ASSESSMENT OF PHYSICIANS' RESPONSE TO TEXT ALERTS IN PATIENTS WITH REDUCED RENAL FUNCTION BY USING A TEXT MESSAGE ALERTING SYSTEM

Introduction: Adverse drug events are mostly dose dependent and preventable. About 50% of these adverse effects are due to inappropriate dosing especially in patients with renal failure. Objective: We aimed to determine the impact of short message alerting on physicians' drug dosing of patients with decreased renal function. Methods: Eighteen physicians accepted to enroll in the study. Their patients who received at least one of the six selected drugs were selected for evaluation. The patients with an estimated glomerular filtration rate of 50 ml/minute or lower were randomly divided into two groups of case and control. An alert was sent to the physician in charge of the intervention (case) group. Physicians' reactions was recorded as "dose adjustment", "discontinuation of medication" or "none" and were compared in both groups. The reaction time of physicians before and after receiving alerts was recorded as well. Results: One hundred and thirty seven patients entered the study. The study results showed a significant difference in overall changes between the two groups (*** P <0.001). The rate of dose adjustment increased significantly after sending alerts to physicians (*** P <0.001). However, there was not a significant difference regarding discontinuation of medication between groups (P= 0.76). On the other hand, prompt reaction of physicians (0-6 hours after sending short message) significantly increased after intervention (* P < 0.05). Nevertheless, physicians' reaction time in 6-24 hours and 24-48 hours was not changed significantly after intervention. Conclusion: The results of this study show that informing physicians about the renal function of the patients leads to appropriate dosing

Drug utilization evaluation of meropenem: an important broad-spectrum antibiotic for the treatment of serious bacterial infections in hospitalized patients

Increasing trend in the development of antibiotic resistance is one the major concerns of health care systems throughout the world. Several factors are responsible of the emergence of this problem of which frequent inappropriate uses of antimicrobial agents plays an important role. Therefore, in the study we aimed to assess the appropriateness of the usage of meropenem, a broad-spectrum antibiotic, in a teaching affiliated hospital.This study is an observational prospective research on drug utilization. All patients admitted to Masih Daneshvari hospital that had received meropenem during Jun to July 2011 were enrolled in the study. To evaluate the appropriate use of meropenem, an institutional standard guideline was designed by pharmacy and therapeutic committee using evidence-based guidelines. Prescriptions were considered appropriate if they were compliant with the guideline.  The total number of meropenem vials used during this period was 2153 vials. Most prescriptions started empirically (85.9%). Of these, 16.9% of prescriptions continued according to lab results whereas 69% of meropenem courses remained empirical. Our results showed that meropenem was started appropriately in 64.8% of patients whereas just 74.3% of patients received the drug for an adequate duration.In conclusion, our study and several other surveys detected various areas of inappropriate use of broad-spectrum antiobiotics such as meropenem. With regard to the important role of these drugs in the treatment of serious nosocomial infections, a combination of both restrictive and educational measures appears to be necessary to improve rational antibiotic usage as well as to decrease in the frequency of antibiotic resistant.</p

Vancomycin Utilization Evaluation in a teaching hospital: A case- series study in Iran.

Background: Increasing antimicrobial resistance is now a critical point of human being in the world. Especially wide spectrum antibiotics resistance germs like vancomycin-resistant enterococci (VRE) should be dealt as soon as possible as an emergency conflict. Our study tries to reveal the amount of irrational use of vancomycin in a teaching hospital in Iran. Methods: We elected the whole inpatients that received vancomycin between February 2007 and May 2008. Results: Forty four out of those 45 patients had inappropriate indication and dosing regimen of vancomycin (97.7%). The most use of vancomycin was recorded in hematology – oncology ward and then Intensive Care Unit (ICU). Culture responses were negative despite great clinical evidence of infection. Conclusion: Vancomycin irrational use was high compared to other countries and it could be concerned as a major health problem by health policy makers and physicians to deal. However more detailed researches are needed to reveal the other aspects of this problem. Implementation of antibiotic protocols and standard treatment guidelines are recommended

Evaluation and determining of the Pattern of the Human Albumin Utilization at Shahid Rahimi Hospital, Khorramabad, Iran

Background: The World Health Organization (WHO) has supported many intervention strategies, including executive, educational, and monitoring proceedings to improve the evaluation of drug use and the drug management system. Since the resources are limited, it is essential to utilize existing resources properly. Serum albumin is the most abundant blood protein produced in the liver. Different forms of albumin are available in the market and employed to treat hypovolemia, Cirrhotic ascites, severe burns, septic shock, hyperstimulation syndrome, etc. Due to the high price of albumin and its importance for saving patient’s lives.Methods: precisely according to the determined protocols, and it’s unreasonable and irrational medication should be avoided. Statistical analysis was performed in Shahid Rahimi Hospital of Khorramabad, Iran, from March 2018 to March 2019. Albumin administration for randomly selected patients receiving albumin in different wards was evaluated. The main sources to retrieve information were pharmacy drug folders, patient folders (including laboratory information), and nursing folders. Age, sex, weight, ward, albumin level, symptoms, and final dose were recorded for each patient. Contraindications to the administration of albumin or any caution in its use were also considered. Data were analyzed by using SPSS16 and Excel software. Independent T-test and Chi-square test were employed to compare quantitative and qualitative variables. 271 patients were studied, including 160 men and 111 women.Results: The two male and female surgical wards with 41 patients had the highest percentage of patients admitted with albumin administration. Also, the most common cause of albumin administration in patients was hypoalbuminemia. 55% of albumin prescriptions in Shahid Rahimi Hospital of Khorramabad were irrational, driving a substantial financial burden for the healthcare system and patients. Among all the prescribed cases, only 5.2% were approved by the pharmacist. Finally, 77.1% of patients recovered, and 22.9% died.Conclusion: Considering that the highest percentage of patients receiving albumin administration, both among patients with irrational administration and in general, were in men's and women's surgical wards, it is recommended that the drugs prescribed in these wards be further investigated and get pre- Approved by a pharmacist to prevent higher medical costs for patients and healthcare system.          Keywords: Albumin; Hypovolemia; Cirrhotic Ascites; Septic Shock; Hyperstimulation Syndrome    

Risk factors of thyroid abnormalities in bipolar patients receiving lithium: a case control study

BACKGROUND: Lithium-induced thyroid abnormalities have been documented in many studies. They may occur despite normal plasma lithium levels. The objectives of this study were: 1) to determine possible relationship between lithium ratio, defined as erythrocyte lithium concentrations divided by plasma lithium concentrations, and thyroid abnormalities in bipolar patients receiving lithium and 2) to find other possible risk factors for developing thyroid abnormalities in the subjects. METHODS: Sixty-eight bipolar patients receiving lithium therapy were enrolled in a cross-sectional evaluation of thyroid function test and thyroid size. Patients were divided into two groups based on their thyroid function tests and thyroid sizes. Erythrocyte and plasma lithium concentrations were determined by atomic absorption spectrometry for each patient. Lithium ratio was then calculated. RESULTS: No significant differences were found between age, positive family history of affective disorder, plasma lithium concentration, erythrocyte lithium concentration, and lithium ratio comparing the two groups. Thyroid abnormalities was significantly higher in women than in men (p < 0.05). CONCLUSIONS: Lithium ratio does not appear to have a predictive role for thyroidal side effects of lithium therapy. Female gender was the main risk factor. We suggest more frequent thyroid evaluation of bipolar women who are treated with lithium

Evaluation of Hepatoprotective Effect of Silymarin Among Under Treatment Tuberculosis Patients: A Randomized Clinical Trial

Abstract Hepatic toxicity is the most serious adverse effect of anti tuberculosis drugs. This study was performed to evaluate the efficacy of silymarin as a hepatoprotective herbal agent. In a randomized double blind clinical trial, 70 new cases of pulmonary tuberculosis were divided into two groups. The intervention group was assigned to receive silymarin and the control group received placebo. Tuberculosis was treated by classic regimen consisting isoniazid, rifampin, pyrazinamide and ethambutol. No statistically significant difference was found between the two groups concerning the frequency of drug induced liver injury or mild elevation of liver enzymes. Silymarin was safe without any major side effect. Our results showed no significant hepatoprotective effect of silymarin among patients on tuberculosis treatment

Increasing the Number of Adverse Drug Reactions Reporting: the Role of Clinical Pharmacy Residents

Abstract Detection of adverse drug reactions (ADRs) in hospitals provides an important measure of the burden of drug related morbidity on the healthcare system. Spontaneous reporting of ADRs is scare and several obstacles to such reporting have been identified formerly. This study aimed to determine the role of clinical pharmacy residents in ADR reporting within a hospital setting.Clinical pharmacy residents were trained to report all suspected ADRs through ADRreporting yellow cards. The incidence, pattern, seriousness, and preventability of the reported ADRs were analyzed. During the period of 12 months, for 8559 patients, 202 ADR reports were received. The most frequently reported reactions were due to anti-infective agents (38.38%). Rifampin accounted for the highest number of the reported ADRs among anti-infective agents. The gastro-intestinal system was the most frequently affected system (21.56%) of all reactions. Fifty four of the ADRs were reported as serious reactions. Eighteen of the ADRs were classified as preventable. Clinical pharmacy residents involvement in the ADR reporting program could improve the ADR reporting system

Assessment of physicians' response to text alerts in patients with reduced renal function by using a text message alerting system

Introduction: Adverse drug events are mostly dose dependent and preventable. About 50% of these adverse effects are due to inappropriate dosing especially in patients with renal failure. Objective: We aimed to determine the impact of short message alerting on physicians' drug dosing of patients with decreased renal function. Methods: Eighteen physicians accepted to enroll in the study. Their patients who received at least one of the six selected drugs were selected for evaluation. The patients with an estimated glomerular filtration rate of 50 ml/minute or lower were randomly divided into two groups of case and control. An alert was sent to the physician in charge of the intervention (case) group. Physicians' reactions was recorded as "dose adjustment", "discontinuation of medication" or "none" and were compared in both groups. The reaction time of physicians before and after receiving alerts was recorded as well. Results: One hundred and thirty seven patients entered the study. The study results showed a significant difference in overall changes between the two groups (*** P <0.001). The rate of dose adjustment increased significantly after sending alerts to physicians (*** P <0.001). However, there was not a significant difference regarding discontinuation of medication between groups (P= 0.76). On the other hand, prompt reaction of physicians (0-6 hours after sending short message) significantly increased after intervention (* P < 0.05). Nevertheless, physicians' reaction time in 6-24 hours and 24-48 hours was not changed significantly after intervention. Conclusion: The results of this study show that informing physicians about the renal function of the patients leads to appropriate dosing

The Rate of Physicochemical Incompatibilities, Administration Errors. Factors Correlating with Nurses' Errors

Medication errors are commonly encountered in hospital setting. Intravenous medications pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. We aimed to determine the rate of errors during the preparation and administration phase of intravenous medications and the correlation of these errors with the demographics of nurses involved in the process. One hundred patients who were receiving IV medications were monitored by a trained pharmacist. The researcher accompanied the nurses during the preparation and administration process of IV medications. Collected data were compared with the acceptable guidelines. A checklist was filled for each IV medication. Demographic data of the nurses were collected as well. A total of 454 IV medications were recorded. Inappropriate administration rate constituted a large proportion of errors in our study (35.3%). No significant or life threatening drug interaction was recorded during the study. Evaluating the impact of the nurses' demographic characteristics on the incidence of medication errors showed that there is a direct correlation between nurses' employment status and the rate of medication errors, while other characteristics did not show a significant impact on the rate of administration errors. Administration errors were significantly higher in temporary 1-year contract group than other groups (p-value < 0.0001). Study results show that there should be more vigilance on administration rate of IV medications to prevent negative consequences especially by pharmacists. Optimizing the working conditions of nurses may play a crucial role

Management of Community Acquired Pneumonia in a Teaching Hospital: The Role of Established Guidelines

ABSTRACT Background: In spite of established guidelines developed by the American Thoracic Society (ATS), Infectious Diseas