveness of prophylactic systemic antibiotics in preventing ventilator-associated pneumonia (VAP) in patients receiving invasive mechanical ventilation (IMV) in intensive care units (ICUs) remains uncertain. This meta-analysis aims to evaluate the efficacy of antibiotic prophylaxis in reducing the incidence of VAP among the IMV population. We conducted an extensive search of databases, including PubMed, Web of Science, Embase, and the Cochrane Library, from their inception to December 2023. We aimed to identify studies evaluating the effects of prophylactic systemic antibiotics on VAP, early- and late-onset VAP, mortality rates, median ventilation days, and lengths of ICU and hospital stays, facilitating a comprehensive meta-analysis. Seven studies involving 939 patients indicated that the use of preventive antibiotics reduced VAP compared to control groups (risk ratio [RR] of 0.61). The early-onset VAP rate was also lower in the treatment group compared to the control groups (RR of 0.40). Prophylactic systemic antibiotics may effectively reduce VAP incidence in ICU patients on IMV but do not significantly impact other clinical outcomes. These findings may stem from the fact that VAP accounts for a small fraction of ICU deaths, and most studies focused on early-onset VAP, which has lower mortality. However, definitive recommendations cannot be established without the necessity of well-designed randomized controlled trials.

Objective: Anticoagulation therapy, including enoxaparin, is crucial for preventing blood clots in patients at risk for thromboembolic events. However, due to enoxaparin's enhanced renal elimination, proper prophylactic dosing may be challenging. This exploratory study evaluates antifactor X_a levels in patients with augmented renal clearance (ARC) receiving enoxaparin prophylaxis.

Methods: Forty patients aged 18 years or older receiving 40 mg of enoxaparin for deep vein thrombosis prophylaxis with a high ARC score were observed. ARC was confirmed by creatinine clearance exceeding 130 mL/min. Exclusion criteria included various conditions impacting hemostasis. The objective was to assess antifactor X_a levels 4 h after the fourth dose of enoxaparin administration using a chromogenic assay.

Findings: The mean ± standard deviation of the antifactor X_a levels was 0.28 ± 0.21. A significant number of participants (65%) had suboptimal antifactor X_a levels.

Conclusion: The prophylactic use of enoxaparin in patients with ARC may result in insufficient antifactor X_a levels. Although the mean levels were within the target range, many individuals did not reach the target level. Healthcare providers should consider renal function and ARC when prescribing enoxaparin to prevent thromboembolic events.

Objective: This cross-sectional study aimed to assess the knowledge, attitudes, and practices (KAPs) of pharmacists in Yazd, Iran, regarding dietary supplements (DSs).

Methods: A cross-sectional survey assessed KAP regarding DS among pharmacists and pharmacy students in Yazd community pharmacies. Data were collected using a validated questionnaire covering demographics, DS knowledge, attitudes toward DS and counseling, and practices. Expert panel review confirmed face and content validity; reliability was established (Cronbach's alpha). SPSS 16.0 was used for statistical analysis, including descriptive statistics (means, standard deviations, and percentages) for KAP scores, Pearson correlations for KAP relationships, and t-tests/ANOVA for associations with demographics/professional factors. Significance was set at P < 0.05.

Findings: Significant correlations were observed among all KAP parameters. Pharmacists' knowledge and practice scores were significantly associated with age, educational level, years of experience, and professional title. Attitudes toward counseling on DS were also considerably linked to professional titles. Notably, a substantial majority (91.8%) of pharmacists expressed a positive attitude toward their role in DS counseling.

Conclusion: This study highlights the interrelation of knowledge, practice, and attitudes regarding DS among pharmacists in Yazd and their association with demographic and professional factors. The overwhelmingly positive attitude toward DS counseling suggests a promising foundation for enhancing pharmacists' engagement. To realize this potential fully, targeted interventions to improve knowledge and practice, particularly among younger and less experienced pharmacists, are warranted.

Objective: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) is a major intensive care unit challenge, particularly in Iran, due to limited antibiotic options. This study compared the efficacy of adding levofloxacin and colistin inhalation form to the baseline regimen of colistin and meropenem in treating VAP caused by MDR-GNB.

Methods: Patients with VAP were randomly assigned to the colistin group (n = 24), receiving 2 million international unit (MIU) every 8 h, and the levofloxacin group (n = 22), receiving 250 mg every 12 h, alongside intravenous colistin (4.5 MIU every 12 h) and meropenem (1 g every 8 h). Clinical improvement using the Clinical Pulmonary Infection Score (CPIS) on days 1, 5, and 7, the clinical response on day 7, and inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) on days 1, 3, 5, and 7 were evaluated.

Findings: CPIS scores significantly decreased in both groups: Colistin (-3.67 ± 2.14, P < 0.001) and levofloxacin (-4.41 ± 1.71, P < 0.001), with no intergroup difference (P = 0.200). The clinical response analysis indicated that levofloxacin was associated with fewer treatment failures and more partial responses, whereas colistin demonstrated higher rates of complete response; however, these differences were not statistically significant (P > 0.05). Acute kidney injury occurred only in the colistin group (n = 8; 33.3%). Bronchospasm and cough occurred in one levofloxacin patient (4.54%), showing a significant difference in adverse effects (P = 0.004). Mortality rates were higher in the colistin group (n = 17; 70.8%) compared to the levofloxacin group (n = 10; 45.5%), though this difference was not statistically significant (P = 0.08).

Conclusion: Levofloxacin inhalation may be considered an effective alternative to colistin inhalation for treating VAP caused by MDR-GNB. It offers similar efficacy and lower nephrotoxicity.