Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients - Validation of the “MRCI-Arabic”

The medication regimen complexity index is widely used in clinical practice and many studies, to assess the complexity of medication regimens. The goal of this study is to validate the medication regimen complexity index-Arabic (MRCI-Arabic) version among older patients. Methods: This methodologic study was conducted in older patients (≥ 65 years old) who were native Arabic speakers at a community pharmacy located in Istanbul, Turkey. After the translation and cultural adaptation process finished, medication regimens of 30 patients were evaluated for test-retest reliability three weeks apart by the rater who was a native Arabic speaker. The inter-rater correlation was calculated in study population (n =100). The link between the number of medications and the score of medication regimen complexity was used to assess convergent validity. The difference in the score of pharmaceutical regimen complexity in stratified age groups was used to examine discriminant validity. Results: The inter-rater and test-retest reliability of the MRCI-Arabic total scale and its subsection were extremely high (Spearman’s rho ranged from 0.996 to 1; p <0.001). There was a strong and positive correlation between the total MRCI-Arabic score and the number of medications (r = 0.830; p < 0.001), the number of chronic diseases (r = 0.641; p < 0.001). Conclusion: The Arabic validation of the MRCI is a validated tool that can be used by native Arabic-speaking healthcare professionals to determine the complexity of their patients’ medication regimens

COVID-19 Vaccination Scenarios:A Cost-Effectiveness Analysis for Turkey

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving

Identification of Drug-Related Problems and Investigation of Related Factors in Patients with COVID-19: An Observational Study

Objective:Clinical prognosis of coronavirus disease-19 (COVID-19) may be severe and unexpected. Patients may quickly progress to respiratory failure, infections, multiple organ dysfunction, and sepsis. The main objective of this study is to investigate the drug-related problems of patients with COVID-19 and related factors.Method:A prospective observational study was conducted on patients with COVID-19 between September 2020 and May 2021. Patients’ demographics, comorbid diseases, prescribed medicines and laboratory findings were recorded. Drug-related problems (DRPs) were identified by a clinical pharmacist according to recent guidelines, UpToDate® clinical decision support system and evidence-based medicine.Results:The median age of 107 patients was 64 and 50.46% of them were male. The median number of comorbidities was 3 (2-4) per patient. The majority of the patients had at least one comorbidity (88.79%) other than COVID-19 and the most frequent comorbidities were hypertension, diabetes mellitus and coronary artery disease. The total number of DRPs was recorded as 201 and at least one DRP was seen in 75 out of 107 patients. The median number of DRPs was 2 (0-8). In multivariate model, number of comorbidities (odss ratio (OR)=1.952; 95% confidence interval (CI)=1.07-3.54, p<0.05, number of medications (OR=1.344; 95% CI=1.12-1.61, p<0.001), and serum potassium levels (OR=5.252; 95% CI=1.57-17.56, p<0.001) were the factors related with DRPConclusion:This study highlights the DRPs and related factors in patients with COVID 19 in hospital settings. Considering unknown features of the infection and multiple medication use, DRPs are likely to occur. It would be beneficial to consider the related factors in order to reduce the number of the DRPs

Helicobacter pylori eradikasyonunun farmakoekonomisi ve deney hayvanlarında nonstreoidal antiinflamatuvar ilaç kaynaklı ülserlerin önlenmesi

ÖZETPeptik ülser gelişiminde rolü olduğu bilinen en önemli iki faktör Helicobacter pylori varlığı ve nonsteroidal antiinflamatuvar (NSAİ) ilaç kullanımıdır. Çalışmamız, bu iki sorundan biri olan Helicobacter pylori'nin eradikasyonuna yönelik tedavi stratejilerinin farmakoekonomik yönden karşılaştırılması ve diğer önemli sorun olan NSAİ ilaçlara bağlı ülserlerin önlenmesine yönelik tedavilerin değerlendirilmesi olarak planlandı. Endoskopik olarak Helicobacter pylori (+) bulunan 75 hasta, farmakoekonomik analizi yapılacak olan 7 tedavi protokolüne rastgele atandı. 7 gün süreli, 2x30 mg Lansoprazol, 2x1 g Amoksisilin ve 2x500 mg Klaritromisin (LAK); 14 gün süreli, 2x20 mg Omeprazol, 2x250 mg Klaritromisin ve 2x500 mg Metronidazol (OKM); 1x40 mg Omeprazol, 3x500 mg Amoksisilin ve 3x500 mg Metronidazol (OAM); 3x250 mg Metronidazol, 4x500 mg Amoksisilin, 1x300 mg Ranitidin ve 4x300 mg Bizmut (MARB); 2x20 mg Omeprazol, 2x1 g Amoksisilin ve 2x500 mg Klaritromisin (OAK); 2x40 mg Omeprazol, 2x500 mg Klaritromisin ve 2x1 g Amoksisilin (OKA); 2x20 mg Omeprazol, 3x500 mg Amoksisilin ve 4x300 mg Bizmut (OAB) tedavi protokolleriyle tedavi edilen hastalar, tedavi bitiminden 2 ay sonra ikinci endoskopiyle değerlendirildiler. %90'lık eradikasyon başarısı ve 158 $'lık maliyet-etkinlik oranına ulaşan MARB,$'lık maliyet-etkinlik oranına ulaşan OKA, diğer tedavi rejimlerine göre daha maliyet-etkin bulundular. Maliyet-etkinlik oranları birbirlerine yakın bulunan LAK ve OAK arasında yapılan 'artan maliyet' analizine göre LAK'ın daha maliyet-etkin olduğu görüldü. Eradikasyon oranları sırasıyla %50, %50 ve %60 bulunan OKM, OAM ve OAB, diğer protokollere göre maliyet-etkin bulunmadılar. Deney hayvanlarında, 50 mg/kg s.c. indometazin ile birlikte farklı dozlarda uygulanan antiülser ilaçlarının ülser oluşumunu önleme etkinlikleri değerlendirildi. 5 günlük tedavi sonunda histopatolojik olarak yapılan incelemelerde, 100 µg/kg p.o. misoprostol (M-T1), 10 µg/kg p.o. misoprostol (M-T2), 5 mg/kg i.p. omeprazol (O-T1), 10 µg/kg p.o. misoprostol + 1,5 mg/kg omeprazol (MO-T) ve 10 µg/kg p.o. misoprostol + 10 mg/kg i.p. ranitidin (MR-T) tedavilerinin, indometazin kaynaklı ülserleri koruduğu görüldü. Bu tedavi rejimleriyle elde edilen koruma oranları sırasıyla, %71,4; %50; %47,6; %52,4 ve %50 bulundu. Ranitidin, bizmut ve düşük doz omeprazol ile tek tek tedavi edilen deney hayvanlarındaki ülser skorlarının, indometazin grubundan istatistiksel olarak farklı olmadığı ve sonuç olarak yeterli bir koruma sağlamadıkları görüldü. Sonuç olarak, klinik eczacıların gelecekteki en önemli rollerinden biri olarak kabul edilen farmakoekonomi alanındaki çalışmamızın, Helicobacter pylori eradikasyon tedavisine; deneysel hayvan çalışmamızın da, NSAİ ilaç kaynaklı ülserlerin önlenmesine yönelik tedavilere katkıda bulunacağına inanmaktayız. SUMMARYA PHARMACOECONOMIC STUDY OF HELICOBACTER PYLORI ERADICATION AND PREVENTION OF NONSTEROIDAL ANTIINFLAMMATORY DRUG INDUCED ULCERS IN RATS'Helicobacter pylori infection' and 'nonsteroidal antiinflammatory drug (NSAID) use' are two of the most important factors in the development of peptic ulcer disease. Our study sought to make a pharmacoeconomic comparison of different Helicobacter pylori treatment strategies and prophylactic approaches to NSAIDs induced gastrointestinal damage. A total of 75 patients diagnosed by endoscopy as Helicobacter pylori (+) were randomised to receive one of 7 Helicobacter pylori treatment protocols. These protocols were as follows: Lansoprazole 30 mg bid., Amoxicillin 1 g bid. and Clarithromycin 500 mg bid. (LAC) for 7 days; Omeprazole 20 mg bid., Clarithromycin 250 mg bid. and Metronidazole 500 mg bid. (OCM); Omeprazole 40 mg qd., Amoxicillin 500 mg tid. and Metronidazole 500 mg tid. (OAM); Metronidazole 250 mg tid., Amoxicillin 500 mg qid., Ranitidine 300 mg hs. and Bismuth 300 mg qid. (MARB); Omeprazole 20 mg bid., Amoxicillin 1 g bid. and Clarithromycin 500 mg bid. (OAC); Omeprazole 40 mg bid., Clarithromycin 500 mg bid. and Amoxicillin 1 g bid. (OCA); Omeprazole 20 mg bid., Amoxicillin 500 mg tid. and Bismuth 300 mg qid. (OAB) each for 14 days. All patients were evaluated a second time by endoscopy after 2 months of treatment. MARB and OCA were more cost-effective than the other treatment regimens. The eradication rates and cost-effectiveness ratios determined for these protocols were 90%, $158 for MARB and 90$194 for OCA. As we found no differences between the LAC and OAC protocols, we performed an incremental analysis of these protocols. The incremental analysis showed that LAC was more cost-effective than OAC. The OCM, OAM and OAB protocols were not found cost-effective due to their low eradication rates: 50%, 50% and 60%, respectively.We also determined the efficacy of different antiulcer drugs for the prevention of 50 mg/kg s.c. indomethacin induced ulcer in rats. In histopathological examinations performed after 5 days of treatment, the following treatment models were found to be effective in the prevention of indomethacin induced gastric lesions: 100 µg/kg p.o. misoprostol (M-T1), 10 µg/kg p.o. misoprostol (M-T2), 5 mg/kg i.p. omeprazole (O-T1), 10 µg/kg p.o. misoprostol + 1,5 mg/kg omeprazole (MO-T) and 10 µg/kg p.o. misoprostol + 10 mg/kg i.p. ranitidine (MR-T). The prevention rates achieved by these treatments were 71,4%; 50%; 47,6%; 52,4% and 50%, respectively. The ulcer scores in groups treated with ranitidine, bismuth and low dose omeprazole were not found to be different from the indomethacin group score, so that; the efficacy of these groups was not enough to prevent indomethacin induced ulcers.In conclusion, we believe that our pharmacoeconomic study will be valuable to clinicians, clinical pharmacist and all health policy makers in deciding upon appropriate Helicobacter pylori eradication treatments, while our experimental animal study will be helpful in determining NSAID induced ulcer prevention therapy

Impact of Clinical Pharmacist-led Interventions in Turkey

Detecting drug-related problems (DRPs) is important in pharmaceutical care in for better therapeutic outcomes. Clinical pharmacists-led comprehensive medication management plays a crucial role in the rational use of drugs by preventing, identifying, and resolving DRPs. In this review, we aimed to determine the effect of interventions on patient outcomes performed by clinical pharmacists in Turkey. A systematic literature search was performed on PubMed, Google Scholar, EMBASE, Cochrane Library, and Turkish databases (ULAKBIM, Dergipark). The main categories were clinical pharmacist, intervention, and Turkey. Two reviewers reviewed each article independently. Two independent reviewers screened all records and extracted datadisagreements were resolved through a consensus. Randomized controlled studies, pre- to post-intervention comparison studies, and cross-sectional studies including pharmacist-led interventions were included in the review. This review included 15 articles evaluating clinical pharmacist interventions. Ten studies (66.7%) focused on DRPs and pharmacist interventions to these problems, while the remaining 5 (33.3%) studies focused on patient education and adherence issues. Studies were conducted in oncology (33.3%), geriatrics (20.0%), chest diseases (13.3%), psychiatry (6.7%), cardiology (6.7%), and infectious diseases (6.7%) clinics. When results of studies are reviewed, most of the interventions were made at the prescriber level followed by the drug level and patient level. Problems were solved in 54.2-93.2% of DRPs, and adherence, patient knowledge, or skills were improved in most of the studies. Most of the studies were carried out within the scope of a postgraduate or doctorate thesis and yet various positive outcomes such as the prevention of side effects, increased quality of life, and decreased duration of hospital stay were observed with high positive rates of interventions, which indicate that other healthcare workers are ready to collaborate with the clinical pharmacists in Turkey

Arg753Gln polymorphism of the human Toll-like receptor 2 gene from infection to disease in pediatric tuberculosis

The aim of this study is to examine the occurrence of the Arg753Gln polymorphism of the Toll-like receptor 2 (TLR2) gene in Turkish children with pulmonary and/or extrapulmonary tuberculosis (TB) disease compared with that in healthy children with latent TB infection (LTBI) and to assess the risk of progression from LTBI to active TB disease in children. The Arg753Gln polymorphism of the TLR2 gene was studied in 198 TB patients compared with 200 ethnically and age-matched children with LTBI. The culture confirmed TB patients were more frequently Arg753GIn heterozygous [odds ratio (OR) 5.05, 95% confidence interval (95% CI) 2.61-9.76, p = 0.00], and Gln allele frequency was significantly higher in the patient group (13.86% vs 3.5%, OR 4.40, 95% CI 2.34 - 8.30, p = 0.00). We also showed that the frequencies of the heterozygous Arg753GIn genotype and the Gln allele were significantly higher in patients with pulmonary TB alone and in patients with definitive pulmonary plus extrapulmonary TB than in children with LTBI. Our data suggest that the Arg753GIn polymorphism of the TLR-2 gene influences the speed of progression from infection to TB disease in children. Further investigations are needed to clarify whether this polymorphism has a strong impact on susceptibility to TB in children. (C) 2011 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved