Journal of Research in Pharmacy Practice最新文献

Objective: Infections are an important cause of morbidity and mortality after hysterectomy. Here, we aimed to investigate and evaluate the beneficial effects of metronidazole vaginal gel on the rate of surgical site infections in women undergoing elective abdominal hysterectomy.

Methods: This is a randomized prospective, double-blind controlled clinical trial performed in 2020 in Isfahan on 108 candidates for elective hysterectomy. At the beginning of the study, we completed a checklist of the patient's characteristics (patient age, body mass index [BMI], and history of medical conditions such as diabetes, hypertension, anemia, and immune deficiency) and the cause of hysterectomy. All patients were randomized into two groups. The first group received a lubricant vaginal gel single dosage, and the second group received a 0.75% metronidazole vaginal gel single dosage the night before surgery. Patients were visited up to 6 weeks after surgery, and the frequency of infection at the surgical site was determined.

Findings: The rates of infection were lower in patients who received metronidazole vaginal gel (5.8%) compared to the control group (11.6%) (P = 0.03). Patients with an estimated blood loss volume of more than 500 mL had higher rates of infection (13.46%) compared to patients with a bleeding volume of fewer than 500 mL (1.9%) (P = 0.001). We also found that patients with diabetes (13.5%) and patients with BMI more than 30 kg/m²(13.5%) had higher rates of infection compared to patients without diabetes (5.8%) and patients with BMI <30 kg/m² (11.5%) (P = 0.001 for both). Patients with higher hospitalization duration had higher infection rates (P = 0.009).

Conclusion: Administration of a single dosage of metronidazole vaginal gel before abdominal hysterectomy may reduce surgical site infection and have clinical values.

Objective: In the initial days of the coronavirus disease 2019 (COVID-19) pandemic, the Indian Council of Medical Research (ICMR) recommended the use of hydroxychloroquine (HCQ) as chemoprophylaxis for health-care workers (HCWs) involved in the care of COVID-19 patients. The present survey aimed to assess the knowledge and compliance of HCQ prophylaxis as per the ICMR recommendations among Indian HCWs during the first wave of the pandemic.

Methods: A validated 19-item questionnaire-based survey was distributed to HCWs in our apex tertiary care institute who had completed their duties in the COVID-19 wards to assess the knowledge, attitude, and compliance of all sections of HCWs regarding the ICMR-recommended HCQ prophylaxis. Participation in the survey was voluntary, and anonymity was maintained. Data obtained from the responses were collated and analyzed.

Findings: Two hundred and fourteen out of 250 HCWs completed the survey (85.6% response rate). Among 214 participants, 87.9% were below the age of 40 years. 83.2% were aware of the use of HCQ for possible prevention of COVID-19 infection, while only 24.6% took HCQ for 7 weeks as was recommended during that period. The main reasons given by 37.3% of the HCWs for not taking HCQ were their knowledge and research on HCQ, where side effects were prominent. Side effects were reported by 35% of the respondents, of which the most notable was nausea/vomiting (14%) followed by gastritis (12%).

Conclusion: The poor compliance with HCQ prophylaxis by HCWs was influenced by their knowledge and research, lack of strong scientific evidence, and drug-associated adverse effects.

Objective: To explore the services community pharmacists in Lagos state provided to their communities during the COVID-19 pandemic.

Methods: A cross-sectional survey of community pharmacists drawn from all the Association of Community Pharmacists' zones in Lagos state was done from April to June 2021. Data were collected using a structured, self-reported online questionnaire via Google Forms and were analyzed using descriptive and inferential statistical analysis.

Findings: Two hundred and forty community pharmacists participated in the study; the response rate was 80.5%. Patient counseling (99.6%), assessment and treatment of common acute ailments (99.6%), and patient education on hygiene (99.6%) were the most reported services provided by community pharmacists. The COVID-19 infection prevention and control measures most frequently practiced by the pharmacists include cleaning of floors with soap and water (98.4%), provision of hand sanitizers for staff use (97.1%), and taking precautions when handling prescriptions and dispensing drugs (96.7%). Significant barriers to the provision of the services were reduced workforce in the pharmacy, time constraints, and extended working hours. Zinc (98.3%), Vitamin C (97.5%), and ivermectin (95.0%) tablets were the most reported medications for the prevention and treatment of COVID-19 infection.

Conclusion: Community pharmacists in Lagos state actively provide pharmacy services and practice various recommended infection prevention and control measures to mitigate the spread of COVID-19 infection in their communities.

Objective: The present study aims to evaluate the awareness of a sample of the general population and health-care professionals regarding the use of antibiotics and antibiotic resistance and identify the factors associated with antibiotic resistance.

Methods: This prospective questionnaire-based study was conducted for 3 months, from July to September 2020, in Karaikal, Puducherry (India). The health professionals included doctors in pre- and paraclinical teaching departments (those not involved in clinical practice), laboratory technicians, and PhD students pharmacists. The questionnaire had two parts which health professionals answered, whereas the general population answered only the second part.

Findings: About 38.5% of the population reported using antibiotics frequently among the responses obtained. Around 66.5% of the general population usually stop the antibiotic within 1 or 2 days after they feel better, and 11% of the people believed that adding an extra antibiotic would make them better. Among the health professionals, more than 90% responded that self-medication is the major reason for antibiotic resistance and was unsure of the overprescription of antibiotics.

Conclusion: The results show variable responses and suggest the need for intervention programs to increase the knowledge among the general population regarding the rational use of antibiotics.

Objective: Hyperbilirubinemia has been considered one of the most common clinical conditions in newborn babies. As a traditional medicine, chicory distillate may be beneficial in reducing bilirubin. This randomized, double-blind clinical trial was conducted to determine the effect of chicory extract on hyperbilirubinemia in neonates.

Methods: The clinical trial was conducted among 154 participants with hyperbilirubinemia. The study group was selected and randomly divided into the control (n = 77) and intervention (n = 77) groups. In the intervention group, breastfeeding women received a 10% solution of chicory distillate (50 ml every 12 h), whereas, in the control group, the participants received sterile distilled water, 50 ml every 12 h. The infants' bilirubin level was measured before and 24, 48, and 72 h after the intervention. Fisher's exact and Chi-square tests were run to examine qualitative data, while a t-test was applied for independent variables.

Findings: There was a significant difference between the intervention and control groups (P < 0.001). Within each group, a significant difference was found in bilirubin levels among different sampling times (P < 0.001). Although the bilirubin levels reduced during the time intervals in both groups, the reduction rate was significantly higher in the intervention group (P < 0.001). Based on the results, breastfeeding mothers should be aware of including chicory extract in their nutritional programs.

Conclusion: Chicory extract consumption in breastfeeding mothers can reduce bilirubin in their neonate.

Objective: In the present study, we aimed to develop a virtual simulation that allows pharmacy students to play through actual prescriptions and pharmacy practice scenarios productively and on a personal computer. If designed properly, this program may serve as a supplementary educational tool without the need for an existing human tutor that could provide learning outcomes as good as those resulting from traditional paper-based pharmacy practice tutorials.

Methods: A computer-based simulation of a community pharmacy was developed. This program mainly targeted three basic learning needs of pharmacy students: drug dispensing, patient counseling, and dealing with clinical situations related to the patients' prescription or demand for over-the-counter (OTC) recommendations. Fundamental design decisions were based on breaking down the dispensing process into logical components to provide discrete development elements. For teaching patient counseling and clinical skills, instructors wrote scenarios covering the most prevalent pharmacy practice issues, mainly focused on medication use during pregnancy or lactation, OTC recommendations, information related to drug interactions and adverse drug reactions, and interactions between prescription drugs and patient's underlying disease.

Findings: Based on the primary curriculum topics, the development team designed exercises for pharmacy practice units presented to year 5 pharmacy students. Accordingly, exercises were developed to authentically reflect tasks and challenges a community pharmacist would regularly face in the workplace. To fulfill this part, over 2000 real prescriptions were scanned and categorized based on the main drugs included. These prescriptions were used for both activities, namely medication dispensing and clinical scenarios. Furthermore, five senior pharmacy students wrote more than 200 clinical scenarios under a clinical pharmacist's supervision. The main objectives of pharmacy practice courses were followed to cover the most important must-to-know clinical tips, whether related to giving relevant advice as an OTC recommendation, referring the patient to a primary care physician, or just providing a piece of general health advice, which is expected to be comprehensively learned by pharmacy students.

Conclusion: This program was designed as a simulated learning environment to help students develop prescription dispensing and clinical skills. To be considered a success, this simulation needed to provide equivalent or better learning outcomes than the current practice approach, which should be assessed in the future evaluation of the software, and then be promoted accordingly.

Objective: The disposal of unwanted, unused, or expired medicines is a concern. Currently, there is little knowledge regarding their disposal among patients in South Africa. Consequently, there is a need to address this.

Methods: This was a descriptive and quantitative study with patients conducted among 16 primary health-care clinics (PHCs) in South Africa. A structured questionnaire was administered to 171 conveniently selected patients. Data on ideal disposal methods were collected and compared to actual disposal practices.

Findings: 74.9% of patients reported having unused medicines at home, of whom 34.4% wanted these medicines disposed of. However, 64.9% did not know how to dispose of them, with 95.3% reporting having never been informed by health-care professionals of disposal methods. While patients prefer to return medicines to their PHC, only 7.0% did so. Patients' ideal disposal practices included designated collection task teams (25.1%) and dissolving their unused medicines in water (38.6%). However, current practices indicated that patients flushed medicines down the sewer (31.6%) or disposed of them in municipal bins (23.9%).

Conclusion: Patients disposed of their unwanted medicines using incorrect disposal techniques, which they thought were correct. This urgently needs to be addressed.

Objective: The study aimed to assess the prevalence, pattern, and determinants of the self-medication practices with modern and/or complementary and alternative medicine (CAM) therapies in patients with chronic pain.

Methods: The descriptive cross-sectional study was conducted between August 2021 and January 2022 and assessed a representative sample of chronic pain patients visiting outpatient departments in India by administering a semi-structured questionnaire. The survey questionnaire consisted of forty multiple response items, including ten questions that assessed the subjects' sociodemographic profile, for example, age, sex, education, marital status, employment status, residence, and distance of home from any health care facility. The next part of the questionnaire evaluated the practice and determinants of self-medication for chronic pain with modern or CAM therapies. It included thirty questions assessing the reasons, duration, sources of information, procurement methods, preference for a particular system of medicine, knowledge about risks or drug interactions, rationality, perception of the subject, and communication with the physician, among other aspects of self-medication for pain.

Findings: Out of the 325 respondents with chronic pain, those who practiced self-medication (237) were significantly more in number than those who did not (P < 0.05). Among those who self-medicated, the practice was significantly higher in urban participants living closer to healthcare facilities, with better economic backgrounds and higher education (P < 0.05). Modern medicine was the predominant choice of self-treatment for chronic pain compared to various CAM therapies (P < 0.05). Among the alternatives, homeopathic and ayurvedic systems of medicines were preferred. The main reasons for self-medicating were urgency, ease, previous prescriptions, and presumed mildness of the underlying disease. More than one-third of the respondents opined in favor of continuing self-medication in the future.

Conclusion: The prevalent practice of self-medication for chronic pain may not be hazardous, but it can turn into a serious problem if not based on correct information. The inherent risks need to be minimized by increasing awareness, health education, and pharmacy regulations.

Objective: In this study, we assess population-level data of COVID-19 treatments in Iran compared to Ministry of Health (MOH)-published guidelines to gain a better insight into the quality of care for this disease.

Methods: National sales data of each recommended and nonrecommended COVID-19 medicine were used to proxy utilization between March 21, 2020, and March 21, 2021, or Iranian year 1399. COVID-19-attributed sales volume and number of patients were estimated by adjusting sales data with pre-COVID-19 average growth rate, recommended dose, and duration of treatment. Next, they were compared with the MOH guidelines in outpatient and inpatient settings. Furthermore, the list of top 10 molecules of the market and top 10 COVID-19-indicated molecules in terms of values were extracted to assess the economic burden of COVID-19 prescription drugs and their share.

Findings: The estimated number of patients receiving COVID-19 treatments in some outpatient medicines such as recommended hydroxychloroquine was over 2.2 million. Favipiravir and remdesivir were collectively about two inpatient medicines 260,000; however, neither of these two medicines was recommended in the MOH guidelines. In some fewer specific medicines such as dexamethasone, prednisolone, azithromycin, and naproxen, the estimated number of COVID-19-attributed patients were incomparable with the officially announced number of confirmed cases in the year of study, which could be related to nonconfirmed diagnosed cases, irrational use, or prescribing, or limitations of our data and study. The total COVID-19-attributed market of candidate medicines was over 15 trillion IR Rials (almost 4.3% of the total market). Remdesivir, with over 60% of the total COVID-19 attributed market, followed by favipiravir, was among the highest value medicines.

Conclusion: Despite the release of the COVID-19 guideline by Iran MOH, misalignment in the enforcement of decisions was a serious weakness (cases of favipiravir and remdesivir). This weakness led to some economic burden on the health-care system and raised ethical concerns.