Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a Public Hospital in Ghana : a clinical audit study

Background: One in ten of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate making it a potential driver of antimicrobial resistance. The study aimed to evaluate the appropriateness of antibiotic use among ambulatory patients seeking dental care services in a public hospital in Ghana. Methods: A retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected. Results: Overall, 1433 patient medical records were extracted from the database within the study period. The mean age of the patients identified was 39.9 years with almost two thirds being female. Majority (91.1%, n=1306) of them were attended to by a dental nurse. 88.6% (n=1269) of the patients received antibiotics and 87.5% (n=1254) of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Three-quarters of the dental conditions were managed with dual antibiotics comprising of amoxicillin and metronidazole. Antibiotic prescription was associated with the age, gender, the type of prescriber and the type of dental condition diagnosed. Conclusion: There is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital and most are inappropriate. Development of local guidelines supported by education of dental clinicians on empiric use of antibiotics is a suitable target for the antimicrobial stewardship (AMS) team to address in KMH

Development and validation of a tool to improve community pharmacists' surveillance role in the safe dispensing of herbal supplements

Background: There has been an appreciable increase in the use of herbal supplements, including immune boosters, during the current COVID-19 pandemic. However, there are concerns with falsified herbal supplements Objectives Developed a new questionnaire that can potentially help community pharmacists with identifying the extent of falsified herbal supplements. Methods: A cross sectional study conducted over nine months among 500 community pharmacies in the UAE. Face-to-face interviews were undertaken using a structured questionnaire, which was subjected to face and content validity, with the content validity index (CVI) computed. Construct validity was tested using an exploratory factor analysis (EFA) via principally component analysis (PCA). The model was then confirmed through Partial confirmatory factor analysis (PCFA). Reliability was assessed via test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs). Results: An instrument compromised of five domains with a 24-item scale was developed with CVI of 0.843. The KMO measure of sampling adequacy was 0.891, and Bartlett’s test of sphericity indicated significance (p-value < 0.001). Confirmation of the subsequent 5-domains was achieved through PCFA using MLA with oblimin rotation. The PCFA obtained values of 0.962 for NFI, 0.977 for CFI, and 0.987 for TLI; all values were greater than 0.95, and the RMSEA value was 0.03 (i.e., less than 0.06). Consequently, the model had a good fit. All domains demonstrated Cronbach’s alpha coefficients above 0.70, with 0.940 for the full instrument. Meanwhile, all items met the IIC correlation standard of ≥ 0.40. The instrument presented good ICC statistics of 0.940 (0.928 – 0.950) as well as statistical significance (p < 0.001). Those participants who had more than 10 experience years more likely to identify falsified herbal supplements compared to those who have 1 to 10 experience years (p < 0.001). Conclusions: This study developed and validated a new instrument to identify safe herbal supplements products, which will help enhance the role of the community pharmacists in safe and effective treatment of suitable patients with herbal supplements

Potential therapeutic effects of mTOR inhibition in atherosclerosis

Despite significant improvement in the management of atherosclerosis, this slowly progressing disease continues to affect countless patients around the world. Recently, the mechanistic target of rapamycin (mTOR) has been identified as a pre‐eminent factor in the development of atherosclerosis. mTOR is a constitutively active kinase found in two different multiprotein complexes, mTORC1 and mTORC2. Pharmacological interventions with a class of macrolide immunosuppressive drugs, called rapalogs, have shown undeniable evidence of the value of mTORC1 inhibition to prevent the development of atherosclerotic plaques in several animal models. Rapalog‐eluting stents have also shown extraordinary results in humans, even though the exact mechanism for this anti‐atherosclerotic effect remains elusive. Unfortunately, rapalogs are known to trigger diverse undesirable effects owing to mTORC1 resistance or mTORC2 inhibition. These adverse effects include dyslipidaemia and insulin resistance, both known triggers of atherosclerosis. Several strategies, such as combination therapy with statins and metformin, have been suggested to oppose rapalog‐mediated adverse effects. Statins and metformin are known to inhibit mTORC1 indirectly via 5' adenosine monophosphate‐activated protein kinase (AMPK) activation and may hold the key to exploit the full potential of mTORC1 inhibition in the treatment of atherosclerosis. Intermittent regimens and dose reduction have also been proposed to improve rapalog's mTORC1 selectivity, thereby reducing mTORC2‐related side effects

Assessing knowledge, attitude and practice of community pharmacists on the pain management and implications in UAE children

Objective: There are concerns with the optimal management of pain in children, with sub-optimal management negatively impacting on physical, emotional social functioning, exacerbated by pain in children being multi-modal. Community pharmacists across countries play an important role in managing pain in patients including children's pain. Consequently, the objective of this study is to assess knowledge, attitudes and practices (KAP) of pain management in children among community pharmacists in UAE. Methods: A cross-sectional study was conducted using a structured questionnaire that was developed and piloted. The final questionnaire, which comprised two parts, had acceptable validity and internal consistency. Results: 867 out of 922 community pharmacists took part in UAE (94% response rate) and were visited by trained researchers. The most from independent pharmacies (53.9%) and having more than 10 years of experience (68.9%). The overall KAP score was 70%, with gender, pharmacy type, years of experience, educational level and position significantly associated with KAP. Encouraging knowledge areas included pain is one of the vital signs in children (88.6%), the intensity of pain should be rated by a pharmacist before discussing treatment options (92.2%) and the choice of treatment should depend on issues including intensity and duration (87.2%). Areas of concern included the contents of the WHO analgesic ladder (32.0%) and children may sleep in spite of severe pain (42.9%). Conclusion: There were areas of good knowledge of pain management among community pharmacists in UAE. Areas of concern including knowledge of the WHO analgesic ladder need to be addressed as part of future educational input during training and post qualification

Access to community pharmacy services for people with disabilities : barriers, challenges, and opportunities

Health care is a basic human right; however, people with disabilities continue to encounter barriers that prevent them from accessing the care they need.1 The negative features of the relationship between a patient with a health condition and their contextual circumstances (personal and environmental variables) are referred to as disability. Disability is an overarching word encompassing difficulties such as activity limits and participation restrictions.2 Recent research revealed that a billion individuals (15% of the world population) are believed to live with disabilities. Between 110 (2.2%) and 190 million (3.8%) of these people have substantial difficulty in functioning.2 People with disabilities experience varying access to health care in different nations and societies across the world.3 They encounter impediments to health-care access, especially in poor and middle-income nations, which widen the gap in access for people with disabilities between the developing and developed world.4 According to studies, health disparities occur as a result of disability, including unmet clinical requirements, a lack of emphasis on health promotion, and insufficient access to quality health care and preventative services.5 According to a survey of persons with major mental problems, 35 to 50% of people in industrialized nations and 76 to 85% of those in developing countries received no mental health-care intervention in the year preceding the research.2 Inadequate policies and standards, unfavorable attitudes, a lack of service supply, insufficient money, and inadequate access and communication were the key impediments to health-care access.2 Institutions that provide health-care services should be easily accessible to anyone in need of such services. Because of their longer hours, accessibility, price, and lack of requirement for an appointment, community pharmacists are often the first point of contact for most people seeking health-care assistance.6,7 As a result, pharmacies represent an important source of primary health care. However, despite some encouraging advancements, community pharmacies are still not accessible to disabled people. As a result, recognizing the barriers to access to community pharmacy services faced by people with disabilities is critical and will help to enhance health-care provision in the future