Knowledge, perception and practice of medication use review among community pharmacists in southwestern Nigeria

Background: Medication use review (MUR) is an emerging concept in medicine management that has recorded success in many developed countries.Purpose: To evaluate knowledge, perception and practice of MUR among community pharmacists (CP) in southwestern Nigeria.Method: A cross-sectional study was carried out among 100 CP recruited from Oyo and Osun states between January and March, 2015, using a pre-tested  questionnaire. Demographic information and CP’s knowledge, perception and current practice of MUR were evaluated using open-ended, closed-ended and Likert-scale questions. Respondents’ scores for 6-item knowledge test questions and description of specific component of MUR services were categorised as score>3 (good  knowledge) and score≤3 (poor knowledge). Descriptive statistics were used to  summarize data. Ranked variables were evaluated using Kruskal-Wallis test at  p<0.05. Results: Fifty-nine (59.0%) CP from Oyo and 41(41.0%) from Osun state participated. Sixty-five (70.7%) had score>3 indicating “good” knowledge of MUR, while 27 (29.3%) had score≤3 suggesting “poor” knowledge. Forty-two (42.0%)  claimed to provide MUR service; of this, 14 (33.3%) had scores>3 indicating those who gave correct description of specific component of MUR. Lack of adequate time for counselling (49; 49.5%) and lack of specialized training for pharmacists  (45;45.5%) were cited as barriers to MUR practice. Majority (51; 51.5%) agreed that MUR service should be incorporated into community pharmacy practice.Conclusion: Knowledge of MUR concept among community pharmacists in Oyo and Osun states is considerable, but description of specific component of MUR services by respondents was poor. There is therefore a need for continuous training on emerging concepts among pharmacists, so as to stimulate interest in patient-oriented service.Keywords: Medication use review, Community pharmacist, Knowledge, Perceptio

ANALYTICAL SOLUTION OF THE RELATIVISTIC KLEIN-GORDON WAVE EQUATION

In this study, the solution to Klein-Gordon equations with focus on analytical methods is discussed. The analytical methods used in this research are the Variational Iteration Method (VIM) developed by Ji-Huan He, Adomian Decomposition Method (ADM) by Adomian and New Iterative Method (NIM) developed by Daftardar Gejji and Jafari. The modified Adomian Decomposition method by Wazwaz was used to solve the linear inhomogeneous and nonlinear Klein-Gordon equations to accelerate the convergence of the solution and minimizes the size of calculation while still maintaining high accuracy of the analytical solution. All the problems considered yield the exact solutions with few iterations. The solutions obtained were compared with the exact solution and the solutions obtained by other existing methods. The solutions obtained by the three methods yield the same results and all the problems considered show that the Variational Iteration Method, Adomian Decomposition Method and New Iterative Method are very powerful and potent in solving Klein-Gordon equations and can be used to obtain closed form solutions of linear and nonlinear differential equations (ordinary and partial)

Financial Shenanigans : A Case Study of Nigeria

This study investigates the identified cases of financial shenanigans in between 2001 and 2009 in Nigeria. The scope of this study includes the identification of the common attempts and approaches used by companies and the motivations for financial shenanigans. A cross country comparison of the characteristics of the corporate reporting environments between Nigeria and Malaysia was also carried out. This study finds that the most common attempt used by the sample companies are majorly revenue overstatement and understating the expense accruals. Revenue and expenses are the major accounts which have a direct impact on the net income of a company and as a result, the main targets for manipulation. From the findings of this study, the motivations for financial shenanigans are external contract incentives, stock over pricing, closeness to contract covenants and management compensation contract incentives. From the cross country comparison between Nigeria and Malaysia, the findings show that board size and composition negatively affected the performance of firms in both countries. This is due to the fact that there is a high rate of family ownership of these companies and they exert dominant control of the board, rendering them inactive and in some cases, irrelevant. Thus in both countries, corporate governance should look beyond compliance, box- ticking and sign-off of the compliance requirements by the regulatory authorities and focus more on human capital training and developments which will promote honest and accurate financial reporting in both countries

Genetic Variants Improve Breast Cancer Risk Prediction on Mammograms

Several recent genome-wide association studies have identified genetic variants associated with breast cancer. However, how much these genetic variants may help advance breast cancer risk prediction based on other clinical features, like mammographic findings, is unknown. We conducted a retrospective case-control study, collecting mammographic findings and high-frequency/low-penetrance genetic variants from an existing personalized medicine data repository. A Bayesian network was developed using Tree Augmented Naive Bayes (TAN) by training on the mammographic findings, with and without the 22 genetic variants collected. We analyzed the predictive performance using the area under the ROC curve, and found that the genetic variants significantly improved breast cancer risk prediction on mammograms. We also identified the interaction effect between the genetic variants and collected mammographic findings in an attempt to link genotype to mammographic phenotype to better understand disease patterns, mechanisms, and/or natural history.

Geographical and seasonal barriers to mammography services and breast cancer stage at diagnosis

Introduction: Routine mammography screening and early detection are important prognostic indicators for breast cancer. Geographical and seasonal barriers to mammography services and relationship to breast cancer stage at diagnosis were examined. Methods: Travel time to mammography center, seasonal distribution of mammogram use, mammography frequency, and stage of cancer were retrospectively examined in 1428 female patients diagnosed with primary breast cancer at a tertiary care clinic system in Wisconsin, USA, from 2002 to 2008. Results: Women with no missed mammograms before diagnosis lived a median of 15 minutes from the nearest facility, while those who missed five of their past five annual mammograms lived nearly twice as far, with a median travel time of 27 minutes (p<0.0001). There was a direct relationship between travel time to nearest mammogram facility and stage of breast cancer at diagnosis, with travel time increasing from 17 to 24 minutes for stage 0 and stage 4 breast cancers, respectively (p=0.0586). Women were less likely to undergo mammography screening during the winter months (p<0.0001), especially women with greater than 30 mi (48.3 km) to travel to the nearest mammogram facility (p=0.0448). Conclusions: In the studied service area, travel time to nearest mammogram center appears inversely related to regular mammography screening and breast cancer stage at diagnosis. Mammograms are less common in the winter, especially in women with further to travel. This is the first study to demonstrate that inclement winter weather may impact on screening behaviors in rural areas and demonstrates the importance of considering climate as part of geographical access to preventative care

Slow, but complete, resolution of mitomycin-induced refractory thrombotic thrombocytopenic purpura after rituximab treatment

Thrombotic thrombocytopenic purpura (TTP) is a critical complication of treatment with mitomycin C. We retrospectively describe the case of a patient with progressive renal cell carcinoma and mitomycin-induced TTP refractory to plasma exchange and glucocorticoids; we describe the clinical course, successful management of TTP with rituximab, and follow-up of this case. Mitomycin-induced TTP resolved completely by a total of 4 infusions of rituximab 375 mg/m2 on a weekly basis, and it took up to 12 months to obtain a platelet count of >100,000/µL. Rituximab is indicated for the treatment of mitomycin-induced TTP refractory to plasma exchange and glucocorticoids, and it could improve the patient's quality of life despite the presence of underlying malignancy

Association of Programmed Cell Death 1 Inhibitor with Circumorificial Plasmacytosis

Introduction: The development of immune checkpoint inhibitors is considered one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-1 (PD-1) receptors that has demonstrated antineoplastic activity against various malignancies, including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab is associated with numerous adverse reactions including mucosal and cutaneous reactions referred to as immune-related adverse events. These events can impact patient quality of life and lead to dose reduction or discontinuation of the medication. A comprehensive understanding of pembrolizumab’s toxicities is crucial for the initiation of treatment. Case Presentation: We present the case of a 27-year-old man with stage IVB thymic carcinoma with a bulky anterior mediastinal mass, bilateral jugular, bilateral peritracheal, and bilateral cardiophrenic lymphadenopathies, and a small pericardial effusion. He received pembrolizumab IV every 3 weeks for 53 cycles over 39 months. The patient developed bleeding oral lesions approximately 38 months after treatment with pembrolizumab. Conclusion: The patient’s pembrolizumab treatment was not interrupted and the perioral rash ultimately improved after treatment with steroids

Prostate Cancer Metastasis to the Stomach

Prostate cancer commonly manifests with bony metastases. Visceral metastasis can also occur in the lungs and liver. However, stomach metastasis related to prostate cancer is rare. Here, we report a case of prostate cancer metastatic to the stomach. A 66-year-old male was diagnosed with prostate adenocarcinoma. He was noted as having abdominal discomfort, nausea, and vomiting 18 months after the diagnosis. A histopathologic examination and an esophagogastroduodenoscopic gastric biopsy revealed stomach-metastatic adenocarcinoma. He was also noted as having cerebellar metastatic lesions, which were identified by using a brain magnetic resonance imaging (MRI) scan. The patient died of cardiovascular complications 5 months after the diagnosis of stomach metastasis

Differentiated thyroid cancer: millions spent with no tangible gain?

The incidence of differentiated thyroid cancer (DTC) has rapidly increased worldwide over the last decades. It is unknown if the increase in diagnosis has been mirrored by an increase in thyroidectomy rates with the concomitant economic impact that this would have on the healthcare system. DTC and thyroidectomy incidence as well as DTC specific mortality were modelled using Poisson regression in New South Wales (NSW), Australia per year and by sex. The incidence of 2002 was the point from which the increase in rates were assessed cumulatively over the subsequent decade. The economic burden of potentially avoidable thyroidectomies due to the increase in diagnosis was estimated as the product of the additional thyroidectomy procedures during a decade attributable to rates beyond those reported for 2002 and the national average hospital cost of an uncomplicated thyroidectomy in Australia. We found that the incidence of both DTC and thyroidectomy doubled in NSW between 2003 and 2012, while the DTC specific mortality rate remained unchanged over the same period. Based on the 2002 incidence, the projected increase over 10 years (2003-2012) in thyroidectomy procedures was 2,196. This translates to an extra cost burden of over AUD$ 18,600,000 in surgery-related healthcare expenditure over one decade in NSW. Our findings suggest that, if this rise is solely attributable to overdetection, then the rising expenditure serves no additional purpose. Reducing unnecessary detection and a conservative approach to managing DTC are sensible and would lead to millions of dollars in savings and reduced harms to patients

The First Case of Postpartum Acquired Hemophilia A in Korea

Acquired hemophilia A (AHA) is a rare coagulopathy caused by autoantibodies to coagulation factor VIII (FVIII). Most patients with AHA have been previously healthy; however, a variety of morbidities have been associated with the condition including pregnancy. A 40-yr-old woman visited our institution with extensive hematoma on the right hip area. Her medical history revealed no personal or familial history of bleeding diathesis. Her coagulation tests showed markedly prolonged aPTT (117 sec), markedly decreased level of FVIII activity (0.4%) and high-titer FVIII inhibitor (77 BU). Collectively, she was diagnosed as having postpartum AHA and was treated with bypassing agents and corticosteroids. Her aPTT was normalized on the 174th postpartum day and FVIII inhibitor showed negative conversion on the 224th postpartum day. This is the first case of postpartum AHA with high-titer FVIII inhibitor in Korea. Timely diagnosis and management can reduce morbidity and mortality of this potentially life-threatening condition