A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This research was led by the Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK.Background: Vulnerable patients from marginalized groups (e.g., people with disabilities, people experiencing homelessness, black and minority ethnic communities) experience higher rates of ill-health, inequitable access to healthcare and low engagement with screening services. Addressing these disparities and ensuring healthcare provision is impartial and fair is a priority for the United Kingdom (UK) healthcare system. Aim: Using Levesque’s access conceptual framework, this study explored the views of patients from marginalized groups, specifically on how access to pharmacy services could be improved and their experiences of receiving a medication review service. Method: Qualitative data were collected via semi-structured interviews on patient experiences of pharmacy services and how access to these could be improved (n = 10). Interviews of patients who had received a medication review from their pharmacist were also conducted (n = 10). Using an interpretivist approach, five ‘demand-side’ dimensions of Levesque’s access conceptual framework were explored (ability to perceive a need for medication support, their ability to seek this support, ability to reach the pharmacy, ability to pay and engage). Results: The findings exposed the medicine, health and social care challenges of vulnerable people and how these are often not being adequately managed or met. Using the access formwork, we unpack and demonstrate the significant challenges patients face accessing pharmacy support. Discussion: Pharmacy organizations need to pay attention to how patients perceive the need for pharmacy support and their ability to seek, reach and engage with this. Further training may be needed for community pharmacy staff to ensure services are made accessible, inclusive and culturally sensitive. Effective engagement strategies are needed to enable the provision of a flexible and adaptable service that delivers patient-centred care. Policy makers should seek to find ways to reconfigure services to ensure people from diverse backgrounds can access such services

Experience with the WHO Surgical Safety Checklist

Despite years of efforts by organizations throughout the world “wrong site” surgery has proven to be a resilient opponent. The purpose of present review article is to revisit the various tools that have been designed specially the WHO Surgical Safety Checklist (SSCL), the purpose of which is to improve patient safety and prevent errors in the site of surgery. Three items were the corner stone of this review. Firstly effectiveness of the tools specially the WHO SSCL, secondly approach of those responsible for implementation and thirdly adherence by organizations to the provided guideline. A general review of the available data showed a clear improvement in patient safety. As a whole medical personnel considered SSCl and other tools as a good addition but these tools have yet to prove their worth in the prevention of “wrong site” surgery. There is a need to strive continuously for improving patient safety and to capitalize on the advances made in this regard to prevent this menace. At our Rawalpindi Medical University affiliated Holy Family Hospital efforts are in place for improving ways and developing protocols to curb the evil of wrong site surgery. We currently adopted a new way proposed by Ragusa et al in which we experimented with keeping the surgical instruments and trolley outside the OR away from the surgery team members. Thus preventing distraction of team members till the completion of SSCl. Additionally the Anesthetist took the responsibility of the implementation of the SSCL. This method also prevented the hierarchal style seen in the operation theatres. 1,2 These sentinel events policy was published in 1996.3 By the Joint Commission. This commission is an independent body which has 20,500 health care facilities accredited with it in the USA. The aim of this policy was to help individuals and organizations to learn from their mistakes and achieve the objective of patient safety and zero rate of wrong site surgery4. Wrong site surgery mean surgery done on the wrong patient, surgery on the wrong site or may be a wrong surgery on the wrong patient.4 After review of the record the American Academy of Orthopedics claimed that the orthopedic surgeons have a 25% likelihood of operating a wrong site during their careers. After this claim a campaign “Sign Your Site” was started which proposed that surgeons should sign the surgical site before surgery is done.5 A similar scheme known as the “SMaX” which stands for signing, marking and X-ray of the spine segment was launched by the North American Spine Society in 2001.6     In 2004 The Joint Commission proposed a Universal Protocol. The Commission made it compulsory for all medical facilities under its accreditation to adopt it.7 This document included confirmation of patient and surgical site, its marking and time out before any elective surgery. The World Health Organization (WHO) a subsidiary of the United Nations, which is charged with managing the global health affairs, developed the “surgical Safety Checklist” in the year 2008. This checklist was a product of the “Safe Surgery Saves Lives” campaign. According to this document three phases have been identified in any surgery,. i.e., “Sign In” prior to the anesthesia induction, “Time Out” before incision and “Sign Out” before the patient leaves the operating room. 8-10 Unfortunately in 2009 Stahel et al found an increased number of wrong site surgery.  11 This was preceded by the Joint Commission report  with similar findings.10 Following these disappointing results the Commission further augmented the importance given to the issue by declaring the Universal Protocol as the National patient Safety Goal.12,13 This review article goes through the studies and literature recently published as SSCL and similar tools that have been developed over time to prevent wrong site surgery and improve patient care. The aim was to identify how effective is the SSCL in achieving its goals. Hurdles in the achieving maximum results were also identified. The thinking and view point of those involved in the implementation were sought, emphasis was also placed on how thoroughly organizations comply with the provided guideline

Gender disparities in lymphocyte counts and cytokine expression in COVID-19

Background: This study seeks to assess gender differences in the severity of COVID-19 infection, which have been noted in different regions during the early stages of the pandemic. Methods: A cross-sectional study conducted at Baquba Teaching Hospital in Diyala, Iraq, from October 1st to December 31st, 2020, included 132 confirmed COVID-19 patients. These patients underwent a comprehensive set of routine laboratory tests, including complete blood count, blood biochemistry, and D-dimer assessment. Statistical analysis was carried out using SPSS-20, with significance set at p < 0.05. Results: The study included patients with a mean age of 45.61 (±11.32) years, predominantly male (63.0%), residing in urban areas (57.6%), and presenting with comorbidities (78.8%). All patients exhibited positive results on CT scans (100%) and CRP tests (100%). However, PCR testing confirmed COVID-19 infection in 87.2% of cases, with 12.8% testing negative. Among males, there was a significant increase in IL-6 and IL-10 levels (42.57 ± 7.64 pg/ml and 255.27 ± 21.03 pg/ml) compared to females (16.43 ± 4.19 pg/ml and 187.48 ± 20.35 pg/ml), with p-values <0.001 and 0.003, respectively. Conversely, there was no significant difference in IFN-ɣ levels between males (165.73 ± 16.54 pg/ml) and females (176.12 ± 17.10 pg/ml), with a p-value of 0.105. However, lymphocyte levels were significantly lower in males (4.79 ± 0.85%) compared to females (14.01 ± 1.36%), with a p-value <0.001. Conclusion: Overall, COVID-19 affects males more severely than females, with males showing weaker immune responses and higher levels of inflammatory cytokines like IL-6 and IL-10. While IFN-ɣ levels do not differ significantly between genders, males have lower lymphocyte counts compared to females

Herbal Teas and Thrombocytopenia: A Curious Case of Yellow Dock and Burdock-Induced Thrombocytopenia

Immune thrombocytopenia (ITP) is a bleeding disorder characterized by a decreased number of platelets. It is an immune system-mediated condition, with formation of antibodies against a structural platelet antigen. Although the pathogenesis remains elusive, primary disease is idiopathic and comprises 80% of cases. However, quite a few secondary causes have been established including Helicobacter pylori, varicella-zoster virus and cytomegalovirus. A few cases with an incidental association with herbal medications have been reported, but this causality has not been studied in detail.Here we present the case of 38-year-old African-American woman who presented with symptomatic thrombocytopenia, with a platelet count of 5 K/μl 1 week after she had consumed herbal tea containing Rumex crispus (yellow dock) and Arctium lappa (burdock). The association between unstudied herbs and ITP needs further research, given the widespread use of these substances and ongoing public uncertainty about their benefits

Use of Ondansetron for Prevention of Spinal Induced Hypotension

Objective: To compare the efficacy of prophylactic administration of Ondansetron before induction of spinal anesthesia with placebo, in preventing spinal induced hypotension. Patients and Methods: This Randomized Control trial was carried out at Holy Family Hospital, Rawalpindi from 29 April 2015 till 28 October 2015. A total of 106 patients were enrolled in the study. Patients in group A, received 6 mg Ondansetron. Patients in group B received normal saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded every 5 minutes after performing spinal anesthesia. The study drug was considered efficacious if absence of hypotension for 20 minutes was recorded after inducing spinal anaesthesia. Data was analyzed using SPSS 17. Results: Hypotension occurred in 7.5% cases in Ondansetron group compared to 28.3% in normal saline group (p=0.005). Conclusion: Ondansetron is effective in preventing spinal induced hypotension.&nbsp

Spectroscopic Analysis of Au-Cu Alloy Nanoparticles of Various Compositions Synthesized by a Chemical Reduction Method

Au-Cu alloy nanoparticles were synthesized by a chemical reduction method. Five samples having different compositions of Au and Cu (Au-Cu 3 : 1, Au-Cu 2 : 1, Au-Cu 1 : 1, Au-Cu 1 : 2, and Au-Cu 1 : 3) were prepared. The newly synthesized nanoparticles were characterized by electronic absorption, fluorescence, and X-ray diffraction spectroscopy (XRD). These alloy nanoparticles were also analyzed by SEM and TEM. The particle size was determined by SEM and TEM and calculated by Debye Scherrer’s equation as well. The results revealed that the average diameter of nanoparticles gets lowered from 80 to 65 nm as the amount of Cu is increased in alloy nanoparticles. Some physical properties were found to change with change in molar composition of Au and Cu. Most of the properties showed optimum values for Au-Cu alloy nanoparticles of 1 : 3. Cu in Au-Cu alloy caused decrease in the intensity of the emission peak and acted as a quencher. The fluorescence data was utilized for the evaluation of number of binding sites, total number of atoms in alloy nanoparticle, binding constant, and free energy of binding while morphology was deduced from SEM and TEM

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life