Treatment of diabetic peripheral neuropathy: a review

Abstract Objectives This review surveys current pharmacotherapies available for the treatment of diabetic peripheral neuropathy (DPN), emphasising their mechanisms of action. Methods A comprehensive literature review focusing on the ‘pharmacotherapy and treatment of diabetic peripheral neuropathy’ was conducted. The Database of International Pharmaceutical Abstracts, EMBASE, PubMed, OVID, Scopus, Google and Google Scholar were searched, and reference lists of relevant articles were also included. Key findings Diabetic peripheral neuropathy is often inadequately treated, and the role of improving glycaemic control specifically in type-2 diabetes remains unclear. It is crucial to explore the mechanisms of action and effectiveness of available therapies. Major international clinical guidelines for the management of DPN recommend several symptomatic treatments. First-line therapies include tricyclic antidepressants, serotonin–noradrenaline reuptake inhibitors, and anticonvulsants that act on calcium channels. Other therapies include opioids and topical agents such as capsaicin and lidocaine. The objectives of this paper are to review current guidelines for the pharmacological management of DPN and to discuss research relevant to the further development of pharmacological recommendations for the treatment of diabetic neuropathy. Summary Diabetic neuropathy is a highly prevalent, disabling condition, the management of which is associated with significant costs. Evidence supports the use of specific anticonvulsants and antidepressants for pain management in patients with diabetic peripheral neuropathy. All current guidelines advise a personalised approach with a low-dose start that is tailored to the maximum response having the least side effects or adverse events

RISK FACTORS IN SOFTWARE DEVELOPMENT PHASES

Each phase of the Software Development Life Cycle (SDLC) is vulnerable to different types of risk factors. Identifying and understanding these risks is a preliminary stage for managing risks successfully. This paper presents a comprehensive theoretical study of the major risk factors threaten each of SDLC phases. An exhaustive list of 100 risk factors was produced. This list reflects the most frequently occurring risk factors that are common to most software development projects

Impact of pharmaceutical care on health outcomes in patients with COPD

Background Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD. Objective The aimof the present studywas to evaluate the impact of pharmaceutical care intervention,with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD. Setting Outpatient COPD Clinic at the Royal Medical Services Hospital. Method In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patientswere followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life,medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS software version 17 for statistical analysis. A P value of\0.05 was considered statistically significant. Main outcome measure The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures. Results A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P\0.001), medication adherence (P\0.05), medication beliefs (P\ 0.01) and significant reduction in hospital admission rates (P\0.05) in intervention patients when compared with control group patients at the end of the study. Conclusion The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD

Extent and nature of unlicensed and off-label medicine use in hospitalized children in Palestine

Objective of the study To determine the extent and nature of unlicensed/off-label prescribing patterns in hospitalised children in Palestine. Setting Four paediatric wards in two public health system hospitals in Palestine [Caritas children’s hospital (Medical and neonatal intensive care units) and Rafidia general hospital (Medical and surgical units)]. Method A prospective survey of drugs administered to infants and children \18 years old was carried out over a five-week period in the four paediatric wards. Main outcome measure Drug-licensing status of all prescriptions was determined according to the Palestinian Registered Product List and the Physician’s Desk Reference. Results Overall, 917 drug prescriptions were administered to 387children. Of all drug prescriptions, 528 (57.5%) were licensed for use in children; 65 (7.1%) were unlicensed; and 324 (35.3%) were used off-label. Of all children, 49.6% received off-label prescriptions, 10.1% received unlicensed medications and 8.2% received both. Seventy-two percent of off-label drugs and 66% of unlicensed drugs were prescribed for children \2 years. Multivariate analysis showed that patients who were admitted to the neonatal intensive care unit and infants aged 0–1 years were most likely to receive a greater number of off-label or unlicensed medications (OR 1.80; 95% CI 1.03–3.59 and OR 1.99; 95% CI 0.88–3.73, respectively). Conclusion The present findings confirmed the elevated prevalence of unlicensed and off-label paediatric drugs use in Palestine and strongly support the need to perform well designed clinical studies in children.The authors wish to thank Dr Chris Cardwell, Department of Epidemiology and Public Health, Queen’s University Belfast, for his statistical support, Nursing & administrative staff at the Caritas and Rafidia hospitals. The Daniel Turnberg UK/Middle East Travel Fellowship for financial support is acknowledge

The Impact of Psychological Empowerment on the Effectiveness of Job Performance: A Field Study on the Jordanian Private Banks

This research aims to identify the concept of empowerment and clarify its various dimensions and their impact, on the effectiveness of job performance in the banking sector. The research has been applied to a sample of 185 employees working at 9 private banks in Jordan. This study found that the degree of practice of employees to the dimensions of empowerment exceed the middle degree, while the level of effectiveness of job performance in these banks was high, as it showed the existence of a significant effect of the dimensions of empowerment (competence, impact) on the effectiveness of job performance, while the other two dimensions (choice, meaning) does not affect significantly in the effectiveness of job performance, the study also pointed to the existence of significant differences between the practice of employees to  empowerment according to the variables (experience, function, bank), and also indicate there are significant differences in the levels of effectiveness job performance, according to the variables (marital status, bank). Keywords: Empowerment, Psychological, Job Performance, Effectiveness, Banks, Jordan

Pharmacovigilance and Adverse Drug Reactions Reporting Process in West-Bank, Palestine

Active national pharmacovigilance programmes are needed to monitor adverse drug reaction (ADR) data in local populations. The objective of this study was to describe the knowledge, experiences, attitudes and perceived barriers to reporting of suspected ADRs by community and hospital pharmacists in West Bank, Palestine. Between December 2014 and March 2015 we conducted a survey about the knowledge and attitude of pharmacists (n = 270) using a face-to-face questionnaire. The questionnaire consisted of questions about the sociodemographic characteristics of the pharmacists, their knowledge of pharmacovigilance and their attitudes towards ADR reporting. Main outcomes measured: The majority of the pharmacists (62.6%) worked in the community pharmacies and more females responded to the questionnaire than males (59% vs 41%). only 11.9% could conceptually or actually define ‘pharmacovigilance’ correctly while one quarter of the respondent pharmacist (24.9%) could define ADR correctly. The hospital clinical pharmacists defined ‘pharmacovigilance’ correctly with higher significance (P<0.001) when compared with community pharmacists. Only 12.2% had ever reported an ADR. The majority of these reports (85%) done by the hospital pharmacists (p<0.0001). The main reasons that discourage the pharmacists from reporting ADRs were ‘‘no enough information available from the patient (76.7%)’’, and ‘‘they did not know how to report (66.7%)’’. The majority of the respondents (92.0%) felt that reporting ADR was their duty and (82%) participants were interested in participating in the National Pharmacovigilance Programme in Palestine. The results show that Palestinian pharmacists have poor knowledge about pharmacovigilance. There is an urgent need for educational programs to train them about pharmacovigilance and ADR reporting scheme