Nurses perception of pharmaceutical care practice: A qualitative approach

Purpose: To evaluate the perception of nurses regarding pharmaceutical care services in the healthcare system of Khyber Pakhtunkhwa (KPK) Province of Pakistan.Methods: This qualitative study was implemented by conducting semi-structured interviews. For data collection, interviews (face-to-face) were conducted after developing an interview guide. The interviewees were 18 nurses and were interviewed at their nursing stations in hospitals.  Interviews were continued until the data reached a saturation point. The respondents signed a written consent form before the start of the interview.Results: From the thematic content analysis, five major themes were extracted as stated here: (a) incognizance of pharmaceutical care; (b) collaboration of nurses and pharmacists; (c) improper distribution system; (d) lack of provision of patient counseling; and (e) pharmacist’s role in reducing prescribing errors.Conclusion: Based to the findings, Pakistani nurses have poor knowledge of pharmaceutical care, thus highlighting the need for organizing pharmaceutical care awareness programs for nurses. On the other hand, nurses have a positive perception of pharmacists’ roles in the healthcare system and want to work with them. Keywords: Perception, Pharmaceutical care, Qualitative study, Nurse, Patient car

Exploring community pharmacists perception towards responsible provision of patient care services: A quantitative assessment

Purpose: To investigate the perception of community pharmacists with regard to pharmaceutical care services in Khyber Pakhtunkhwa (KPK), Pakistan.Methods: This was a cross-sectional survey carried out among the community pharmacists in seven divisions of KPK, namely, Bannu, Dera Ismail Khan, Hazara, Kohat, Malakand, Mardan, and Peshawar. The survey was conducted between July and September 2014. A total of 22 community  pharmacists were identified and approached.Results: Eighteen community pharmacists returned the filled questionnaire showing a response rate of 81.8 %. All participants (n = 18, 100 %) were male. The majority of the participants 55.6 % (n = 10) made it clear that they had never interacted with doctors, while only 33.3 % (n = 6) reported weekly interaction. The major reasons for interaction were to discuss drug alternatives (38.9 %, n = 7) and the availability of prescribed drugs (33.3 %, n = 6). Meanwhile, about 83.3 % (n = 15) of community pharmacists were involved in educating patients, while only 38.9 % (n = 7) spend enough time on each patient. Further, a large proportion of respondents had never documented patients’ medical, allergy and family histories (83.3 %, n = 15). Only 44.4 % (n = 8) of community pharmacists sometimes checked and signed the prescription.Conclusion: Community pharmacists are few in number in the studied area. They are involved in patient counseling but face difficulties in  counseling due to lack of time and insufficient pharmacy staff. Therefore, there is a need to significantly enhance the interaction between  pharmacists and other healthcare professionals to facilitate inter-professional collaboration. Keywords: Community pharmacy, Pharmaceutical care, Perception, Inter-professional collaboratio

Randomized controlled trials covering pharmaceutical care and medicines management: A systematic literature review

Objective To review the effects of pharmaceutical care on hospitalizations, mortality and clinical outcomes in patients. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases to identify studies that were published between 2004 and January 2017. Studies included in this review were randomized controlled trials (RCTs) that spanned across both community and hospital settings. Using strict inclusion/exclusion criteria studies were included if they reported level 1 or 2 outcomes in the hierarchy of outcome measure i.e. clinical and surrogate outcomes (e.g. blood pressure (BP) control, blood glucose level, cholesterol BMI). Each study was assessed for quality using the Jadad scoring system. Results Fifty-four RCTs were included in the present review. Forty-six of these studies ranked high quality according to the Jadad scoring system. Studies were categorized into their general condition groups. Interventions in patients with diabetes, depression, respiratory disorders, cardiovascular disorders, epilepsy, osteoporosis, and interventions in older adults were identified. In the majority of studies pharmaceutical care was found to lead to significant improvements in clinical outcomes and/or hospitalizations when compared to the non-intervention group. Some conditions had a large number of RCTs, for example for cardiovascular conditions and in diabetes. Statistically significant improvements were seen in the majority of the studies included for both of these conditions, with studies indicating positive clinical outcomes and/or hospitalizations rates. Within the cardiovascular condition, a subset of studies, focusing on cardiac heart failure and coronary heart disease, had more mixed results. In other conditions the number of RCTs conducted was small and the evidence did not show improvements after pharmaceutical care, i.e. in depression, osteoporosis, and epilepsy. The majority of interventions were face to face interactions with patients, whilst a smaller number were conducted via the telephone and one via a web-based system. Patient education was a key component of most interventions, either verbal and/or written. Longitudinal data, post intervention cessation, was not collected in the majority of cases. Conclusions RCTs conducted to evaluate pharmaceutical care appear to be effective in improving patient short-term outcomes for a number of conditions including diabetes and cardiovascular conditions, however, other conditions such as depression are less well researched. Future research should attempt to evaluate the conditions where there is a lack of data, whether the positive effects of pharmaceutical care persist in patient populations after the interventions cease and what the long-term clinical outcomes would be of continued pharmaceutical care

Assessment of anxiety and depression in hospitalized cardiac patients of Faisalabad Institute of Cardiology, Pakistan

Purpose: To assess the level of anxiety and depression in hospitalized cardiac patients in Faisalabad Institute of Cardiology, Faisalabad, Pakistan.Methods: The study was conducted on hospitalized cardiac patients at Faisalabad Institute of Cardiology (FIC), Faisalabad. Aga Khan University Anxiety and Depression Scale (AKUADS) was applied to estimate the occurrence of depression and anxiety in selected participants. This study involved 400 diagnosed hospitalized cardiac patients and another 400 participants without cardiac disease as control group.Results: The anxiety and depression level in hospitalized cardiac patient’s was 79.5% (318), compared with 68.25 % (273) of the control group. Female patients were also more prone to depression than male patients. Psychological suffering was 1.80 times more in the hospitalized cardiac patients (OR = 1.804, 95 %CI = 1.308 - 2.488, p = 0.0001). The results showed that gender was the leading factor in the occurrence of co-morbidities such as depression and anxiety.Conclusion: Depression symptoms are more common among hospitalized patients than in those without cardiac disease. Close monitoring is required and patients with psychiatric illness should be referred for appropriate treatment to overcome this risk.Keywords: Hypertension, Anxiety, Depression, Gender, Cardiac patient

Development of in vitro-in vivo correlation for nimesulide loaded ethylcellulose microparticles

A predictive in vitro-invivo correlation (IVIVC) can empower in vitro dissolution as a surrogate for in vivo bioavailability / bioequivalence. IVIVCs can decrease regulatory burden by decreasing the number of biostudies required in support of a drug product. The present study concerns the establishment of in vitro-in vivo correlation for three different sustained release nimesulide loaded ethylcellulose microparticulate formulations (M1, M2 and M3) and conventional tablet (100 mg Nimaran®-Novartis, Pakistan). In vitro dissolution study was conducted in phosphate buffer pH 6.8 stirred at 50 rpm and 37 ± 0.5ºC. A validated HPLC method was adopted to conduct bioavailability studies in young healthy human volunteers. Ultimately IVIVC of prepared microparticles and conventional tablet was established using Wagner-Nelson method. M1 and M2 formulations and Nimaran® exhibited good linear IVIVC (R2 = 0.9220, 0.9124, 0.8728, respectively) as compared to M3 (R2 = 0.9449). The results substantiate the success of this mathematical simulation study encourage researchers to conduct biowaiver studies for other BCS class II drugs.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study

The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers

What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study

The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers

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Abstract: The objective of this study was to formulate stable and controlled release microparticles for simultaneous delivery and UV spectrophotometric detection in combined dosage of an non-steroidal anti-inflammatory drug (NSAID) (Nimesulide, NMS) and a spasmolytic agent (Tizanidine, TZN) to maintain plasma concentration that may increase patients compliance, improved therapeutic efficacy, The aim was also to reduce severity of upper GI side effects of NMS because of alteration in delivery pattern via slow release of drug from microparticles and to increase the benefits of spasticity and disability for spastic patients by administering TZN in a modified release formulation as these two drugs are often prescribed in combination for the management of pain associated with muscles spasm. Ethyl cellulose was used as a retardant polymer. Drug-polymer and drug-drug compatibility study were conducted by different analytical tests. Microparticles were prepared by coacervation thermal change method. The prepared microparticles were characterized for their micromeritics and drug loading. The prepared microparticles were light yellow, free flowing and spherical in shape. The drugloaded microparticles showed 87% and 91% entrapment efficiency of NMS and TZN, respectively, and release was extended up to 10 h. The infrared spectra, differential scanning calorimetry thermograms and XRD spectra showed the stable character of both the drugs in the drug-loaded microparticles. The in vitro release study of microparticles was performed in phosphate buffer pH 6.8. Linearity was observed in the concentration range of 5.0ñ30.0 µg/mL of NMS and 0.5ñ3.0 µg/mL of TZN. The microparticles have a potential for the prolongation and simultaneous delivery of the NIM and TIZ. The proposed UV method for simultaneous detection can be used for routine analysis of combined dosage form