Patients’ Medication Taking Behaviours: Critiques of Relevant Terminologies

Various terms describing patient’s behavior regarding adherence tomedication use have been a subject for debate internationally.Problems in relation to this terminology issue are identified as: 1)variation of terminologies used in research literature; 2) variation ofdefinitions of the terminologies; 3) only one terminology in Thailanguage used for this patient’s behavior compared to those used inEnglish. Researchers or healthcare professionals should be able tounderstand differences and similarity of these terminologies tochoose appropriate terminologies in research on drug use.Furthermore, the terminology and its definitions should be statedexplicitly in academic articles which would allow readers tounderstand research contexts and be able to compare study results.Keywords: drug-related problems, compliance, adherence,concordanc

การพัฒนามาตรการควบคุมกำกับการดำเนินการห้องพยาบาลในสถานประกอบกิจการ จังหวัดระยอง Development of Control Measure for Medical Care Unit in Enterprises in Rayong Province

บทคัดย่อ วัตถุประสงค์: เพื่อสำรวจสถานการณ์การดำเนินการห้องพยาบาลของสถานประกอบกิจการในจังหวัดระยอง และสังเคราะห์มาตรการควบคุมกำกับระดับนโยบายต่อการดำเนินการห้องพยาบาลของสถานประกอบกิจการระหว่างหน่วยงานที่เกี่ยวข้อง วิธีการศึกษา: ใช้การวิจัยแบบผสานวิธี เริ่มด้วยแบบสำรวจการดำเนินการห้องพยาบาล ในห้องพยาบาลของสถานประกอบกิจการ 189 แห่ง วิเคราะห์ข้อมูลด้วยสถิติเชิงพรรณนา ตามด้วยการอภิปรายกลุ่มผู้เชี่ยวชาญ 9 คน ที่มีประสบการณ์เกี่ยวข้องกับห้องพยาบาลจากหลายภาคส่วน โดยใช้ร่างมาตรการควบคุมกำกับห้องพยาบาลที่สังเคราะห์จากผลการสำรวจและกรอบประเด็นสนทนาเป็นเครื่องมือ วิเคราะห์ข้อมูลแบบอุปนัยเพื่อสร้างมาตรการควบคุมกำกับระดับนโยบายจากข้อมูลที่ปรากฏบนพื้นฐานของการวิเคราะห์สถานการณ์ ผลการศึกษา: มีห้องพยาบาลที่มีรายการเวชภัณฑ์ครบถ้วนเพียง 6 แห่ง (ร้อยละ 3.2) ขณะที่มีไม่ครบ 135 แห่ง (ร้อยละ 71.4) มี 125 แห่ง (ร้อยละ 66.1) ที่มีรายการเวชภัณฑ์เกินกว่าที่กำหนด และ 131 แห่ง (ร้อยละ 69.3) มีการจัดการด้านเวชภัณฑ์ไม่เหมาะสม ผลการอภิปรายกลุ่มสังเคราะห์ได้มาตรการควบคุมกำกับการระดับโยบายต่อการดำเนินการห้องพยาบาลของสถานประกอบกิจการ คือ 1) ให้หน่วยงานภายนอกหรือตัวแทนแรงงานตรวจสอบห้องพยาบาลได้ตลอดเวลาที่มีลูกจ้างอยู่ทำงาน 2) ผู้มีหน้าที่ควบคุมกำกับจากภาครัฐประสานงานร่วมกันเพื่อส่งเสริมสนับสนุนการยกระดับมาตรฐานห้องพยาบาล และ 3) องค์กรหรือตัวแทนของลูกจ้างต้องสนับสนุนการดำเนินการของนายจ้างและผู้ควบคุมกำกับห้องพยาบาลให้จัดบริการสุขภาพที่เหมาะสม สรุป: การดำเนินการห้องพยาบาลในสถานประกอบกิจการในจังหวัดระยองส่วนใหญ่ยังไม่เป็นไปตามกฎกระทรวงแรงงานฯ จึงควรมีการนำมาตรการควบคุมกำกับฯ ที่พัฒนาขึ้น ไปทดลองใช้เพื่อให้เกิดผลสัมฤทธิ์ในการคุ้มครองสุขภาพของลูกจ้างอย่างยั่งยืน คำสำคัญ: ห้องพยาบาล, สถานประกอบกิจการ, การควบคุมกำกับ, มาตรฐาน,จังหวัดระยอง Abstract Objective: To investigate the operational work situation of Medical Care Units in enterprises in Rayong province and synthesize control measures to direct the implementation of Medical Care Units in enterprises. Methods: Mixed methods using explanatory sequential design were employed. Initially, a survey using the data collection form for examining Medical Care Units operation was undertaken in a sample of 189 Medical Care Units in enterprises and descriptive statistics was used for data analysis. Later, a focus group discussion of 9 experts with experiences in the operation of Medical Care Units was performed using a draft control measure synthesized from the survey data and the dialogue framework as tools. Analytic induction was applied for interpretation and conclusion of the final control measure. Results: Only 6 Medical Care Units had all items of medical supplies (3.2%) in the list; 48 units had completed lists but insufficient amounts of medical supplies (25.4%); 135 units had incomplete lists of medical supplies (71.4%); and 125 units (66.1%) had items of medication supplies exceeding the standard list. 131 Medical Care Units (69.3%) had improper management of pharmaceuticals. Basd on the focus group discussion, 3 control measures for supervising the operation was synthesized, namely 1) providing access for outside agencies or worker representatives to audit the units, 2) providing regulators from the government agencies cooperate to promote and support the upgrading of units, and 3) representatives of employees must support the actions of employers and unit regulators for the best health services in the enterprises. Conclusion: The operation of Medical Care Units in enterprises in Rayong province mostly did not meet the standard. The control measures for supervising the unit operation were synthesized for a sustainable protection of the workers’ health. Keywords: Medical Care Unit, Enterprises, Control Measure, Standard, Rayong Provinc

DEVELOPMENT, CHARACTERIZATION AND SKIN IRRITATION OF MANGOSTEEN PEEL EXTRACT SOLID DISPERSION CONTAINING CLAY FACIAL MASK

Objective: To develop a clay facial mask containing mangosteen peel extract solid dispersion (MPESD) for enhancing α-mangostin bioavailability and to determine suitable clay-based facial mask.Methods: The MPESD were prepared by a melting-solvent method employing PVP K30 and poloxamer 188 as a carrier. The water solubility was determined by HPLC method. The in vitro skin permeability was examined using porcine ear epidermis. The effects of clay types on the physical stability of MPESD and α-mangostin adsorption capacity were evaluated. The skin irritation was determined by 4 h human patch test.Results: After dissolved optimal formulation of MPESD in water, the spherical micelle was observed with a mean size of ~150 nm and showed significantly α-mangostin water solubility enhancement of ~7 mg/ml, 700 times greater than MPE. Upon mixing the MPESD with clays, a dry powder was obtained. In vitro permeation studies of the MPESD mixed with titanium dioxide showed lowest α-mangostin permeation, while MPESD mixed with mica or talcum showed similar permeation profile as free MPESD solutions. No sign of skin irritation was observed in volunteers after application of the MPESD-based clay facial mask patch on the inner forearm skin for 4 h.Conclusion: MPESD demonstrates a promising technique for improving water solubility and permeation of α-mangostin which reducing the staining effect. In addition, it is safe for topical application and cosmetically acceptable

Association of HLA-B*5701 genotypes and abacavir-induced hypersensitivity reaction: a sysyematic review and meta-analysis

OBJECTIVES: This study aimed to systematically review and quantitatively synthesize the association between HLA-B*5701 and abacavir-induced hypersensitivity reaction (ABC-HSR). METHODS: We searched for studies that investigated the association between HLA-B genotype and ABCHSR and provided information about the frequency of carriers of HLA-B genotypes among cases and controls. We then performed a meta-analysis with a random-effects model to pool the data and to investigate the sources of heterogeneity. RESULTS: From 1,026 articles identified, ten studies were included. Five using clinical manifestation as their diagnostic criteria, 409 and 1,883 subjects were included as cases and controls. Overall OR was 23.6 (95% CI = 15.4 – 36.3). Whereas, the another five studies using confirmed immunologic test as their diagnostic criteria, 110 and 1,968 subjects were included as cases and controls, respectively. The association of ABC-HSR was strong in this populations with HLA-B*5701. Overall OR was 1,056.2 (95% CI = 345.0 – 3,233.3). CONCLUSIONS: Using meta-analysis technique, the association between HLA-B*5701 and ABC-HSR is strong in the studies using immunologic confirmation to identify ABC-HSR. These results support the US FDA recommendations for screening HLA-B*5701 allele before initiating abacavir therapy

Are we on the right track? Answers from a national survey of Thai graduates’ perceptions during the transition to the 6-year PharmD program

Purpose: To serve the higher demands of pharmaceutical services, pharmacy education in Thailand has shifted from 5-year BPharm program to 6-year PharmD program with two specialization tracks: pharmaceutical care (PC) and industrial pharmacy (IP). This study aimed to compare the perceptions regarding professional competencies, pharmacy profession, and planned workplace between graduates with 5-year BPharm and 6-year PharmD and between those with PC and IP specialty.Methods: A cross-sectional national survey using a paper–pencil self-administered questionnaire was distributed to all new graduates attending the pharmacy licensure examination in March 2015.Results: Of all 1,937 questionnaires distributed, 1,744 were returned and completed (90% response rate). Pharmacy graduates rated highest on their competencies in professional ethics, followed by PC services and system management. They rated low confidence in medication selection procurement and pharmaceutical industry competencies. The 6-year PharmD graduates showed higher confidence in ethics and professional pride than the 5-year BPharm graduates. Graduates with PC specialty rated higher perceived competency in PC, system management, primary care, and consumer protection domains, while the IP graduates were superior in IP and medication selection and procurement domains, and most graduates (PC and IP) intended to work mainly in a hospital or a community pharmacy. Hospital was preferred for the PC graduates, and the IP graduates were more likely to work in pharmaceutical industry, regulation and consumer protection, sales and marketing, and academia.Conclusion: With some gaps still to be filled, the transition from 5-year BPharm to 6-year PharmD program with specialty tracks gave extra confidence to graduates in their specialty competencies and professional pride, leading to differences in preferred workplace. The findings of this study reflect that Thai pharmacy education continues to adjust to the needs of the society and the changing health care environments. Longitudinal monitoring to observe this transition is needed for both curriculum adjustment and competency of the graduates

Drug-Related Hospital Admissions : An Epidemiological Assessment of Prevalence, Risk Factors, Nature and Clinical Significance

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Efficacy of Clinacanthus nutans extracts in patients with herpes infection: Systematic review and meta-analysis of randomised clinical trials

Objective: To examine the efficacy of Clinacanthus nutans extracts in treatment of Herpes genitalis and Herpes zoster from randomised clinical trials (RCTs). Methods: Bibliographic databases, including MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, AMED, WHO trial registry, http://www.clinicaltrial.gov, Thai Index Medicus, and Index Medicus Siriraj library, were searched from their inception dates to February 2010 without language restrictions. Methodological quality of included trials was assessed using Jadad's quality scale and Cochrane's risk of bias. Results: Four RCTs (n= 286) met our inclusion criteria which include two studies on H. genitalis and the other two on H. zoster; in these studies, a total of 151 patients were assigned to the C. nutans group of H. genitalis trials, a pooled relative risk of C. nutans preparations against placebo for a 3 day-full crusting was 6.62 (95% C.I. 3.83-11.47) and of a 7-day complete healing was 3.77 (95% C.I. 2.46-5.78). In H. zoster, the relative risk for a 3 day-full crusting was 3.21 (IQR 0.97-10.58). Conclusions: This meta-analysis and systematic review suggests some beneficial effects of C. nutans preparations on treatments of H. genitalis and H. zoster. However, more robustly designed trials are needed to substantiate the benefit of these plants, specifically on their active purified compounds, and their potencies and benefits on treatment outcome of H. genitalis and H. zoster

Analysis of medication consultation networks and reporting medication errors: a mixed methods study

Abstract Background To examine characteristics of verbal consultation about medication within social networks of hospital inpatient medication system, and their associations with medication error reporting. Method The setting was a 90-bed provincial district hospital with 4 wards, 7 physicians, 5 pharmacists, 44 nurses, 5 pharmacist assistants, and 4 unskilled ancillary workers. A mixed method comprising (i) a prospective observational study for investigating incidences and the nature of reporting medication errors, and (ii) a social network analysis for patterns of interaction. Results Out of 5296 prescriptions, 132 medication errors were reported during the one month study period: an incidence rate of 2.5%. Every incident of medication errors was formally documented through pharmacists. The most frequent medication errors were in pre-transcribing (n = 54; 40.9%). The pharmacists were central in the whole network of consultation on medication with the mean in-degree centrality of 35 (SD 14.9) and mean out-degree centrality of 15.4 (SD 11.1). Two bridging participants were identified who were influential communicators connecting the network (betweenness centrality). Medication error reporting were influenced by (i) participants whose advice is sought and viewed as trustworthy (in-degree centrality; p < 0.001), (ii) sex (p = 0.01), and (iii) level of education (p = 0.04). Conclusion In-degree centrality was the most important network characteristic. A culture of medication safety can be fostered by encouraging consultation about the medication of in-patients within the hospital network where reporting of medication errors is essential

The diagnostic accuracy of isothermal nucleic acid point-of-care tests for human coronaviruses: A systematic review and meta-analysis

Many recent studies reported coronavirus point-of-care tests (POCTs) based on isothermal amplification. However, the performances of these tests have not been systematically evaluated. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy was used as a guideline for conducting this systematic review. We searched peer-reviewed and preprint articles in PubMed, BioRxiv and MedRxiv up to 28 September 2020 to identify studies that provide data to calculate sensitivity, specificity and diagnostic odds ratio (DOR). Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was applied for assessing quality of included studies and Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) was followed for reporting. We included 81 studies from 65 research articles on POCTs of SARS, MERS and COVID-19. Most studies had high risk of patient selection and index test bias but low risk in other domains. Diagnostic specificities were high (&gt; 0.95) for included studies while sensitivities varied depending on type of assays and sample used. Most studies (n = 51) used reverse transcription loop-mediated isothermal amplification (RT-LAMP) to diagnose coronaviruses. RT-LAMP of RNA purified from COVID-19 patient samples had pooled sensitivity at 0.94 (95% CI: 0.90–0.96). RT-LAMP of crude samples had substantially lower sensitivity at 0.78 (95% CI: 0.65–0.87). Abbott ID Now performance was similar to RT-LAMP of crude samples. Diagnostic performances by CRISPR and RT-LAMP on purified RNA were similar. Other diagnostic platforms including RT- recombinase assisted amplification (RT-RAA) and SAMBA-II also offered high sensitivity (&gt; 0.95). Future studies should focus on the use of un-bias patient cohorts, double-blinded index test and detection assays that do not require RNA extraction