Polypharmacy in elderly cancer patients : challenges and the way clinical pharmacists can contribute in resource-limited settings

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role

Salmonella gastroenteritis outbreak in a family: a case report

Five members of a family were brought to emergency with complaints of high grade fever, pain abdomen, diarrhoea and vomiting. The symptoms started after five hours of food, the vegetable curry by this family. Four of them were in hypovolemic shock and two had significant pus cells in stool examination. All of them were discharged by seven days. Stool culture of three of these patients showed salmonella. Keywords: food poisoning, hypovolemic shock, diarrhea, emergency, gastroenteritis, salmonella, vomitin

DRUG UTILISATION STUDY OF STROKE AND OTHER PATIENTS ADMITTED TO GENERAL WARD OF NEUROLOGY UNIT AT QUATERNARY CARE PRIVATE HOSPITAL

Objective: To study the profile of the patient, the pattern of their illness and their drug use patterns attending to general ward of quaternary care hospital.Methods: Prospective observational study of 2 mo was performed at neurology unit of the quaternary care private hospital, India. Patients aged above 20 y with at least one neurological drug in prescription were included to observe their demographic profile, illness pattern and drug use. The data was analysed and summarised as frequency and percentage using microsoft excel and presented as tables.Results: Among 60 patient that were enrolled, more were males (N=33, 55%) than females (N=27, 45%) and within the age group of 60-70 y (N=22, 36.67%). The majority of patients were diagnosed with strokes (N= 48, 80%) where the cerebrovascular accident was most common (N=16, 26.66%). Males (N=29, 60.4%) were more prone to get stroke than females (N=19,39.6%). An average number of drugs per prescription was 5.7, the percentage of antibiotics, generic drugs and injections were 36.6%, 0.05% and 44.14% respectively. A total of 28 different drug classes with 61 different drugs was utilised. Fourteen drug classes had been accounted for 90% of drugs utilisation. Clopidegrol+Aspirin have frequently used the drug.Conclusion: Most people attending neurology unit were elderly. Stroke occupies 1st list for the burden. Average drugs for neurology visit remain high. Wide types of drug classes are utilised in neurological ward

Association Between Patient Race/Ethnicity, Health Literacy, Socio-Economic Status, and Incidence of Medication Errors:A Systematic Review

Introduction: Medication errors represent a significant source of healthcare-related harm, leading to mortality, morbidity, and substantial costs to health systems. Existing evidence highlights dissatisfaction and perceived discrimination experienced by patients from minority ethnic and disadvantaged backgrounds within healthcare settings. Objective: The study aimed to systematically review the literature on associations between patient race/ethnicity, socio-economic status, health literacy, and the incidence or patient experience of medication errors in healthcare and community (home) settings. Methods: A systematic review was conducted by searching an electronic database including EMBASE, MEDLINE, and PsycINFO. Studies published in English from January 2010 to October 2023, which explored the association between ethnicity, social disadvantage, and medication errors, were included. Results: Thirteen studies met the inclusion criteria from an initial identification of 2075 titles. Findings indicated that minority ethnic patients were more susceptible to prescription errors, undertreatment, administration errors, and suboptimal medication monitoring and follow-up by healthcare providers. Patients with low health literacy and limited English proficiency were also significantly likely to experience comprehension errors and medication discrepancies. Furthermore, ethnicity and social disadvantages were also associated with an increased risk of overdosing in pediatric medication administration, particularly among parents using dosing cups. Conclusion: Minority ethnic background, low socio-economic status, and low health literacy can risk a higher likelihood of patients experiencing medication errors. Increasing awareness of these disparities among healthcare staff is essential for developing targeted interventions to mitigate inequalities in patient experiences and care outcomes in relation to medication use and safety. Future research should investigate the importance of intersectionality, such as multiple social disadvantages in this context.</p

Sustainable biogas production potential in Nepal using waste biomass: A spatial analysis

Biogas plays a significant part in replacing solid biomass and fossil fuels for cooking. However, the implementation of appropriate policies to promote the development of biogas plants is hindered by a lack of adequate assessment of the biogas potential in Nepal. Thus, we estimate the potential of biogas production at the district level of Nepal from available waste biomass, including livestock manure, agricultural residues, and organic fraction of municipal solid waste (OFMSW). Our estimates show the theoretical potential of biogas production from livestock manure of 1890 million m3 year−1, agricultural residues of 2290 million m3 year−1, and OFMSW of 234 million m3 year−1. The total biogas production is 4412 million m3 year−1, equivalent to 153 million liquefied petroleum gas (LPG) cylinders yearly. Using this biogas potential to replace LPG and solid biomass for cooking could result in avoided CO2, CO, and PM2.5 emissions of 6.3 million tons year−1, 0.4 million tons year−1, and 0.04 million tons year−1, respectively. Our findings suggest that the Terai districts of Morang, Sunsari, Saptari, and Banke, as well as the Hilly districts of Kavrepalanchok, Dhading, and Nuwakot, have a significant amount of biogas-producing potential. Utilising this potential could also contribute to achieving several Sustainable Development Goals and a clean cooking energy transition in Nepal. For this, governments need careful planning, designing, policy support, and facilitation on bio-resource management and utilisation at the local level.<br/

Translation and cultural adaptation of EORTC QLQ-LC 29 into Nepalese language for lung cancer patients in Nepal

Background: The quality of life (QoL) of patients with lung cancer (LC) may be affected by disease-related limitations such as patients’ functioning, the severity of symptoms, financial problems resulting along with the side effects of the treatment. The objective of this study was to translate LC-specific QoL questionnaire EORTC QLQ-LC29 into Nepalese language for Nepalese LC patients. Methods: In the process of translation, the European Organization for Research and Treatment of Cancer (EORTC) translations guidelines were followed. The translated questionnaire was pilot-tested in a sample of 15 patients with LC. Descriptive statistics were calculated with SPSS version 21.0. Results: All steps of the EORTC translation guideline were followed successfully. Fifteen lung cancer patients were included in the pilot study. Sixty percent were male and the mean age was 49.87 (range 21–76 years). For all items not related to thoracic surgery, patients used the entire range of the response options from 1 to 4 and no missing responses were observed. The highest mean (indicating a high symptom burden) was observed for the item number. 35 (shortness of breath; Mean = 3.33, SD = 1.11) and the lowest mean for an item number. 45 (dizzy; Mean = 1.73, SD = 0.96). Conclusion: The Nepalese version of EORTC QLQ-LC29 is a result of a successfully conducted rigorous translation procedure, and is highly comprehensible as well as acceptable to Nepalese LC patients. Thus, the Nepalese version of EORTC QLQ-LC29 is ready to be used in international clinical studies as well as in Nepalese clinical practice

Advancing opioid stewardship in low-middle-income countries:challenges and opportunities

The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.</p

Views of healthcare professionals on complementary and alternative medicine use by patients with diabetes:a qualitative study

BackgroundRecent estimates indicate that a significant proportion of diabetic patients globally, up to 51%, are utilizing complementary and alternative medicine (CAM). To improve patient-provider communication and optimize prescribed treatments, healthcare professionals (HCPs) must understand the factors associated with CAM use among diabetic patients. There is a dearth of literature on HCPs perspectives on CAM use by diabetic patients. This study explored HCPs knowledge, perspective, and views on their diabetic patients’ use of CAM.MethodsQualitative study using one-to-one semi-structured interviews conducted with 22 HCPs involved in the care of diabetic patients (6 endocrinologists, 4 general practitioners, 4 nurses and 8 pharmacists). Participants were recruited through general practices, community pharmacies and a diabetic centre in Saudi Arabia. Data were analyzed using thematic analysis.ResultsFive key themes resulted from the analysis. HCPs generally demonstrated negative perceptions toward CAM, particularly regarding their evidence-based effectiveness and safety. Participants described having limited interactions with diabetic patients regarding CAM use due to HCPs’ lack of knowledge about CAM, limited consultation time and strict consultation protocols. Participants perceived convenience as the reason why patients use CAM. They believed many users lacked patience with prescribed medications to deliver favourable clinical outcomes and resorted to CAM use. ConclusionsHCPs have noted inadequate engagement with diabetic patients regarding CAM due to a lack of knowledge and resources. To ensure the safe use of CAM in diabetes and optimize prescribed treatment outcomes, one must address the communication gap by implementing a flexible consultation protocol and duration. Additionally, culturally sensitive, and evidence-based information should be available to HCPs and diabetic patients. <br/

Assessing and addressing climate-induced loss and damage in Nepal

Loss and damage associated with climate change has gained increasing importance in international climate change negotiations, research, and policy making in recent years. It is a significant consequence of inadequate action from the international community on delivering climate action. Loss and damage is already happening in developing countries like Nepal and it is important to understand how this can be assessed and addressed at national and sub-national level. This study examines how the issue of loss and damage is evolving in international policy and in Nepal. Most importantly, by reviewing the existing risk and impact assessment tools and proposing how these can be strengthened, it aids the national policy process in understanding how loss and damage will impact communities and nature