Improving medication safety and diabetes management in Hong Kong: A multidisciplinary approach

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Improving Medication Safety and Diabetes Management in Hong Kong – A Multi-disciplinary Approach

AIM: To characterise drug-related problems (DRPs) among patients with diabetes in Hong Kong and their clinical significance and to explore pharmacists’ role in the multi-disciplinary diabetes management team by evaluating the outcome of their clinical interventions. METHODS: An observational study was conducted at the Diabetes Clinic of a local public hospital from October 2012 to March 2014. Following weekly screening, selected high-risk patients were interviewed by a pharmacist prior to doctors’ consultations for medication reconciliation and review. DRPs were identified and documented by the pharmacists, who presented clinical recommendations to doctors to optimise patients’ drug regimens and resolve or prevent potential DRPs. RESULTS: A total of 522 patients were analysed and 417 DRPs were identified. The incidence of patients with DRPs was 62.8% with the mean number of DRPs per patient being 0.9±0.6. The most common DRP categories were related to dosing (43.9%), drug choice (17.3%) and non-allergic adverse reactions (15.6%). Drugs most frequently involved targeted the endocrine and cardiovascular system (CVS). The majority (71.9%) of DRPs were of moderate clinical significance and 28.1% were considered minor problems. DRPs were totally solved by doctors’ acceptance of pharmacists’ recommendations (50.1%), partially solved (11.0%) or received acknowledgement from doctors (5.5%). CONCLUSIONS: Pharmacists, in collaboration with the multi-disciplinary team, demonstrated positive impact by identifying, resolving and preventing DRPs in patients with diabetes. Further plans for sustaining a pharmacy service in the Diabetes Clinic would enable further studies to explore pharmacists’ long-term impact on improving patients’ clinical outcomes in diabetes management. New knowledge added by this study: Studies have demonstrated pharmacists’ important contribution to the identification, resolution and prevention of drug-related problems through medication reconciliation and review. Most of the identified problems were related to dosing with moderate clinical significance according to Dean and Barber’s validated scale for scoring medication errors. Over half of pharmacists’ clinical interventions were accepted or acknowledged by doctors to improve medication management. IMPLICATIONS FOR CLINICAL PRACTICE OR POLICY: Collaboration between pharmacists and other healthcare professionals is valuable for the improvement of medication safety in the management of diabetes

Immunosuppressants in systemic lupus erythematosus – treatment options and potential toxicity

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Short-course chemotherapy of pulmonary tuberculosis

The last four decades have seen spectacular developments in the management of pulmonary tuberculosis. The discovery of streptomycin in 1943 by Waksman was soon followed by other drugs with anti-tuberculosis activity, such as PAS, isoniazid, pyrazinamide, thioacetazone, ethambutol, rifampicin and others. The dis-covery of the anti-tuberculosis activity of isonia-zid in 1952 was a great land-mark which re-volutionalised the treatment of tuberculosis. Because of its high efficacy, low toxicity and low cost, isoniazid soon became the drug of choice in tuberculosis. Administered alone daily for 12 months, it has a potential of producing bacteri-ological quiescence in approximately 70% of pulmonary tuberculosis cases excreting isoniazid-sensitive cultures in their sputum. The con-comitant administration of thioacetazone or PAS daily for 1 year increases the efficacy of the regimen to about 85%. However, approximately 20% of the patients with quiescent disease at 1 year have a bacteriological relapse after stopping chemotherapy, so that the overall efficacy of the 2-drug regimens is reduced to less than 70% even among those patients who consume the drugs regularly. Such relapses can be prevented by continuing chemotherapy beyond 12 months for another 6-12 months. It is, therefore, customary to prescribe regimens of 8-24 months to tuberculosis patients

Sexual enhancement products for sale online : raising awareness of the psychoactive effects of Yohimbine, Maca, Horny Goat Weed and Ginkgo Biloba

Copyright © 2014 Ornella Corazza et al.This is an open access article distributed under theCreativeCommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedIntroduction. The use of unlicensed food and herbal supplements to enhance sexual functions is drastically increasing. This phenomenon, combined with the availability of these products over the Internet, represents a challenge from a clinical and a public health perspective. Methods. A comprehensive multilingual assessment of websites, drug fora, and other online resources was carried out between February and July 2013 with exploratory qualitative searches including 203 websites. Additional searches were conducted using the Global Public Health Intelligence Network (GPHIN). Once the active constitutes of the products were identified, a comprehensive literature search was carried out using PsycInfo and PubMed. Results. The most common sexual enhancement products available on the Internet were identified. Their active ingredients included yohimbine, maca, horny goat weed and Ginkgo biloba. These four substances were reported with the occurrence of adverse events and the induction of psychological symptoms, such as mood changes, anxiety, and hallucinations as well as addictive behaviours. Conclusions. Uncontrolled availability of sexual enhancement products that contain potentially harmful substances is a major public healthconcern.Thepossible impact on population health, particularly among subjects with psychiatric disorders, usually at risk for sexual dysfunction, may be significant. This new trend needs to be extensively studied and monitoredPeer reviewedFinal Published versio

Shorter treatment for minimal tuberculosis (TB) in children (SHINE): A study protocol for a randomised controlled trial

BACKGROUND: Tuberculosis (TB) in children is frequently paucibacillary and non-severe forms of pulmonary TB are common. Evidence for tuberculosis treatment in children is largely extrapolated from adult studies. Trials in adults with smear-negative tuberculosis suggest that treatment can be effectively shortened from 6 to 4 months. New paediatric, fixed-dose combination anti-tuberculosis treatments have recently been introduced in many countries, making the implementation of World Health Organisation (WHO)-revised dosing recommendations feasible. The safety and efficacy of these higher drug doses has not been systematically assessed in large studies in children, and the pharmacokinetics across children representing the range of weights and ages should be confirmed. METHODS/DESIGN: SHINE is a multicentre, open-label, parallel-group, non-inferiority, randomised controlled, two-arm trial comparing a 4-month vs the standard 6-month regimen using revised WHO paediatric anti-tuberculosis drug doses. We aim to recruit 1200 African and Indian children aged below 16 years with non-severe TB, with or without HIV infection. The primary efficacy and safety endpoints are TB disease-free survival 72 weeks post randomisation and grade 3 or 4 adverse events. Nested pharmacokinetic studies will evaluate anti-tuberculosis drug concentrations, providing model-based predictions for optimal dosing, and measure antiretroviral exposures in order to describe the drug-drug interactions in a subset of HIV-infected children. Socioeconomic analyses will evaluate the cost-effectiveness of the intervention and social science studies will further explore the acceptability and palatability of these new paediatric drug formulations. DISCUSSION: Although recent trials of TB treatment-shortening in adults with sputum-positivity have not been successful, the question has never been addressed in children, who have mainly paucibacillary, non-severe smear-negative disease. SHINE should inform whether treatment-shortening of drug-susceptible TB in children, regardless of HIV status, is efficacious and safe. The trial will also fill existing gaps in knowledge on dosing and acceptability of new anti-tuberculosis formulations and commonly used HIV drugs in settings with a high burden of TB. A positive result from this trial could simplify and shorten treatment, improve adherence and be cost-saving for many children with TB. Recruitment to the SHINE trial begun in July 2016; results are expected in 2020

Drug wastage among the elderly living in old aged homes in Hong Kong

The extend of drug wastage among elderly living in old aged homes was never investigated. Upon the completion of the previous study on pharmaceutical services provided to elderly living in old aged homes, the amount of drugs wasted from 3,020 residents in one of the delegated pharmacies over a 4-month period were counted and their costs were calculated. The total cost of wasted drugs amounted to be HKD$96,924, with drugs acting on the central nervous system contributed to the highest cost of HKD$26,872 (27.7%), followed by respiratory drugs of HKD$23,875 (24.6$22,965 (23.7%). The results showed that for health institutes dispensing prescriptions of long duration to the elderly could lead to considerable amount of drug wastage and this issue should be addressed.link_to_subscribed_fulltex

A comprehensive review of influenza and influenza vaccination during pregnancy

Influenza is a highly infectious respiratory disease that can impose significant health risks leading to increased morbidity and mortality. Receiving influenza vaccination is the most important and effective means of preventing the infection and its related complications. During pregnancy, physiological changes increase susceptibility to influenza infection, and women contracting infectious diseases during pregnancy are more likely to have adverse pregnancy and neonatal outcomes. Influenza vaccination during pregnancy is safe for both pregnant women and their fetus, and pregnant women are now the highest priority group for vaccination. Despite the accumulated evidence of the benefits and safety of influenza vaccination during pregnancy, uptake among pregnant women remains suboptimal. Concerns about the vaccine's safety persist, and the fear of birth defects remains the predominant barrier to vaccination. Targeted interventions have been shown effective in enhancing influenza vaccination uptake among pregnant women. Reluctance to be vaccinated should be addressed by offering accurate information to counteract the misperceptions about the risk of influenza infection during pregnancy as well as to educate mothers about the safety and benefits of influenza vaccination. High-quality randomized controlled trials are recommended to evaluate the effectiveness of individual or multifaceted approaches to increase vaccine uptake.postprin