Investigating the Use of Human Albumin in a Non-Teaching Hospital in Iran

Abstract Albumin is an expensive drug which imposes relatively high cost on the health care system. Doing ABC analysis in Shahid Motahari Hospital, it was revealed that albumin is categorized in class A. Therefore, the present study aimed to evaluate the pattern of albumin use and the physiciansʹ adherence to evidenced-based albumin guidelines in this large general non-teaching hospital in Shiraz, Iran. This study is an observational retrospective research on drug utilization. All patients admitted to Shahid Motahari hospital that had received albumin during the study period of one year (December 2013 to December 2014), were included in the study. To evaluate the appropriate use of albumin, an internal guideline was prepared using several evidence-based guidelines. Prescriptions were considered correct and appropriate if they were compliant with the standard guideline. The result of this study indicated that about 87.3% of patients had received albumin improperly. Nephrotic syndrome without hypoalbuminemia (23.6%) was the most prevalent reason for albumin misuse and internal ward was the most consuming unit. The findings of this study, similar to those of previous investigations in Iran, revealed the high percentage of inappropriate albumin usage in Iranian teaching and non-teaching hospitals. Regarding the high cost and short supply of this drug, educating physicians through educational programs to best implement the standard guidelines is highly recommended

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

Impact of Omega-3 Supplementation on High Sensitive C-Reactive Protein Level and 30-Day Major Adverse Cardiac Events After the Implementation of Coronary Stent in Patients with Chronic Kidney Disease: A Randomized Clinical Study

Purpose: Studies have revealed that patients with chronic kidney disease (CKD) are more susceptible to adverse effects of percutaneous coronary intervention (PCI). In addition, the role of elevated high sensitive C-reactive protein (hs-CRP) in the prediction of adverse cardiac outcomes after coronary stent implantation has already been shown. Therefore, in this study, we aimed to evaluate the effect of omega-3 supplementation on hs-CRP and 30-day major adverse cardiac events (MACE) in patients with CKD undergoing elective PCI. Methods: In this randomized trial, 80 CKD patients who were candidates for elective PCI, were randomly assigned to two groups; the first group received a single dose of omega-3 (2500 mg, 12 h before PCI) as well as the standard drug regimen of PCI and the second group received placebo plus the standard therapy (325 mg loading dose of aspirin, 600 mg loading dose of clopidogrel, and weight-adjusted intravenous heparin). Hs-CRP levels were measured at baseline and 24 h after the intervention as a primary endpoint. The secondary endpoint was the incidence of MACE over a 30-day period after PCI. Results: Omega-3 did not significantly decrease post-PCI serum level of hs-CRP; however, the overall 30-day MACE was significantly lower in the omega-3 group compared to the control group (p=0.05). Conclusion: Our results revealed the positive effect of the omega-3 supplement on decreasing 30-day MACE; hence, omega-3 may be considered as an effective adjunctive therapy to the standard drug regimen used before PCI. The evaluation of the effect of omega-3 on long-term MACE is recommended for future studies

Association between high sensitivity C-reactive protein (hs-CRP) levels and the risk of major adverse cardiovascular events (MACE) and/or microembolic signals after carotid angioplasty and stenting

Background: To evaluate the association between pre/post-procedural high sensitive C-reactive protein (hs-CRP) level and hs-CRP difference, and the risk of major adverse cardiovascular events (MACE) or new diffusion-weighted MRI lesions after carotid angioplasty and stenting (CAS). Methods: In this study, conducted in 2016 in Shiraz (Iran), patients who underwent diagnostic angiography and CAS were recruited. CAS was performed with distal embolic protection device on patients with both standard and high risk of endarterectomy. Pre/post-procedural hs-CRP, and hs-CRP difference were determined by immunoenzymometric assay method. Results: A total of 50 patients with diagnostic angiography and 60 patients with CAS were enrolled. No death, myocardial infarction, ischemic or hemorrhagic stroke, and need to revascularization occurred during the 30-days of the post-procedural period. Accordingly, the statistical evaluation in associating MACE and hs-CRP levels was impossible. Angioplasty was associated with higher frequency of elevated post-procedural hs-CRP in comparison to angiography (P=0.003). The higher age, symptomatic lesions, negative history of hypertension, and hs-CRP difference had significant association with the presence of new DWI lesions in univariate analysis (all P&#60;0.05). Angioplasty of left carotid bulb and post-procedural hs-CRP levels was very close to the level of significance (P=0.06). But only left sided lesions had positive association (P=0.037) and hypertension had negative association (P=0.037) in multivariate regression analysis. There were significant association between post-procedural hs-CRP level (P=0.02) and hs-CRP difference (P=0.003), and the number of new lesions; and the hs-CRP difference and the accumulated lesion surface area (P=0.009). Conclusion: Post-procedural hs-CRP and hs-CRP difference may predict embolic complications of CAS

Effect of pretreatment with omega-3 supplement on cardiac necrosis markers in chronic kidney disease patients undergoing elective percutaneous coronary intervention

Objective: Studies have demonstrated the direct relation between elevation in cardiac necrosis markers and increased risk of cardiovascular complications after percutaneous coronary intervention (PCI) in chronic kidney disease (CKD) patients. In this study, we sought to evaluate the effect of omega-3 on creatine kinase-MB (CK-MB) and troponin-I in CKD patients undergoing elective PCI. Methods: Eighty CKD patients, candidate for elective PCI, were randomly assigned into two groups: Group A – receiving omega-3 (2.5 g, 12 h before PCI) plus standard treatment (n = 37) and Group B – control group, receiving only standard therapy (aspirin 325 mg and clopidogrel 600 mg loading dose and weight-adjusted intravenous heparin) (n = 43). Blood samples were collected before and 24 h after PCI for measuring CK-MB and troponin-I. The primary endpoint was considered to be postprocedural variations of CK-MB and troponin-I levels in both groups. The secondary endpoint was the percentage of pre-procedural myocardial infarction (PMI) occurrence, defined as the elevation of post-PCI troponin-I, between study groups. Findings: Both the baseline and 24-h CK-MB were significantly higher in omega-3 group. Although 24-h troponin-I increased less in omega-3-treated arm compared to the control group, no statistically significant variation was observed between the two groups. With regard to PMI occurrence, no significant difference was detected among study groups. Conclusion: Despite the beneficial but nonsignificant effects of omega-3 on decreasing post-PCI elevation of troponin-I and PMI occurrence, further investigations with bigger study population, higher doses of omega-3 and longer duration of treatment, and long-term follow-up of patients are required to better test the potential effects of omega-3 in improving clinical outcomes in CKD patients undergoing PCI

Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran

Objective: In this study, we aimed to evaluate the attachment to stress ulcer prophylaxis (SUP) guideline in the neurology wards of two teaching and nonteaching hospitals. Methods: A total of 243 patients were retrospectively reviewed in the neurology wards of two teaching and nonteaching hospitals. To assess the appropriate administration of SUP, an internal guideline was prepared using the American Society of Health-System Pharmacists (ASHP) protocol. Findings: SUP prescriptions were noncompliant with ASHP guideline in about 93.1% and 84.6% of cases in the nonteaching and teaching hospitals, respectively. Conclusion: SUP may be better practiced in teaching hospitals versus nonteaching ones

Evaluation of knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter drugs for the treatment of diarrhea in children: A pretest-posttest survey

Objective: In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. Methods: In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Findings: Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists′ knowledge was statistically increased (P < 0.001) and the pharmacists′ performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists′ tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. Conclusion: It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists′ knowledge and therefore improving their performance in prescribing OTC medicines

Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist's intervention

Objective: Nowadays, the role of clinical pharmacists has become more prominent by more clinical pharmacists joining the health-care teams. This study was aimed to assess the role of a clinical pharmacist specialist in detecting and managing drug-related problems (DRPs) in the neurology ward of a tertiary care teaching hospital in Iran. Methods: This is a prospective cross-sectional study conducted on 123 hospitalized patients admitted to the neurology ward of a teaching hospital. The clinical pharmacist visited the patients and filled out the designed pharmacotherapy sheet for each patient. Then, the general pharmacist checked the patients' files and pharmacotherapy sheets and categorized DRPs using modified method of “The Pharmaceutical Care Network Europe classification, Version 5.01.” Findings: A total of 168 errors were found and 346 interventions were done by the clinical pharmacist during the study period. The most common form of errors in our study was “drug choice problems” (57.76%). The acceptance rate of interventions was 41.91% among physicians. Conclusion: The large number of interventions reported in several studies, as well as this study, revealed that clinical pharmacy services could contribute to a rationalization of drug therapy and may eventually lead to more medication safety

Usefulness of Danaparoid sodium in patients with Heparin-induced thrombocytopenia after cardiac surgery

Objective: Thrombocytopenia is a common problem in cardiovascular surgery patients. However, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of prophylaxis or treatment with heparin. Prompt management of HIT with an alternative anticoagulant is necessary due to the extreme risk of thrombotic complications. Therefore, we evaluated the effects of danaparoid in the treatment of HIT in patients with cardiac surgery who are at moderate to high risk of HIT. Methods: A prospective observational study involving 418 postcardiac surgery patients who received unfractionated heparin and low-molecular weight heparin was conducted in an educational tertiary cardiac care hospital in Iran. All patients were assessed for HIT type II based on thrombocytopenia and pretest clinical scoring system, the "4T′s" score. HIT patients were treated with 1500-2500 units intravenous bolus danaparoid sodium followed by 200-400 units/h for a mean of 5 days. Successful response to danaparoid therapy, defined as augmentation in platelet count and improvement of thrombotic events was assessed in all patients treated with danaparoid. Findings: According to pretest clinical score (4T′s), the probability of HIT was high in 14 (3.3%) patients and intermediate in three ones (0.7%). 15 patients with HIT were treated with danaparoid. One death occurred in danaparoid-treated group due to persistent thrombocytopenia. The rest of patients were treated successfully with danaparoid without any major thrombotic complication. Conclusion: According to our data and the previous studies′, HIT can be managed prosperously with danaparoid in postcardiac surgery patients. However, with the absence of any increase in platelet count after 3-5 days of danaparoid therapy and/or the occurrence of a new thrombotic event, danaparoid cross-reactivity with heparin should be suspected