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

Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Palestine: a cross-sectional study

Background Acne vulgaris (AV) is a common dermatological disease affecting almost 85% of teenagers. Patients with AV usually present at community pharmacies during the early stages of their disease. Aim The aim of this study was to assess community pharmacists’ knowledge, attitudes, and practice toward AV management in West Bank in Palestine. Methods This study was a cross-sectional questionnaire-based study. The questionnaire included four sections: 1) demographic, 2) knowledge, 3) attitude and practice items related causes, and 4) treatment options and counseling during management of patients with AV. A convenience sampling method was implemented in this study. Parametric and non-parametric tests were used to compare different issues as appropriate. P < 0.05 were considered significant. Result A total of 270 community pharmacists were interviewed, and more than half (54.1%) were males. The study revealed that community pharmacists had an inadequate level of knowledge on management of AV; only 7.7% had high levels of knowledge. Pharmacists have positive attitude regarding AV management, but inadequate knowledge was reflected on their treatment practices; only 10% of participants independently dealt with AV without referral. Pharmacists with a low level of knowledge showed five times more referrals than those with a high level of knowledge (OR: 5.3; P < 0.001), and those with a bachelor degree showed three times more referrals than postgraduates (OR: 3.3; P < 0.001). Conclusion There is a demand to update dermatological knowledge of community pharmacists and encourage them to attend structured training programs about the management of AV.Funding source: None

Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD)

Aims To investigate the effect of a range of demographic and psychosocial variables on medication adherence in chronic obstructive pulmonary disease (COPD) patients managed in a secondary care setting. Methods A total of 173 patients with a confirmed diagnosis of COPD, recruited from an outpatient clinic in Northern Ireland, participated in the study. Data collection was carried out via face-to-face interviews and through review of patients’ medical charts. Social and demographic variables, co-morbidity, self-reported drug adherence (Morisky scale), Hospital Anxiety and Depression (HAD) scale, COPD knowledge, Health Belief Model (HBM) and self-efficacy scales were determined for each patient. Results Participants were aged 67±9.7 (mean ± SD) years, 56 % female and took a mean (SD) of 8.2±3.4 drugs. Low adherence with medications was present in 29.5 % of the patients. Demographic variables (gender, age, marital status, living arrangements and occupation) were not associated with adherence. A range of clinical and psychosocial variables, on the other hand, were found to be associated with medication adherence, i.e. beliefs regarding medication effectiveness, severity of COPD, smoking status, presence of co-morbid illness, depressed mood, self-efficacy, perceived susceptibility and perceived barriers within the HBM (p<0.05). Logistic regression analysis showed that perceived ineffectiveness of medication, presence of co-morbid illness, depressed mood and perceived barriers were independently associated with medication non-adherence in the study (P<0.05). Conclusions Adherence in COPD patients is influenced more by patients’ perception of their health and medication effectiveness, the presence of depressed mood and comorbid illness than by demographic factors or disease severity

Assessment of the inhalation technique and adherence to therapy and their effect on disease control in outpatients with asthma

Objectives The objective of this study was to assess correct use of inhaler devices, adherence to inhaler corticosteroid treatment and their effects on asthma control. Methods This study was a prospective, single-centre, observational study conducted between July and February 2016 at Al-Makased Hospital, respiratory outpatient clinic. Inhaler technique of asthma patients using pressurized metered-dose inhalers or dry powder inhalers (Turbuhaler (TH) and Accuhaler DiskusTM (ACC)) were assessed against published inhaler technique checklists. Asthma control variables measured using Asthma Control Test (maximum 25, higher score corresponding to better asthma control) were assessed, and adherence to asthma medications was assessed by Morisky adherence scale. Key findings Two hundred and twenty patients were recruited in the study. The mean age was 42.3 15.2 years and 59.1% were male. One hundred and seventeen (53.2%) were using TH, 60 (27.3%) were using ACC and 43(19.5%) were using MDIs. Only 22 (10%) were smoker and only 48 (21.8%) patients were their asthma controlled (ACT score >20). The devices were used correctly by 79.1% of patients using MDI, 69% of ACC and 55.6% of TH users (P > 0.001). The most common improper step was ‘forceful inhalation’ (65.4%) made by the MDI users, ‘Not exhaling to residual volume’ (58.7%) made by ACC users and ‘Not inhaling deeply enough’ (52.2%) made by TH users. Multivariate analysis showed that the likelihood of having controlled asthma was significantly higher in those with correct inhaler techniques (OR 2.3; 95% CI: 1.08–4.77; P = 0.028), high adherence to medications (OR 2.37; 95% CI: 1.05–4.92; P = 0.03) and having a higher level of education (OR 2.58; 95% CI: 1.19–3.63; P = 0.018). Conclusions It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique.This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine

Aims: Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. Methods: The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. Results: Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR = 2.52; CI: 0.9-4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9-5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2-4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1-4.6, P = .04). Conclusion: Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.We thank all workers at health clinics at Ramallah and Bethlehem who helped in finishing this study and also we thank the participants who willingly accepted to share for the purpose of this study

Pharmaceutical care for adult asthma patients: A controlled intervention one‐year follow‐up study

Asthma is a clinical problem with social, psychological and economic burdens. To improve patient disease management, different education programmes have been developed. Challenges in asthma management may be partially attributed to nonadherence or improper use of inhalers. This study aimed to implement and assess hospital‐based pharmaceutical care services for asthmatic patients. A 12‐month, single‐ centre, randomized, controlled study was initiated in asthmatic adult patients who had been divided into either a control or intervention group. Patients in the control group received the usual care, and patients in the intervention group received patient counselling per study protocol that covered asthma knowledge, control, adherence to treatment and inhalation techniques. The main variables compared measurements at baseline with those at 6 and 12 months. A total of 192 patients completed the study protocol: 90 in the control group and 102 in the intervention group. The control group included 90 patients, and the intervention group included 102 patients. Over the course of the 12‐month follow‐up period, a significant difference was observed between intervention and control groups with respect to asthma control (38.2% vs 10.0%; P < .001), mean correct inhalation technique (confidence interval [CI]: 8.1, 7.8‐8.5 vs CI: 6.1; 5.6‐6.6; P = .01) and good medication adherence (60.7% vs 50.0%, P = .02). There were 34% and 25% decreases in emergency room visits and hospital admissions, respectively, in the intervention group compared to the control group. This study emphasizes the importance of patient counselling in asthma management and the significant contribution that the pharmacist's intervention can have on asthma control

Pharmacists’ Knowledge, Attitudes and Practices Towards Herbal Remedies In West Bank, Palestine

Background: There is an increasing trend towards consumption of complementary and alternative herbal products in many parts of the world. Objectives: The purpose of this study was to investigate the knowled - ge and attitudes among pharmacists in West Bank, Palestine towards the use of herbs. Methods: Self-administered questionnaire was designed as the study instrument and distributed among 350 qualified pharmacists working in government and private pharmacies in West Bank, Palestine. Results: The response rate was 82.9% (290/350). The mean age of the pharmacists was 32.9 (SD=6.5) years. The majority of the phar - macist 238 (82.1%) worked in the community pharmacies and their experience in practice ranged from 1 to 26 years. Product package instructions and product representative were the most consulted by the pharmacists (128; 44.2% and 73; 25.2% respectively). General health tonic preparations were the most widely dispensed drugs (142; 48.9%), followed by cough preparations (55; 19.0%) and slimming agents (64; 22.1%). The Majority of pharmacists (195; 67.2%) belie - ved herbal remedies were effective; however, about fifty percent of the pharmacists had concern about their safety. The knowledge of respondents about the indications of herbal medicine was good, but their awareness of interactions, contraindications and adverse effects was inadequate. The majority of Pharmacists (255; 87.9%) believed that herbal product should undergo increased regulation and (215; 74.9%) believed that information available about herbal and natural product isn't adequate

Beliefs About Medicine and Glycemic Control Among Type 2 Diabetes Patients: A Cross-Sectional Study in West Bank, Palestine

Introduction: To examine the mean differences between patient beliefs about medicine with reference to adherence and glycemic control. Methods: This study utilized a cross-sectional questionnaire-based approach. Adherence to medication was measured with the Morisky Green Levine Medication Adherence Scale (MGLS); glycemic control as the last HbA1c test value; and beliefs about medicine with the Beliefs about Medicines Questionnaire (BMQ). Results: According to MGLS scale, 220 (57.9%) of the diabetic patients were classified as high adherent to their medications and 160 (42.1%) were classified as low adherent. Patients had strong believes in their medication, the mean necessity score was significantly outweighed the mean concerns score (17.7 vs 14.4; P < .001). Low adherent patients had significantly more concerns about long term effect of medications (14.4 vs 13.8; P < .008). No significant mean differences were found between glycemic controlled and uncontrolled group regarding necessity or concern domains. Conclusion: Assessing beliefs about medicine is crucial for recognizing patients at risk of low adherence, which offers a way to help patients with diabetes to achieve a better glycemic control.The author(s) received no financial support for the research, authorship, and/or publication of this article

Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study

AIMS: Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of antimicrobial stewardship programme (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS: A prospective audit with intervention and feedback by ASP team within 48-72 h of antibiotic administration began in September 2015. Four months of pre-ASP data were compared with 4 months of post-ASP data. Data collected included clinical and demographic data; use of antimicrobials measured by defined daily doses, duration of therapy, length of stay, readmission and all-cause mortality. RESULTS: Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial use by 24.3% (87.3 defined daily doses/100 beds vs. 66.1 defined daily doses/100 beds P < 0.001). The median (interquartile range) of length of stay was significantly reduced post ASP [11 (3-21) vs. 7 (4-19) days; P < 0.01]. Also, the median (interquartile range) of duration of therapy was significantly reduced post-ASP [8 (5-12) days vs. 5 (3-9); P = 0.01]. There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; P = 0.1) and (26.1% vs. 24.6%; P = 0.54) respectively. CONCLUSIONS: Our prospective audit and feedback programme was associated with positive impact on antimicrobial use, duration of therapy and length of stay

Societal perspectives on community pharmacy services in West Bank - Palestine

Understanding the public's view of professional competency is extremely important; however little has been reported on the public�s perception of community pharmacists in Palestine Objectives: To determine the perception of Palestinian consumers of the community pharmacist and the services they offer Method: This project used the survey methodology administered by structured interviews to consumers who attended the 39 randomly selected pharmacies, in six main cities in Palestine. The questionnaire had range of structured questions covering: Consumers� patronage patterns, consumers� interaction with community pharmacists, consumers� views on how the pharmacist dealt with personal health issues, procedure with regard to handling private consultations. Results: Of 1,017 consumers approached, 790 consumers completed the questionnaire (77.7 %). Proximity to home and presence of knowledgeable pharmacist were the main reasons for patients to visit the same pharmacy. Physicians were identified as the preferred source of advice by 57.2% and pharmacists by 23.8%. Only 17% of respondents considered pharmacists as health professionals who know a lot about drugs and are concerned about and committed to caring for the public. In addition, 49% indicated that pharmacists spoke more quietly cross the counter during counseling and almost one third reported that the pharmacist used a private area within the pharmacy. The majority of respondents would be happy to receive different extended services in the community pharmacy like blood pressure monitoring. Conclusions: Palestinian consumers have a positive overall perception of community pharmacists and the services they offer. Awareness should be created amongst the public about the role of pharmacist and the added value they can provide as health care professional. There is a need to consider privacy when giving patient counseling to increase user satisfaction.Entender la visión del público de la competencia profesional es extremamente importante; sin embargo, se ha comunicado poco sobre la percepción del público sobre la farmacia comunitaria en Palestina. Objetivos: Determinar la percepción de los consumidores palestinos de farmacias comunitarias y los servicios que éstas ofrecen. Métodos: Este proyecto utilizó la metodología de encuesta administrada a través de entrevistas estructuradas a consumidores que visitaron 39 farmacias aleatoriamente seleccionadas en las seis principales ciudades de Palestina. El cuestionario tenía una serie de preguntas estructuradas que cubrían: patrones de clientela de los consumidores, interacción de los consumidores con los farmacéuticos comunitarios, visión de los consumidores de como los farmacéuticos tratan sus problemas personales, procedimientos relativos al manejo de las consultas privadas. Resultados: De los 1017 consumidores que se aproximaron, 790 completaron el cuestionario (77,7%). La proximidad a casa y la presencia de un farmacéutico reconocido fueron las dos razones principales de que los pacientes visitasen la misma farmacia. Los médicos fueron identificados como la fuente preferida de consejo por el 52,2% y los farmacéuticos por el 23,8%. Sólo el 17% de los respondentes consideró a los farmacéuticos con profesionales de la salud que sabían mucho sobre medicamentos y que se preocupaban y se comprometían en cuidar del público. Además, el 49% hablaba más bajo sobre el mostrador durante el consejo y casi un tercio comunicó que el farmacéutico usó un área privada en la farmacia. La mayoría de los entrevistados estarían contentos por recibir varios servicios ampliados de las farmacias comunitarias con la monitorización de presión arterial. Conclusiones: Los consumidores palestinos tienen una percepción general positiva de los farmacéuticos comunitarios y los servicios que ofrecen. Se debería aumentar el conocimiento del público sobre el papel del farmacéutico y el valor añadido que pueden proporcionar como profesionales de la salud. Para aumentar la satisfacción del usuario, es necesario considerar la privacidad cuando se proporciona consej