Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 8 Articles
Although wide ranges of anti-hypertensives are available still hypertension (HTN) and its complications are major cause for adult morbidity and mortality and knowledge of existing prescribing patterns in the treatment of hypertension can help in improving clinical practice in this field. A prospective observational study was aimed to assess the HTN and its treatment. Out of 232 patients, 44.83% were males and 55.17% females. 16.37% young adults (30-45years) developed HTN, 60% patients were found to have risk factors (family history and social habits). We observed, 184 were hospitalized with HTN, 21% developed concomitant diseases (chest pain, SOB, Blurred vision), 31% were found to have other comorbidities. 40 patients were found to have isolated systolic HTN, 3 were shown abnormal elevation in B.P (≥210/100 mm of Hg). 46 patients were found with severe level of elevation in both systolic and diastolic pressure (>160/115). 24 and 3 patients were shown moderate level of elevation in systolic (140-160) and diastolic (90-115) BP respectively. 108 patients received 2-drug therapy, mostly (70%) β blocker + CCB’s, 105 patients received monotherapy, mostly (55%) β blockers. we concluded that there is immediate need to improvise the awareness programs regarding disease, periodic BP monitoring and its prevention at early stage, as the prevalence of HTN in young adults is seen, there is a need to improve the usage of diuretics....
Asthma is responsible for major number of deaths worldwide with majority in America affecting even India with 57.15% of total population. The risk factors of asthma are smoking, allergens like animal dander, pollen grains of flowers, dust and smoke of cooking sticks. People with asthma have poor quality of life due unaware of risk factors for asthma, so as to improve their quality of life , clinical pharmacist should play a key role to make patients aware of the risk factors causing asthma. A Prospective observational study was conducted taking 122 asthma diagnosed patients to improve their quality of life with awareness about risk factors using pictogram in general medicine units of tertiary care teaching hospital. Out of 122 patients, most of patients were male (79) with maximum of patients in age group of 56-65, workers (54), illiterate (89), rural (93), socio economic status (56 are very poor). Patients have smoking habit (50) and patients were having chewing tobacco habit (5) as risk factors, people allergic to dust (34), major symptoms were shortness of breath (92) and wheezing (72), severe (50.82% of total population). The prevalence rate of asthma was found to be 20.71%. Study concludes that clinical pharmacists should play a responsible role in improving the quality of life of asthma patients by conducting awareness studies and programs to patients....
Background: Drug addiction is a complex and chronic mental disease, which places a large burden on the\r\nAmerican healthcare system due to its negative effects on patients and their families. Recently, network\r\npharmacology is emerging as a promising approach to drug discovery by integrating network biology and\r\npolypharmacology, allowing for a deeper understanding of molecular mechanisms of drug actions at the systems\r\nlevel. This study seeks to apply this approach for investigation of illicit drugs and their targets in order to elucidate\r\ntheir interaction patterns and potential secondary drugs that can aid future research and clinical care.\r\nResults: In this study, we extracted 188 illicit substances and their related information from the DrugBank\r\ndatabase. The data process revealed 86 illicit drugs targeting a total of 73 unique human genes, which forms an\r\nillicit drug-target network. Compared to the full drug-target network from DrugBank, illicit drugs and their target\r\ngenes tend to cluster together and form four subnetworks, corresponding to four major medication categories:\r\ndepressants, stimulants, analgesics, and steroids. External analysis of Anatomical Therapeutic Chemical (ATC) second\r\nsublevel classifications confirmed that the illicit drugs have neurological functions or act via mechanisms of\r\nstimulants, opioids, and steroids. To further explore other drugs potentially having associations with illicit drugs, we\r\nconstructed an illicit-extended drug-target network by adding the drugs that have the same target(s) as illicit drugs\r\nto the illicit drug-target network. After analyzing the degree and betweenness of the network, we identified hubs\r\nand bridge nodes, which might play important roles in the development and treatment of drug addiction. Among\r\nthem, 49 non-illicit drugs might have potential to be used to treat addiction or have addictive effects, including\r\nsome results that are supported by previous studies.\r\nConclusions: This study presents the first systematic review of the network characteristics of illicit drugs, their\r\ntargets, and other drugs that share the targets of these illicit drugs. The results, though preliminary, provide some\r\nnovel insights into the molecular mechanisms of drug addiction. The observation of illicit-related drugs, with partial\r\nverification from previous studies, demonstrated that the network-assisted approach is promising for the\r\nidentification of drug repositioning....
Medical errors are a broad term used to represent all errors that take place within the healthcare system e.g., diagnostic errors, equipment failure, mistreated surgery and medication errors. Medication errors are probably one of the most common types of medical error includes prescribing, dispensing and medication administration errors. This may be because most drug doses in paediatric medications calculated individually, based on the patient’s age, weight, body surface area, and/or their clinical condition. Majority of drugs used in children are unlicensed or off-label thereby increase the potential for medication errors and risks associated with extemporaneous dispensing as adult dosage forms used for paediatrics. Restricted evidence suggests that the prevalence of medication errors and corresponding harm could be higher in children than in adults. It is necessary to identify indications for which medicines actually used in paediatrics, as well as the dosage forms. Effectiveness studies are necessary to determine the results in real-life clinical situations, and then to match evidence of harm to effectiveness by age group. Clinical Pharmacists have the responsibility of ensuring the safe and effective use of medications. Even though other health care providers and health care systems must significantly contribute to this effort but pharmacists, as champions of the medication use process, must take a leading role. This paper presents a literature review on the role of clinical pharmacists in reducing medication errors, adverse effects and highlights the pharmacist-physician-patient collaboration for all patients in the pediatric age group....
treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED\r\ntriage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs\r\nto improve site-of-care decisions and to simplify early discharge management. Different triage scores have been\r\nproposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have\r\nsuboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced\r\ninto clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial\r\npatient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a)\r\ntreatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at\r\nthe most proximal time point of ED admission.\r\nMethods/design: Prospective, observational, multicenter, multi-national cohort study. We will include all\r\nconsecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for\r\nnon-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later\r\nbatch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded.\r\nAttending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to\r\nthe medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for\r\ndischarge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic\r\nmedical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and\r\nfunctional status, re-hospitalization, satisfaction with care and quality of life measures.\r\nWe aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage\r\nalgorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated\r\nby the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission)\r\nwithin 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post\r\nacute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early\r\nrecognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to...
Background: Physical activity on prescription (PAP) is a successful intervention for increasing physical activity\r\namong patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and\r\nthere is limited information about GPs� attitudes to counselling using PAP as a tool. The aim of the study was to\r\nexplore and understand the meaning of prescribing physical activity from the general practitioner�s perspective.\r\nMethods: Three focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south\r\nof Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed\r\nverbatim, analysed using qualitative content analysis.\r\nResults: The analysis resulted in four categories: The tradition makes it hard to change attitude, Shared\r\nresponsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear\r\nguidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but\r\nthey do not prescribe physical activity as a treatment. Physician�s education focuses on the use of pharmaceuticals.\r\nThe responsibility for patients� physical activity level is shared with other health professionals, the patient and\r\nsociety. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration.\r\nPAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to\r\nemphasize an increased level is considered to be redundant and the GPs think it should be administered by\r\nsomeone else in the health care system. Scepticism about the result of the method was also expressed.\r\nConclusions: There is uncertainty about using PAP as a treatment since physicians lack education in nonpharmaceutical\r\nmethods. The GPs do not regard the written referral as a prioritized task and rather refer to other\r\nprofessionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and\r\narrangements for the method to gain credibility and become everyday practice among GPs....
Bacterial antibiotic resistance is mainly developed due to self-medication with antibiotics. The objective of this study was to estimate the occurrence of antibiotics self-medication among secondary and tertiary level students in Karachi, Pakistan. We administered a cross-sectional survey to secondary and tertiary level students (n = 780) at four institutes located in different regions of Karachi. The questionnaires consisting of 23 closed and open questions were used. The participants were asked about the patterns of antibiotic usage, reasons for self-medication, types of antibiotics used and if they completed the full course of antibiotics or not. The analysis of data was performed with descriptive statistics and logistic regression. The rate of the prevalence of antibiotics self-medication was 71.4%. The frequency of antibiotic self-medication was highest at the intervals of one month 29%. Metronidazole (67.3%) had been the most common antibiotic used. 55% of the participants said that their treatments were unsuccessful. The most critical reason given for carrying out self-medication had been that it was less expensive than medical care in hospitals 41.7%. 58% did not complete the full course of antibiotics and 48% of the participants possessed little knowledge about the adverse health effects of antibiotics, whereas 9% of the students were ignorant of any health risks correlated with self-medication with antibiotics. Based on the results of our study we conclude that irrational use of antibiotics through self-medication seems to be a common trend among tertiary level students as compared to secondary level students in Karachi. There is an urgent need of appropriate interventions to solve the problem....
Background: The aim of this study was to assess the association between prescription changes frequency (PCF)\r\nand hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures\r\ncomorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescription\r\nchanges over a 3-month period.\r\nMethods: A retrospective matched caseââ?¬â??control design was conducted. 10.000 patients were selected randomly from\r\nthe Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The\r\nprimary study outcome was the number of prescription changes during several three-month time periods starting 18,\r\n12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched\r\nfor age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient.\r\nWe classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start.\r\nResults: The study population comprised 8,681 hospitalized patients and an equal number of matched nonhospitalized\r\npatients. The odds ratio of hospital admission increased with an increase in PCF category. At 3 months before the index\r\ndate from PCF=1 OR 1.4 [95% CI 1.3-1.5] to PCF= 2ââ?¬â??3 OR 2.2 [95% CI 1.9-2.4] and to PCF = 4 OR 4.1 [95% CI 3.1-5.1]. A\r\nhigher CDS score was also associated with an increased odds ratio of hospitalization: OR 1.3 (95% CI 1.2-1.4) for CDS\r\n3ââ?¬â??4, and OR 3.0 (95% CI 2.7-3.3) for CDS 5 or higher.\r\nConclusion: The prescription change frequency (PCF) is associated with hospital admission, like the CDS.\r\nPharmacists and other healthcare workers should be alert when the frequency of prescription changes increases.\r\nClinical rules could be helpful to make pharmacists and physicians aware of the risk of the number of prescription\r\nchanges....
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