The pharmaceutical care in asthma — Polish and global perspective

The pharmaceutical care is a pharmacist’s contribution to the care of individual patients and leads to optimize the use of drugs. The pharmaceutical care may improve adherence, clinical effectiveness of providing therapy and improve the health-related quality of life. The conducted literature review confirmed that pharmaceutical care and advanced pharmaceutical services are clinical effective in asthma. The implementation of pharmaceutical care under Polish conditions is currently insufficient and remains challenging for the future. Herein we should admit, that the polish government has recently put an effort to appoint specially dedicated team establishing a program of reimbursed pharmaceutical care. This move should be considered as a new phase for amendments community pharmacy in Poland. The experience of different health care systems, including for instance United Kingdom, Australia or Canada, might be used in the process of changing Polish perspective. Herein, we have reviewed the literature and highlighted the services creating the program of pharmaceutical care in asthma. This unique work describes the complex nature of optimal pharmaceutical services emphasizing the strong necessity of multidimensional approach in this field.The pharmaceutical care is a pharmacist’s contribution to the care of individual patients and leads to optimize the use of drugs. The pharmaceutical care may improve adherence, clinical effectiveness of providing therapy and improve the health-related quality of life. The conducted literature review confirmed that pharmaceutical care and advanced pharmaceutical services are clinical effective in asthma. The implementation of pharmaceutical care under Polish conditions is currently insufficient and remains challenging for the future. Herein we should admit, that the polish government has recently put an effort to appoint specially dedicated team establishing a program of reimbursed pharmaceutical care. This move should be considered as a new phase for amendments community pharmacy in Poland. The experience of different health care systems, including for instance United Kingdom, Australia or Canada, might be used in the process of changing Polish perspective. Herein, we have reviewed the literature and highlighted the services creating the program of pharmaceutical care in asthma. This unique work describes the complex nature of optimal pharmaceutical services emphasizing the strong necessity of multidimensional approach in this field

Adherence to treatment – a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert stand-point

The adherence to treatment is defined as the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore, it is pivotal to know the patient’s true adherence to medication, understand the causes of low adherence, and take actions to improve adherence. The authors assumed that individual, complex health education started during hospitalisation and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, and highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all these activities. Introduction. A substantial proportion of patients with cardiovascular diseases do not respond to the treatment sufficiently [1–3]. Several factors of poor response to medication should be taken into ac-count, including inadequate drug intake [4–6]. To systematise the phenomenon of following medical recommendations, the term “adherence” was proposed. The World Health Organisation (WHO) defines “adherence” as “the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare pro-vider” [7]. Adherence has been also defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result” [8]. Previously the term ‘compliance’ was widely used, particularly in negative concord as ‘non-compliance’. Nowadays ‘compliance’ is associated with a more pejorative connotation than ‘adherence’ because ‘non-compliance issues’ are mostly patient-oriented without a deeper view into the different set of factors, e.g. obstacles identified in the healthcare system. Thus, currently in scientific deliberations we usually prefer usage of the term ‘adherence’ [9].The adherence to treatment is defined as the extent to which a person’s behavior including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore it is pivotal to know the true patient's adherence to medication, understand the causes of low adherence and take actions to improve adherence. The authors assumed that the individual, complex health education started during hospitalization and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all of these activities

The role of pharmacist and place of pharmaceutical care in the therapy of hypertension

Rozpowszechnienie nadciśnienia tętniczego oraz polipragmazja stosowana w jego terapii stanowią wyzwanie dla lekarzy i okazję do współpracy przedstawicieli zawodów medycznych. Narzędziem umożliwiającym optymalizację farmakoterapii jest opieka farmaceutyczna. Opieka farmaceutyczna w nadciśnieniu tętniczym to rozwiązanie efektywne kosztowo i klinicznie. Trwają prace nad wypracowaniem refundowanej opieki farmaceutycznej w warunkach polskiego systemu ochrony zdrowia. Implementowanie opieki farmaceutycznej do praktyki aptecznej umożliwia większą integrację środowiska lekarskiego i aptekarskiego.The prevalence of hypertension and existing polypharmacotherapy used in its treatment is a challenge for physicians and the opportunity to promote across professional collaboration within the healthcare system. Pharmaceutical care is a cost-effective, clinically-effective tool used for pharmacotherapy optimization. Currently government is working on the elaboration of reimbursed pharmaceutical care in the conditions of the Polish health care system. Implementing pharmaceutical care into community pharmacy gives the possibility of greater integration of the medical and pharmacists environment

Opieka farmaceutyczna w terapii astmy — perspektywy polska i globalna

Opieka farmaceutyczna jest wkładem farmaceuty w proces opieki nad pacjentami, co w rezultacie prowadzi do optymalizacji stosowania leków. Może ona wpłynąć korzystnie na przestrzeganie zaleceń terapeutycznych (adherencję) przez pacjentów, poprawiać efektywność kliniczną terapii oraz jakość życia zależną od zdrowia. Przeprowadzony przegląd piśmiennictwa potwierdził, że opieka farmaceutyczna i zaawansowane usługi farmaceutyczne wpływają na efektywność kliniczną i skuteczność terapii astmy. Opieka farmaceutyczna w Polsce jest obecnie niedostateczna i wymaga wielu działań w przyszłości. Polski rząd podjął ostatnio wysiłek utworzenia specjalnej grupy ekspertów, której zadaniem jest opracowanie programu refundowanej opieki farmaceutycznej. Przedsięwzięcie to otwiera nowy etap na drodze doskonalenia praktyki farmaceutycznej w Polsce. W procesie zmiany polskiego systemu można wykorzystać doświadczenie systemów opieki zdrowotnej z innych krajów, w tym Wielkiej Brytanii, Australii lub Kanady. W prezentowanej pracy dokonano przeglądu piśmiennictwa, zwracając uwagę na usługi wchodzące w skład programu opieki farmaceutycznej w leczeniu astmy. W tej unikatowej pracy opisana została złożona natura usług farmaceutycznych i położony nacisk na potrzebę wielowymiarowego podejścia w tej dziedzinie.Opieka farmaceutyczna jest wkładem farmaceuty w proces opieki nad pacjentami, co w rezultacie prowadzi do optymalizacji stosowania leków. Może ona wpłynąć korzystnie na przestrzeganie zaleceń terapeutycznych (adherencję) przez pacjentów, poprawiać efektywność kliniczną terapii oraz jakość życia zależną od zdrowia. Przeprowadzony przegląd piśmiennictwa potwierdził, że opieka farmaceutyczna i zaawansowane usługi farmaceutyczne wpływają na efektywność kliniczną i skuteczność terapii astmy. Opieka farmaceutyczna w Polsce jest obecnie niedostateczna i wymaga wielu działań w przyszłości. Polski rząd podjął ostatnio wysiłek utworzenia specjalnej grupy ekspertów, której zadaniem jest opracowanie programu refundowanej opieki farmaceutycznej. Przedsięwzięcie to otwiera nowy etap na drodze doskonalenia praktyki farmaceutycznej w Polsce. W procesie zmiany polskiego systemu można wykorzystać doświadczenie systemów opieki zdrowotnej z innych krajów, w tym Wielkiej Brytanii, Australii lub Kanady. W prezentowanej pracy dokonano przeglądu piśmiennictwa, zwracając uwagę na usługi wchodzące w skład programu opieki farmaceutycznej w leczeniu astmy. W tej unikatowej pracy opisana została złożona natura usług farmaceutycznych i położony nacisk na potrzebę wielowymiarowego podejścia w tej dziedzinie

The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures — part II

Objectives: The second part of the study was to assess the effects of the types of anaesthesia along with multimodal analgesia on the stability of vital functions at the critical moment of awakening from anaesthesia. Material and methods: The material comprised the medical records at the Department of Anaesthesiology and Intensive Care in Szczecin. The anaesthesia record forms and recovery room observation charts of 150 patients from the Gynaecology Clinic who had undergone category III and IV surgical procedures between October 2018 and January 2019 were selected for analysis. The patients were divided into three groups: 1. Patients given multimodal analgesia with non-opioid and opioid analgesics. 2. Patients given multimodal analgesia with non-opioid analgesics and adjuvants. 3. Patients given multimodal analgesia with non-opioid and opioid analgesics, as well as neuraxial anaesthesia. Results: The average minimum heart rate in the operating room was 63.92 in group I, 61.48 in group II, and 62.34 in group III. The most common cause of bradycardia during surgery was insufflation. The average SBP prior to surgery was similar in groups I and II — 128.74 and 128.66, respectively. The average maximum values during surgery were 135.24 in group I, 139.34 in group II, and 142.32 in group III. At the time of discharge from the post-anaesthetic care unit, all the patients from the study group had achieved an Aldrete score of 10. Following the anaesthesia, 24% of the patients in group I, 22% in group II, and 28% in group III required oxygen therapy. Conclusions: When using multimodal analgesia, the time required to fully awaken even after extensive surgical procedures was no longer than two hours

The polypill in the primary and secondary prevention of cardiovascular diseases — efficacy, clinical safety and impact on the adherence

Mimo ciągłego postępu nauk medycznych częstość występowania chorób układu sercowo-naczyniowego (CVD) stale się zwiększa. Warto podkreślić, że obserwowane w ostatnich dwóch dekadach zmniejszenie o połowę śmiertelności z powodu tej grupy chorób jest głównie skutkiem odpowiedniej prewencji wtórnej. W tym kontekście poprawa stopnia przestrzegania zaleceń terapeutycznych (adherence) pozostaje kluczowym wyzwaniem dla badań i praktyki klinicznej, co podkreślono w wytycznych European Society of Cardiology/American Heart Association w zakresie zapobiegania CVD. W świetle ostatnio opublikowanych badań polypill jest przydatnym narzędziem zwiększającym stopień przestrzegania zaleceń terapeutycznych. Z punktu widzenia technologii farmaceutycznej opracowanie akceptowalnej formulacji dla polypill to zadanie złożone, trudne i kosztochłonne. W istocie szeroka popularyzacja stosowania polypill może przynieść wymierne korzyści systemowi ochrony zdrowia, również polskim pacjentom. Użyteczność takiej formulacji udowodniono w realiach rzeczywistej praktyki klinicznej, w zakresie zwiększania stopnia przestrzegania zaleceń terapeutycznych, bezpieczeństwa oraz skuteczności klinicznej. Ostatnio opublikowanedoniesienia naukowe wskazują ponadto, że polypill poprawia rokowanie pacjentów w prewencji wtórnej CVD. Biorąc pod uwagę postęp nauk medycznych i farmaceutycznych w tym względzie, należy oczekiwać coraz większej liczby produktów leczniczych tego typu na rynku Unii Europejskiej.Despite continuous advances in medicine, the prevalence of cardiovascular disease (CVD) has steadily increased. Interestingly, the half of the overall reduction in CVD mortality observed over the past two decades could be attributed to appropriate treatment for secondary prevention. In this sense, the improvement of adherence remains a key challenge for medical research and clinical practice, which has been also highlighted in the European Society of Cardiology/American Heart Association guidelines on cardiovascular disease prevention. In light of the recently published works. Polypill, defined as a fixed dose combination, is one of the useful tools to improve patients' adherence. Although, from pharmaceutical point of view, the development of an acceptable formulation remains particularly complex and rather expensive, it could essentially improve cost-effectiveness by, for instance, reaching underdeveloped regions. Indeed, polypill may simplify healthcare delivery, support the comprehensive prescription of evidence-based drugs. The use of polypill has been affirmed in the context of daily clinical practice beyond a reasonable doubt by improving adherence, safety and clinical efficacy profile. The results from recently published clinical trials in the area of cardiovascular prevention confirm the benefit of polypill particularly in the secondary prevention. Given the advancements in this field of research, the increased number of polypills in the European Union pharmaceutical market in the near future is warranted

The plague of unexpected drug recalls and the pandemic of falsified medications in cardiovascular medicine as a threat to patient safety and global public health: A brief review

Valsartan, losartan, and irbesartan, are widely used in the treatment strategies of cardiovascular medicine diseases, including hypertension and heart failure. Recently, many formulations for the aforementioned diseases contained active pharmaceutical ingredients and had been abruptly recalled from the market due to safety concerns mainly associated with unwanted impurities — nitrosamines, which are highly carcinogenic substances accidentally produced during manufacturing. Along with cardiovascular medications, formulations containing ranitidine were also recalled from the market. This poses a particular threat to public health due to the non-prescription status of these drugs. Regulatory authorities,  including the Food and Drug Administration and European Medicines Agency among others, have taken action to minimize patient risk and improve the manufacturing quality as well as re-checking current guidelines and recommendations. While these steps are necessary to avoid further recalls, authorities should remember the growing concerns of patients regarding the safety and efficacy of pharmacotherapy. Apart from the genuine manufacturing mistakes mentioned above, falsified and counterfeit medications should be at the heart of global attention. The lack of a well-accepted definition of falsified/counterfeit medications has impeded political and scientific efforts to mitigate risk of this phenomenon. Falsified Medicines Directive should be considered the most pivotal legislation recently enacted to harmonize international cooperation. In summary, one should remember that only international and direct collaboration between patients, stakeholders, and authorities be considered a remedy for a pandemic of falsified medicines and plague of unexpected recalls due to safety concerns.

An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education

Late latent syphilis as a challenging issue in the twenty-first century

Introduction: Syphilis is one of the oldest sexually transmitted diseases caused by the bacterium Treponema pallidum. It is characterized by multiple clinical presentations and a long duration. Acquired syphilis is divided into early (≤ 1 year after infection) and late (> 1 year after infection) stages. Venereal diseases, more often defined as sexually transmitted diseases (STDs), result from behaviours influenced by socio-economic, psychological, and cultural factors. Although the spectrum of sexually transmitted diseases, apart from classic syphilis and gonorrhoea, encompasses a wide range of aerobic and anaerobic bacteria, viruses, protozoans, fungi, and even insects, the frequency of late syphilis has been on the rise in recent years. It is a significant clinical problem in our country. Irrespective of the COVID SARS-19 pandemic, this is an important issue of contemporary epidemiology. Objectives: The objective of this study was to present two cases of women diagnosed with acquired late syphilis of unknown duration, treated at the Department and Clinic of Dermatology at the Poznań University of Medical Sciences. Material and methods: CASE 1 — A 72-year-old female patient was admitted to the Clinic of Dermatology with late latent syphilis of unknown duration. The results of laboratory tests showed: a positive syphilis reaction: FTA-ABS 1:100, TPHA — 1:160. One dose of 2.4 million units of intramuscular benzathine penicillin was administered. It was recommended to administer the second dose of 2.4 million units of benzathine penicillin within 7 days of the first dose. CASE 2 — A 29-year-old female patient was admitted to the Department and Clinic of Dermatology at the Poznań University of Medical Sciences with late latent syphilis of unknown duration. A primary lesion on the right labium major, regional lymphadenopathy, and a rash on the right side of the chest were observed. The results of laboratory tests showed: qualitative TPHA test — positive, quantitative TPHA test — positive (titre 1:180), RPR — positive (RPR – titre 1:1). Conclusions: In recent years, the incidence of late syphilis has been on the rise globally. This disease has again become a significant clinical issue requiring particular attention in dermatological and venereological practice. When syphilis is diagnosed, adequate treatment is necessary in accordance with the updated EADV guidelines.Introduction: Syphilis is one of the oldest sexually transmitted diseases caused by the bacterium Treponema pallidum. It is characterized by multiple clinical presentations and a long duration. Acquired syphilis is divided into early (≤ 1 year after infection) and late ( > 1 year after infection) stages. Venereal diseases, more often defined as sexually transmitted diseases (STDs), result from behaviours influenced by socio-economic, psychological, and cultural factors. Although the spectrum of sexually transmitted diseases, apart from classic syphilis and gonorrhoea, encompasses a wide range of aerobic and anaerobic bacteria, viruses, protozoans, fungi, and even insects, the frequency of late syphilis has been on the rise in recent years. It is a significant clinical problem in our country. Irrespective of the COVID SARS-19 pandemic, this is an important issue of contemporary epidemiology. Objectives: The objective of this study was to present two cases of women diagnosed with acquired late syphilis of unknown duration, treated at the Department and Clinic of Dermatology at the Poznań University of Medical Sciences.  Material and methods: CASE 1 — A 72-year-old female patient was admitted to the Clinic of Dermatology with late latent syphilis of unknown duration. The results of laboratory tests showed: a positive syphilis reaction: FTA-ABS 1:100, TPHA — 1:160. One dose of 2.4 million units of intramuscular benzathine penicillin was administered. It was recommended to administer the second dose of 2.4 million units of benzathine penicillin within 7 days of the first dose. CASE 2 — A 29-year-old female patient was admitted to the Department and Clinic of Dermatology at the Poznań University of Medical Sciences with late latent syphilis of unknown duration. A primary lesion on the right labium major, regional lymphadenopathy, and a rash on the right side of the chest were observed. The results of laboratory tests showed: qualitative TPHA test — positive, quantitative TPHA test — positive (titre 1:180), RPR — positive (RPR – titre 1:1). Conclusions: In recent years, the incidence of late syphilis has been on the rise globally. This disease has again become a significant clinical issue requiring particular attention in dermatological and venereological practice. When syphilis is diagnosed, adequate treatment is necessary in accordance with the updated EADV guidelines