The pharmaceutical services to the elderly in the old aged homes in Hong Kong: a scope exercise

Various models of pharmaceutical services have been provided by pharmacists to old aged home residents, however, these models have never been summarised and compared. The aim of this scoping exercise is to identify different kinds of pharmaceutical services currently available to the old aged home residents, by means of systemic literature review, qualitative in-depth interviews with service providers in order to understand their models and qualitative semi-structured interviews with non-pharmaceutical service users in an attempt to investigate reasons why some homes do not subscribe to these services. The results showed that none of the pharmaceutical services currently available can uproot the causes of medication errors, and there is a need to elaborate the roles of pharmacists in a primary care setting.link_to_subscribed_fulltex

Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia

Background: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors evolocumab and alirocumab substantially reduce low‐density lipoprotein cholesterol (LDL‐C) when added to statin therapy in patients who need additional LDL‐C reduction. Methods and Results: We conducted a systematic review and network meta‐analysis of randomized trials of lipid‐lowering therapies from database inception through August 2016 (45 058 records retrieved). We found 69 trials of lipid‐lowering therapies that enrolled patients requiring further LDL‐C reduction while on maximally tolerated medium‐ or high‐intensity statin, of which 15 could be relevant for inclusion in LDL‐C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. PCSK9 inhibitors significantly reduced LDL‐C by 54% to 74% versus placebo and 26% to 46% versus ezetimibe. There were significant treatment differences for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 versus placebo (−74.1%; 95% credible interval −79.81% to −68.58%), alirocumab 75 mg (−20.03%; 95% credible interval −27.32% to −12.96%), and alirocumab 150 mg (−13.63%; 95% credible interval −22.43% to −5.33%) at ≥12 weeks. Treatment differences were similar in direction and magnitude for PCSK9 inhibitor monthly dosing. Adverse events were similar between PCSK9 inhibitors and control. Rates of adverse events were similar between PCSK9 inhibitors versus placebo or ezetimibe. Conclusions: PCSK9 inhibitors added to medium‐ to high‐intensity statin therapy significantly reduce LDL‐C in patients requiring further LDL‐C reduction. The network meta‐analysis showed a significant treatment difference in LDL‐C reduction for evolocumab versus alirocumab

Key Articles, Guidelines, and Consensus Papers Relative to the Treatment of Dyslipidemias—2005

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90074/1/phco.26.7.939.pd

Pharmacological Evaluation of Ethanolic Extract of Withania Coagulans Dunal (Flower Buds)

OBJECTIVE OF THE WORK:The plants are the key source of medicine in Ayurveda for treatment and prevention of diseases and maintenance of healthy life. The plants are used in medicine since antiquity. Much of the medicinal plants are documented in the Ancient Ayurvedic classics and these plants are still used successfully to treat different ailments. One of these plants which is used to treat various disease is Withania coagulans Dunal. The shrub is important for the property of coagulating milk, possessed by its berries; they are used for this purpose in North-West India and adjoining country. Withania coagulans are the most reputed medicinal plants of Ayurveda and has well-descript pharmacological activities such as physiological and metabolic restoration, anti-arthritic, anti-aging, cognitive function, improvement in geriatric states and recovery from neurodegenerative disorders.75, 132 Based on the literature review, it was planned to carry out the biological screening as outlined below To validate acute oral toxicity To study the behavioral coordination in rats To study the antiobesity activity in progesterone induced obese rats To study the antihyperlipidemic activity in fructose induced hyperlipidemic rats To study the analgesic activity To evaluate the antimicrobial activity and anthelmintic activity. CONCLUSION: From the study entitled "Pharmacological Evaluation of Withania coagulans Dunal (Flower buds), the following conclusion could be drawn The present study has thus duly supported the traditional use of Ethanolic Extract of Withania coagulans Dunal have scientifically proved the behavioral coordination, antiobesity, antihyperlipidemic, analgesic, anthelmintic, and antimicrobial activity. Apart from the suggested actions listed in discussion part absence of acute toxicity may also offer a new hope for safe treatment in future. Preliminary phytochemical study ethanolic extract of Withania coagulans Dunal was found to contain Carbohydrates, Protein, Steroids, Flavanoids, Alkaloids, Glycosides and Amino Acids are present. Presence of Alkaloids, Flavanoids and Glycosides in the ethanolic extract of Withania coagulans Dunal was concluded by IR & HPTLC analysis. Though present in small quantities, it was found to produce considerable effects The results of the present study indicate that the ethanolic extract of Withania coagulans was non-toxic up to dose level of 2000mg/kg body weight in albino rats as per acute oral toxicity studies. 1/10th of the LD50 Dose is 200mg/kg is used for Pharmacological screening Evaluation of anti-obesity activity of ethanolic extract of Withania coagulans showed significant anti obesity property by the obtained significant results against Progesterone induced obesity. From the results observed in the Progesterone induced obesity, it may be concluded that the test compound at the dose of 200mg/kg body weight displays a significant anti- obesity activity compared to standard drug Orlistat. The ethanolic extract of Withania coagulans at a dose of 200mg/kg exhibited significant hypolipidemic activity in Fructose induced hyperlipidemic rats. This is showed by the reduction of serum lipid parameters such as triglycerides, total cholesterol, LDL, VLDL, SGOT and SGPT with an increase in HDL concentration in the group treated with 200mg/kg of Ethanolic Extract of Withania coagulans. It is found that there is a significant reduction in the Serum glucose. The ethanolic extract of Withania coagulans was subjected to the Tail Flick Analgesic test, showed a significant inhibitory effect. The ethanolic extract of Withania coagulans was subjected to the Anthelmintic activity against Pheritima posthuma, showed a significant inhibitory effect at higher doses 75mg/10ml of Normal Saline & 100mg/10ml of Normal Saline. The ethanolic extract of Withania coagulans was subjected to the antimicrobial test, showed a significant inhibitory effect on both gram positive, gram negative bacteria and also fungi. In future, further investigation might provide an insight to identify the functional groups in the ethanolic extract of Withania coagulans active responsible for the behavioral coordination, antiobesity, antihyperlipidemic, analgesic, anthelmintic, and antimicrobial effect and to elucidate the exact mechanism of action, which is responsible for the observed significant activity with low toxicity and better therapeutic inde

Smoking cessation problem-based learning: Virtual experience

Background and Objectives: Problem-based learning (PBL) is a student-centered teaching and learning methodology where students collaboratively address specific issues. Tobacco use is a major health issue globally. Health professions and students need to have knowledge and skills to facilitate smoking cessation. The objective of this study is to assess feasibility of PBL during a virtual attachment involving institutions from Malaysia and the USA. Methods: A 4-week smoking cessation virtual attachment was conducted for three third-year University of Pittsburgh, USA pharmacy students. Malaysian smoking cessation experts designed and facilitated a PBL smoking cessation module. It was split into two 2-hour sessions with 3 triggers; Trigger 1: ‘Chief Presentation’, Trigger 2: ‘History & Motivational Interview’, and Trigger 3: ‘Brief 5A’s Intervention’. Students received Trigger 1 a day earlier and discussed amongst themselves. In session 1, Triggers 1-3 were given sequentially and discussed after completing all tasks from each trigger. In session 2 one-week later, facilitators gave formative assessment and students provided reflection regarding the PBL session. Upon completing the four-week virtual attachment, students provided feedback and facilitators graded the students. Result and Discussion: A comprehensive and interactive PBL session was successfully conducted virtually. Based on the clinical practice guidelines of both countries, there were differences in terms of availability and use of cessation medications, but the general principles of smoking cessation consultation and interventions were similar. Students were able to discuss the case openly, putting forth ideas and questions in both sessions. All students provided positive feedbacks regarding the PBL. Conclusions: With the extensive development of online platforms connecting the world over, student virtual attachment and mobility programmes can be easily conducted with minimal cost. A suitable module embedding PBL can be designed and conducted to best suit the online platform and the intended students