Evaluation Of Pharmacist'S Educational Intervention In Improving Treatment Outcomes Of Patients With Rheumatoid Arthritis

Pharmacist’s role in Pakistan’s healthcare system has traditionally been limited to dispensing of medications. Healthcare stakeholders and policy makers have repeatedly called for enhancing this role and involving pharmacists in direct patient care. Therefore, this study was aimed to evaluate pharmacist led educational intervention in improving treatment outcomes of patients with rheumatoid arthritis. A two arm-randomized single-blind controlled trial was designed. One arm was labeled as, ‘control’ group (CG), while other was, ‘intervention’ group (IG). The pharmacist provided an educational intervention in IG and usual care in CG. This study was conducted in rheumatology clinics of 7 hospitals in Karachi, Pakistan. A total of 714 patients were randomly enrolled, 354 in the IG and 360 in the CG

Report: Interactions and conflicts of interests between prescribers and medical sales representatives (MSRs) regarding prescribing and drug promotion practices in Karachi, Pakistan.

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions

Exploring translanguaging praxes in Pakistani multilingual ESL classrooms of first-year students at university level

Though the use of L-1 in multilingual ESL classrooms is abandoned; recent research suggests the significance of using a complete linguistic repertoire. The use of a complete linguistic repertoire implies the free use of all kinds of knowledge of languages. It is linked with translanguaging, which involves the use of two languages in a fluid way to organize mental processes in learning. Adopting the framework of translanguaging and theory of language mode this study has identified the specific ESL classroom situations where students used their complete linguistic and semiotic repertoire during English reading and writing, particularly and during general interaction in the classroom. Moreover, it also explores the motives behind the use of complete linguistic repertoire in identified situations. The data for this experimental study were collected through field notes of classroom observations, video recordings during the intervention, and interviews of teachers and students after the intervention. The findings show that students use their complete linguistic repertoire to negotiate meaning, develop metalinguistic awareness and communicate fearlessly and without anxiety in various situations like brainstorming, outlining, instructions, question statements, jokes, and normal interaction with a teacher and their pairs. The study concludes that by paying attention to the mentioned specific situations, teachers may opt for translanguaging pedagogy in their lesson plans to enhance the L-2 learning process

Which aspects of job determine satisfaction among pharmacists working in Saudi pharmacy settings?

Objective The aim of this study was to evaluate the impact of several employment-related aspects on overall job satisfaction among pharmacists working in Saudi pharmacy settings. Methods A cross-sectional survey was conducted for a period of 1-month (December 2020) among pharmacists working in community pharmacies located in 3 cities of Saudi Arabia. Convenience sampling was employed, and the data was collected using the English version of Job Satisfaction Survey (JSS) questionnaire. The data was analyzed using IBM SPSS version 23. Descriptive statistics such as mean (x̄) and 95% confidence interval range were used to report continuous data; frequency (%) and sample counts (N) were used to report categorical data. Bivariate analyses were conducted using chi square (χ2) test. A multiple linear regression model was formulated to report the employment aspects that determined overall job satisfaction of pharmacists. The study was approved by an ethics committee. Results A total of 241 samples were analyzed. Less than a quarter of pharmacists (N = 54, 22.4%) were satisfied with their job. The overall job satisfaction score was 130.74 out of 199. The sub-scales for co-workers and communication had scores > 15.8 out of 24; subscale for operating conditions had score > 12.5 out of 20. The subscales for promotion and rewards had scores < 14 out of 24. The aspects of communication, fringe benefits and nature of work had the highest contribution towards overall job satisfaction. For a unit increase in score for communication, fringe benefits, and nature of work, the overall job satisfaction score increased by 0.204, 0.2, and 0.199, respectively. Conclusion A very small number of pharmacists seemed satisfied with their job. Satisfaction with communication, nature of work and fringe benefits contributed the most toward overall job satisfaction. Results of this study could provide the means for human resource managers and organizational policy makers to delve into the determinants of satisfaction among pharmacists working in community settings

Pharmacist's viewpoint towards their professional role in healthcare system: A survey of hospital settings of Pakistan

In recent times, the profession of pharmacy has extended progressively in terms of professional services . The profession has been widely acknowledged as a significant occupation in the multidisciplinary establishments of health care . In contrast to developed countries the situation of pharmacy profession is underutilized in developing countries. Their professional role as health care professionals is yet to be recognized by the healthcare providers and the community. Objective: This study aimed to elicit the acceptance , experiences and perceptions of pharmacists towards their role in hospital settings of Pakistan. Methods: A cross-sectional survey was conducted among the pharmacists practising in various hospitals across Pakistan from January to April 2018. Chi -square test was used to analyse responses of respondents regarding their role in the healthcare system of Pakistan. The associations were considered significant at p-value less than 0.05 . The study was ethically approved. Main outcome measure: Acceptance, experiences and perception of pharmacists regarding their professional in hospital settings of Pakistan Results: Out of 500 respondents 396 questionnaires were returned completed (response rate; 87.9%). Most participants (92.2 %) reported interacting with doctors at least once daily, and that was related to drug availability inquiry (72.5%). 91.4% of the participants responded that pharmacy duties are mostly clinical nature. However, only 8.6% reported the duties of pharmacists are technical. 93.4% of the respondents deduce that pharmacists serve as an authentic source of information regarding general medicines. Furthermore, 87.4% of the questioned pharmacists confess that they find their training insufficient to deal with doctors regarding issues related to clinical medicine on behalf of the patients. Conclusion: The study highlights that the pharmacists in Pakistan are willing to perform their duties and provide healthcare benefits to patients. Pharmacists seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations, prescribing. The doctors do not consider the pharmacist as an integral member of healthcare team. There is a need to increase doctor’s awareness regarding the role pharmacists. Therefore, it would be helpful if training and seminars are conducted on the importance of clinical pharmacy services in order to improve the pharmacy services in Pakistan’s health care system

Determinants of academic stress and stress-related selfmedication practice among undergraduate male pharmacy and medical students of a tertiary educational institution in Saudi Arabia

Purpose: To identify factors that promote academic stress and stress-related self-medication practice among undergraduate male students of pharmacy and medical colleges at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Methods: A cross-sectional survey was conducted among undergraduate students of pharmacy and medical colleges of the university. The study used Perceived Stress Scale (PSS) to document academic stress. The responses of the students were analyzed using SPSS version 22. Results: As many as 51.6 % of students’ perceived moderate stress. The majority of students (55.9 %) highlighted examination as a stressor followed by course load (43.2 %) and cGPA (40.4 %). Prevalence of self-medication was 31.58 and 29.20 % among pharmacy and medical students, respectively. Most of the students consumed caffeine (63.8 %) and nicotine (17.8 %) as a drug. Students blamed heavy course load (23.9 %), followed by assignment load (23 %) and examination (21.1 %) for indulging in self-medication. Conclusion: Academic stress in undergraduate students in health disciplines is perceived to be high by the students. Examinations, course load and lack of time for leisure are major determinants of stress. Caffeine and nicotine are most frequently used by a majority of the students for self-medication. Keywords: Stress, Self-medication, Stressor, Caffeine, Nicotine, Student

Perceptions and Attitudes of Medical Sales Representatives (MSRs) and Prescribers Regarding Pharmaceutical Sales Promotion and Prescribing Practices in Pakistan

Pakistan is the 6th most populous country in the world and has an enormous potential for an ever increasing drug market. The health care system is highly prone to unethical drug prescribing practices. In addition, there is a huge tendency of pharmaceutical firms to indulge in unethical drug promotional practices by means of inducements and other benefits through their medical sales representatives (MSRs). On the other hand, the prescribers are also reported to be demanding inducements from these companies in return to write higher number of prescription. This study investigated the ground realities of drug promotion and prescribing practices in Pakistan. Materials and Methods: A cross sectional study was conducted for a period of 8 months in which 472 physicians and 609 medical sales representatives of Pakistan selected through prospective sampling were interviewed on a validated, structured questionnaire. The responses of the target groups were then analyzed for association between variables by Chi–square test (p<0.05) and cross tabulation through SPSS, version 20. Results: Majority of practitioners (83.2%) expected both, good communication skills and knowledge from MSRs and at the same time nearly half (53%) of prescribers demanded CME and almost a third proportion (36%) demanded gifts, incentives and inducements from MSRs. Replying to same question, MSRs disagreed with prescribers and believed that around (~70%) of prescribers ask for inducements with a high percentage i.e. (~64%) among them demanding unethical inducements like excessive free samples, gifts, leisure trips and cars. Majority of physicians (92%) have consensus that the multinational pharmaceutical firms have defined promotional practices while the national pharmaceutical companies (~73%) are mainly involved in unethical practices of drug marketing. Conclusion: Majority of national pharmaceuticals as well as prescribers were involved in unethical drug promotion and prescribing respectively. There is a need of curbing the unethical drug promotion and prescribing and formidable policies governing this issue are required to be implemented by the concerned regulatory authorities to avoid unnecessary harm to the patient’s life and pocket. Strength and weakness of study: The study explored the drug promotion and prescribing practices for the first time in a developing country however, due to sensitivity of the topic a number of respondents hesitated to participate

Development and validation of a novel general medication adherence scale (GMAS) for chronic illness patients in Pakistan

Objective: This study aimed to develop and validate a self-reporting adherence tool termed as General Medication Adherence Scale (GMAS) in Urdu language for measuring adherence toward medication use among Pakistani patients with a chronic disease. Methods: A month-long study (December 2017) was conducted in three tertiary health care settings of Karachi, Pakistan. The tool underwent content and face validity as well as factor analyses, i.e., exploratory, partial confirmatory and confirmatory factor analyses. Random sampling was conducted, and sample size was calculated using item response theory. The item-to-respondent ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR) were calculated. Additionally, estimation of the convergent, discriminant and known group validities, was conducted. Internal consistency was analyzed by testretest reliability, McDonald’s and Pearson correlation coefficient. The factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS version 25. Results: Content validity index (CVI) was reported at 0.8 (SD 0.147) and the tool was content validated with three hypothetical constructs. Factor analyses highlighted a 3- factor structure. The fit indices were calculated with satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than 0.9 and PGFI > 0.5. The values of RMSEA and SRMR were less than 0.07. A Cronbach’s alpha value of 0.84 was obtained in reliability analysis. The test-retest Pearson’s correlation coefficient value was reported at 0.996 (p-value < 0.01). Convergent and discriminant validities for all constructs and, known group validity for two constructs, were established. A high response rate of 91% was achieved in respondents. Patients without insurance coverage appeared to be low adherent compared to those with insurance coverage (p-value < 0.05). Non-comorbid patients were more likely to be highly adherent as compared to comorbid patients (pvalue < 0.01). Conclusion: A novel tool GMAS was developed in Urdu language and was subsequently validated in patients with chronic diseases

Quantification of rutin in rats brain by UHPLC/ESI-Q-TOF-MS/MS after intranasal administration of rutin loaded chitosan nanoparticles

Rutin (RT), an antioxidant drug, has been utilized to treat cerebral ischemia hence a sensitive quantification method for estimation of RT in brain homogenate is necessary to develop. This study aims to prepare RT loaded Chitosan Nanoparticles (RT-CS-NPs) develop and validate ultra-high performance liquid chromatography-electrospray ionization-synapt mass spectrometric method Synapt Mass Spectrometry (Synapt MS) (UHPLC/ESI-QTOF-MS/MS) for quantification of RT in brain homogenate from Wistar rat. The process of chromatographic separation was carried out on Waters ACQUITY UPLC™ with the components of separation in detail as; column: BEH C-18 with dimension as 2.1 mm×100 mm and particle size 1.7 µm, mobile phase: acetonitrile (85 % v/v/v): 2 mM ammonium formate (15 % v/v/v): formic acid (0.1 % v/v/v) and flow rate: 0.25 mL/min. Liquid-liquid extraction method (LLE), in mixture, i.e. ethyl acetate:acetonitrile, was considered to optimize the recovery of analyte from the brain homogenate of Wistar rat. Over a total run time of 5 minutes, the elution time for RT and internal standard (IS), i.e. Tolbutamide, observed was 2.67 and 2.82 min respectively whereas the transition observed for RT and IS was at m/z 611.1023/303.1071 and 271.1263/155.1073, respectively. Results, regarding various processes and parameters studied for RT as summarized, established a linear dynamic range over a concentration range of 1.00 ng/mL - 1000.0 ng/mL with r2; 0.9991±0.0010. Accuracy for intra and inter-assay in terms of % CV revealed a range of 0.45- 2.11 whereas lower limit of detection (LOD) and quantitation (LOQ) observed was 0.09 ng/mL and 0.142 ng/mL, respectively. The analyte stability as well as method specificity and accuracy, i.e. recovery > 86 %, supports the idea for application of current developed method in order to quantify and evaluate the RT-loaded-CS-NPs for RT determination in brain homogenate after intranasal drug delivery

DIRECT COST OF TREATMENT OF DIABETES MELLITUS TYPE 2 IN PAKISTAN

Objective: Diabetes is a serious illness. It is a key and growing threat to the health of the global world. The prime concern of this research was to estimate the cost-of-illness of type 2 diabetes in Karachi, a major metropolitan city of Pakistan. This study was performed on the basis a community perspective to calculate the economic burden of diabetes mellitus type 2 in Pakistan. Methods: This study was conducted in all districts of Karachi, the patients were taken from all economic segment of society from low income group, average revenue and high revenue group. A preliminary test questionnaire was used to collect the data directly from patients and in some locations conducted interviews with patients due to lack of understanding and un-educated patients. The total of 885diabetes patients was selected with convenient random sampling. Results: The average direct cost of all these expense bear by diabetic patient in Pakistan is Pak Rupees Rs.5542 per month. The cost range starts from Rs. 650/month to 20000 per month on the basis of patient economic condition and disease state. The average appointment fee of a physician, laboratory test and medicines came to Rs. 700/visit, 400/test, and 1100/visit precisely. The average travel and food spent was Rs.200/visit and 1000/month. Medicine accounted for largest cost followed by consultation with the physician. Conclusion: This is clearly indicated by this study that considerable cost is amounted by diabetes, it is suggested that a huge amount of resources could be prevented by taking care, initial understanding of the disease and a decrease in diabetes co-morbidities and complications through better diabetes mellitus treatment. Very extensive and cost-effective programs should be started to maximize health benefits and to diminish the prevalence of this epidemic