Journal of Research in Pharmacy Practice最新文献

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.

Objective: Epilepsy is a chronic neurological disorder that affects 0.5%-1% of children. 30%-40% of patients are resistant to current anti-epileptic drugs. Lacosamide (LCM) appeared to be effective, safe, and well tolerated in children and adolescents. This study was aimed to evaluate whether LCM could be an effective add-on therapy in children with refractory focal epilepsies.

Methods: This study was conducted from April 2020 to April 2021 in Imam Hossein Children Hospital, Isfahan, Iran. We included 44 children aged 6 months to 16 years with refractory focal epilepsy (based on International League Against Epilepsy criteria). LCM was given in divided doses of 2 mg/kg/day, increasing by 2 mg/kg every week. The first follow-up visit was 6 weeks later, when all patients had reached the therapeutic dose.

Findings: The average age of the patients was 89.9 months. 72.5% of children had focal motor seizures. Evaluation of percent change in seizure frequency and duration before and after treatment showed a 53.22% reduction in seizure frequency and 43.72% reduction in seizure duration after treatment. Our study group tolerated LCM well, with few side effects. Headache, dizziness, and nausea were common side effects. In line with other studies, none of the suspected risk factors could predict response to LCM treatment.

Conclusion: LCM appears to be an effective, safe, and well-tolerated medication in children with uncontrolled drug-resistant focal epilepsy.

Objective: Trace elements deficiency is common among end-stage renal disease (ESRD) patients due to excessive loss during dialysis and the lower intake secondary to loss of appetite. Selenium (Se) is a trace element that plays an important role in the radical scavenging system and helps the body defend against oxidative stress. This study aims to evaluate the effects of Se supplementation on lipid profile, anemia, and inflammation indices in ESRD patients.

Methods: Fifty-nine hemodialysis patients enrolled and were randomly divided into two groups. Two hundred microgram Se capsules once daily for the case group and matching placebo for the control group were administered for three months. Demographic data were collected at the study beginning. Uric acid (UA), anemia and inflammation indices, and lipid profiles were recorded at the beginning and the end of the study.

Findings: UA and UA-to-HDL (high-density lipoprotein) ratio decreased significantly in the case group (P < 0.001). The changes in lipid profile were not significant among both groups. Hemoglobin slightly increased in the case group, however, it decreased significantly in the control group (P = 0.031). High-sensitivity C-reactive protein (hs-CRP) decreased in the case group and increased in the control group, however, none of these changes were significant.

Conclusion: According to the results of this study, selenium supplementation in ESRD patients could reduce some risk factors related to their mortality, such as the ratio of uric acid to HDL. However, the changes related to lipid profile, hemoglobin level and hs-CRP biomarker were not significant.

Objective: We aimed to evaluate the efficacy of an oral combined tablet of Glycyrrhiza glabra, Viola odorata, and Operculina turpethum (Anti-Asthma^®) as an add-on therapy for the relief of the severity of symptoms in mild-to-moderate childhood asthma.

Methods: This randomized placebo-controlled clinical trial was performed on 60 children and adolescents with chronic mild-to-moderate childhood asthma. Patients were randomly divided into cases who received Anti-Asthma^® oral combined tablets 2 tablets twice dailt for 1 month and controls, received placebo tablets identically the same to Anti-Asthma^® (2 tablets, twice daily, for 1 month) as add-ons to their standard therapy according to the guideline. The severity and frequency of cough attacks and shortness of breath, respiratory test indices (based on spirometry), and the extent of disease control and treatment adherence were measured clinically by validated questionnaires at the beginning and after the study.

Findings: Respiratory test indices improved and the severity of activity restriction decreased significantly in the cases compared to the controls However, the mean difference before and after the study was significantly different between the cases and controls only for the number and severity of coughs and the severity of activity restriction. In the scores of the Asthma Control Questionnaire, the cases group had a significant improvement compared to the controls.

Conclusion: Anti-Asthma^® oral formulation may be effective as an adjunct add-on treatment in the maintenance therapy of mild-to-moderate childhood asthma.

Objective: This study aimed to assess the efficacy of an herbal formulation based on Boswellia sacra in improving cognitive and behavioral symptoms in patients with mild cognitive impairment (MCI) and mild-to-moderate stages of Alzheimer's disease (AD).

Methods: A 3-month, parallel-group, placebo-controlled trial was implemented from October 2021 to April 2022. Patients with MCI and mild-to-moderate stages of AD aged above 50 years (n = 60; 40 women, 20 men) enrolled in the study using clinical diagnosis and a score of 10-30 on the mini-mental state examination (MMSE) test. They were assigned into two groups; one receiving a herbal formulation) include B. sacra, Melissa officinalis, Piper longum, Cinnamomum verum, and Physalis alkekengi) three times a day and the other receiving a placebo for 3 months. The main efficacy measures were the changes in cognitive domains based on the MMSE and changes in behavioral and psychiatric symptoms based on neuropsychiatric inventory (NPI) scores compared with baseline. Side effects were also recorded.

Findings: Results of this study showed significant differences between the two groups after 3 months in terms of all the assessed variables, including the overall result of the mean score of MMSE and NPI tests (P ≤ 0.001). The herbal formulation had the most considerable effects on the domains of orientation, attention, working memory, delay recall, and language of the MMSE test.

Conclusion: Herbal formulation based on B. sacra was significantly effective compared to a placebo in improving cognitive and behavioral symptoms in patients with MCI and mild-to-moderate AD.

Objective: Psychiatric disorders are chronic in nature which require medications for a long duration. These medications have been associated with many adverse events. Failure to recognize an adverse drug reaction (ADR) exposes the patient to continuing risk of ADR, leading to a significant impact on patient's quality of life. Thus, the present study carried out to identify the pattern of ADRs reported due to psychotropic medication.

Methods: This was a cross-sectional study conducted to analyze ADRs reported from the psychiatry department of a tertiary care teaching hospital from October 2021 to March 2022.

Findings: A total of 137 ADRs were identified from 102 patients. Majority of the ADRs were reported from antidepressants, with paroxetine being the leading offending drug. The central nervous system was most commonly affected, and dizziness (13.13%) was the most common ADR noted. On causality assessment, 97 ADRs (70.8%) were of "possible" type. Almost half of the patients with ADRs (47.5%) recovered spontaneously. No ADR encountered turned out to be fatal.

Conclusion: The present study revealed that the majority of ADRs reported from psychiatry OPD were mild in nature. We reinforce the identification of ADR is crucial in the hospital setting process as it gives an insight into the risk-benefit ratio for rational use of the drug.