Current Issue : April - June Volume : 2011 Issue Number : 2 Articles : 9 Articles
Sir, Having read the article by Moghaddam et al1, I would like to bring to light a new foray of monoclonal antibodies in to antibacterial actions especially against Staphylococcus aureus.The active and passive immunity approaches targeting S. aureus, particularly methicillin-resistant S. aureus (MRSA), have been quite promising....
Background\nAntiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.\nMethodology\nWe developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.\nFindings\nOf the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.\nConclusions\nVirtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection....
Background\r\nPreventable adverse drug events (pADEs) are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison) study is initiated.\r\nMethods/Design\r\nA multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care.\r\nThe primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-)medical costs and indirect non-medical costs, extra costs per prevented ADE, number and type of pharmacy interventions, length of hospital stay, complications registered in a national complication registration system for surgery, number of readmissions within three months after initial admission (follow-up), quality of life and number of non-institutionalized days during follow-up.\r\nDiscussion\r\nThis study will assess the cost-effectiveness of ward-based pharmacy care on preventable adverse drug events in surgical patients from a societal perspective, using a comparative study design....
Introduction: Epidemiology of skin diseases has been studied and evaluated occasionally. In view of high incidence of skin diseases and economic burden that it poses, there is a need to evaluate the present epidemiology and prescribing pattern of skin disorders.\nObjective: To assess common skin conditions, drug utilization patterns and cost analysis in Dermatology Out patients Department (OPD) of Tertiary Care hospital.\nMethodology: After taking Ethics committee�s permission, prescriptions of 600 patients attending Dermatology OPD were audited. The prescriptions were analyzed for common skin conditions drug utilization and cost analysis.\n Results: The common skin conditions found were Pyoderma and Scabies while common classes of drugs prescribed were antiallergics, antifungals and steroids. Drugs prescribed by Generic name were 16.6% and Brand names were 83.4%. It was revealed that 30% of total drugs dispensed from hospital pharmacy and 70% from outside pharmacy. Average hospital and outside pharmacy costs were INR19.40 and INR116.20, respectively. The outside pharmacy cost of prescription (Spearman�s Rho = -0.130, p < 0.01) as well as cost paid by the patients (Spearman�s Rho = 0.408, p < 0.001) had a negative correlation with the socioeconomic score as the drugs were prescribed irrespective of the socioeconomic class.\nConclusion: The dermatological prescription analysis gives a message to the prescribing physician to achieve rational and cost effective medical care. The drugs which are made available in the hospital pharmacy should be based on clinical evidence generated from meta-analysis of drug studies, pharmacoepidemiology and pharmacoeconomic studies. There is dire need for physicians training with regards to rational use of drugs and pharmacoeconomics. Hospital should make essential drugs available with continuous monitoring to improve the prescribing pattern. The limitation of this study is that the actual direct costs and indirect costs were not studied. It opens the scope for further study in this area....
Background\r\nAdverse reactions and medication errors are complications of drug use. Spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. In this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ADE) in Germany were assessed using routinely collected hospital data.\r\nMethods\r\nThe study was based on aggregated hospital routine data covering the period 2003 to 2007 and annually recorded as part of the further development of the German Diagnosis-Related Groups. The 505 ICD-10-codes indicating an ADE were categorized in seven groups according to their certainty. Primary diagnoses were considered as a proxy for drug-related admissions, and secondary diagnoses as a proxy for hospital-acquired ADE.\r\nResults\r\nAmong all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced. There was a significant increase in the overall rate of drug-related admissions over time (p < 0.038). Enterocolitis due to Clostridium difficile infection was the most frequent cause of a drug-related admission. About 4.5% of in-patients had experienced a hospital-acquired ADE. In addition, over the course of the study period, the overall frequency of hospital-acquired ADEs significantly increased (p < 0.001).\r\nConclusions\r\nIn Germany, more than 5% of hospital episodes are either caused or complicated by an ADE. Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE. Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed....
Background. Tuberculosis (TB) is a cause of significant morbidity and mortality in patients with AIDS. The goal of our study was to determine predictors of in-hospital mortality in patients with AIDS and disseminated tuberculosis in a middle-income country. Material and Methods. We conducted a retrospective cohort study in a tertiary care center, for patients with AIDS in southern Brazil. From 1996 to 2008, all patients with the diagnosis of disseminated TB were included. Results. Eighty patients were included. In-hospital mortality was 35%?? ( ?? = 2 8 ) . On multivariate Cox regression analysis, low basal albumin ( ?? < . 0 1 ) was associated with death, and fever at admission was related to better survival ( ?? < . 0 1 ) . Conclusion. Albumin levels or fever are independent predictors of survival in patients with HIV and disseminated TB. They can serve as indirect markers of immunodeficiency in patients with disseminated TB and AIDS....
Background\r\nMalaria and Tuberculosis (TB) are important causes of morbidity and mortality in Africa. Malaria prevention reduces mortality among HIV patients, pregnant women and children, but its role in TB patients is not clear. In the TB National Reference Center in Guinea-Bissau, admitted patients are in severe clinical conditions and mortality during the rainy season is high. We performed a three-step malaria prevention program to reduce mortality in TB patients during the rainy season.\r\nMethods\r\nSince 2005 Permethrin treated bed nets were given to every patient. Since 2006 environmental prevention with permethrin derivates was performed both indoor and outdoor during the rainy season. In 2007 cotrimoxazole prophylaxis was added during the rainy season. Care was without charge; health education on malaria prevention was performed weekly. Primary outcomes were death, discharge, drop-out.\r\nResults\r\n427, 346, 549 patients were admitted in 2005, 2006, 2007, respectively. Mortality dropped from 26.46% in 2005 to 18.76% in 2007 (p-value 0.003), due to the significant reduction in rainy season mortality (death/discharge ratio: 0.79, 0.55 and 0.26 in 2005, 2006 and 2007 respectively; p-value 0.001) while dry season mortality remained constant (0.39, 0.37 and 0.32; p-value 0.647). Costs of malaria prevention were limited: 2ââ??¬/person. No drop-outs were observed. Health education attendance was 96-99%.\r\nConclusions\r\nMalaria prevention in African tertiary care hospitals seems feasible with limited costs. Vector control, personal protection and cotrimoxazole prophylaxis seem to reduce mortality in severely ill TB patients. Prospective randomized trials are needed to confirm our findings in similar settings....
C-reactive protein (CRP) is the prototype acute-phase protein. CRP is a marker of infection and/or inflammation in daily clinical practice, the protein has a wide variety of biological properties and functions. Inflammation is one of the cornerstones in the etiology and pathogenesis of atherosclerosis, which led to worldwide attention being focused on CRP and its role in the process of atherosclerosis. CRP plays a role in the expression of different adhesion molecules on endothelial cells and the protein is able to activate human complement within the plaque. it has been proven that an elevated CRP level, with a cut-off point of approximately 3 mg/ l, is associated with an increased risk of occlusive arterial disease, especially acute coronary syndromes. The main objective of this review is use of the Atrovastatin to reducing elevated CRP level....
Background\r\nNaturopaths and Western herbal medicine (WHM) practitioners were surveyed to identify their extent, experience and roles within the community pharmacy setting and to explore their attitudes to integration of complementary medicine (CM) practitioners within the pharmacy setting.\r\nMethod\r\nPractising naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations.\r\nResults\r\n479 practitioners participated. 24% of respondents (n = 111) reported they had worked in community pharmacy, three-quarters for less than 5 years. Whilst in this role 74% conducted specialist CMs sales, 62% short customer consultations, 52% long consultations in a private room and 51% staff education. This was generally described as a positive learning experience and many appreciated the opportunity to utilise their specialist knowledge in the service of both customers and pharmacy staff. 14% (n = 15) did not enjoy the experience of working in pharmacy at all and suggested pharmacist attitude largely influenced whether the experience was positive or not. Few practitioners were satisfied with the remuneration received. 44% of the total sample provided comment on the issue of integration into pharmacy, with the main concern being the perceived incommensurate paradigms of practice between pharmacy and naturopathy. Of the total sample, 38% reported that they would consider working as a practitioner in retail pharmacy in future.\r\nConclusions\r\nThe level of integration of CM into pharmacy is extending beyond the mere stocking of supplements. Naturopaths and Western Herbalists are becoming utilised in pharmacies...
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