Compliance and medication problems in chronic conditions

Objectives: The project aimed to determine the level of medication compliance in patients having a chronic condition and to determine the types and frequency of medication-related problems identified by a pharmacist working in a community pharmacy. Method: The study population was identified from the database of patients receiving free medicinals under the ‘Pharmacy of your Choice’ scheme from a particular community pharmacy. Patients included in the study were older than 60 years of age and taking more than 3 drugs. A Compliance Questionnaire was distributed to these patients. The pharmacist classified medication problems and used a specifically developed data collection tool in order to collate all the relevant patient information. Key findings: Of the 75 patients included in the study, 33 (44%) said they never missed a dose whilst the remaining 42 (56%) were non-compliant. Out of the 205 medication-related problems identified, the most common medication-related problems observed were non-compliance (56%) and the occurence of adverse drug reactions (55%). Conclusion: Compliance is a significant medication-related problem encountered by community pharmacists amongst elderly patients receiving multiple drug therapy for their chronic conditions.peer-reviewe

COVID-19 and tourism: What can we learn from the past?

The impact of the COVID-19 crisis on tourism flows is without precedent in terms of speed and severity. In this paper, we try to infer a possible future scenario for the tourism sector, evaluating the medium-term effects of past pandemics on tourist arrivals. We find that pandemics lead to a persistent decline in tourist arrivals, with the effects being larger in developing and emerging countries. Interestingly, the effects are heterogeneous across countries and episodes, and depend on several economic conditions such as the overall health system performance, the severity of the shock, and the uncertainty induced by the pandemic event

Functional assessment of the collateral-dependent circulation in chronic total coronary occlusion using transthoracic Doppler ultrasound and venous adenosine infusion

The measurement of collateral flow reserve (CFR; the hyperemic/baseline collateral flow velocity ratio) in patients with chronic total coronary occlusion requires invasive and expensive techniques. Noninvasive transthoracic coronary Doppler echocardiography may be an alternative option. Fifty-one patients with chronic total coronary occlusion were evaluated by transthoracic coronary Doppler echocardiography and venous adenosine infusion to measure CFR in occluded coronary arteries (the left anterior descending artery in 44 patients and the artery supplying the posterior descending artery in 7 patients). CFR data were plotted against 3 angiographic parameters: (1) grade of the epicardial filling of the occluded artery (1=absent, 2=partial, 3=complete), (2) stenosis of the donor artery, and (3) the extent of coronary artery disease (vessels with >or=70% stenosis). Collateral flow was maintained at stress in 34 patients (CFR>or=1, range 1.0 to 2.2) but was withdrawn in 17 patients (CFR<1, range 0.25 to 0.90). CFR increased with the degree of angiographic collateral flow (grade 1: 0.73+/-0.29; grade 2: 1.16+/-0.31; grade 3: 1.34+/-0.49; F=5.31, p=0.008). A multivariate model of CFR prediction showed a direct relation with angiographic collateral grade and the number of diseased vessels and an inverse relation with stenosis of the donor artery. In conclusion, CFR measurement is feasible by transthoracic coronary Doppler echocardiography. One third of the patients with chronic total coronary occlusion had collateral flow withdrawal at stress, which occurs when collateral circulation is poor and when the donor artery is stenotic. CFR correlates with angiographic collateral grade and with the extent of coronary artery disease

Guideline comparison and assessment of prescribing trends in Parkinson's disease

Objective: To assess adherence to guidelines for the management of Parkinson’s disease (PD) by healthcare professionals at the Rehabilitation Hospital Karin Grech (RHKG) in Malta. Method: Retrospective and current data of inpatient medical records at RHKG was collected for 90 patients. Guidelines available at the hospital were reviewed and a comparison was compiled. Data collected and the compiled guidelines were used to assess the level of adherence of treatment decisions to guidelines. Analysis of data was carried out using Microsoft Office Excel® 2007 and SPSS® version 17.0. Key findings: Results show generally high adherence to published guidelines. Out of 22 patients started on co-careldopa therapy at the hospital, 16 had treatment decisions which adhered to guidelines. In the case of co-beneldopa, ropinirole and trihexyphenidyl (benzhexol) treatment, all patients had their treatment decisions implemented according to guidelines. Conclusion: Healthcare professionals at RHKG are aware of the presence of treatment guidelines. The adherence of their treatment decisions to guidelines indicates a good quality of care. Frequent assessment of the level of adherence to guidelines using similar studies will ensure optimisation of treatment.peer-reviewe

Chronopharmacology of antihypertensives

Pharmacological treatments of hypertension are associated with a reduction in cardiovascular risk. The blood pressure of both normotensive and hypertensive patients has a particular pattern associated to the biological clock set according to a circadian rhythm. One of the aims of this study was to test the long acting anti-hypertensive medications, atenolol and perindopril for their chronopharmacological properties in their effect on systolic and diastolic blood pressure levels over a period of 24 hours when administered in the morning or evening. Other aims were to compare blood pressure control in patients on atenolol and perindopril with control and normotensive patients and to obtain hourly systolic and diastolic blood pressure values using the ambulatory blood pressure monitor. An ambulatory blood pressure monitor was applied to the recruited patients for 24 hours and results analysed. Atenolol provides better blood pressure control during the early morning following a morning dose, whilst it results in an elevated blood pressure during the early morning when administered in the evening. Evening administered perindopril did not result in optimum blood pressure control throughout the 24h whilst morning administration resulted in an elevated early morning peak during the critical early morning period.peer-reviewe

Palliative care in cancer patients

In palliative care - the holistic care of patients with advanced disease - managing pain and other symptoms is crucial. This article describes a study aimed at developing pharmacist intervention within a local provider's care programme.peer-reviewe

COVID-19 e turismo: cosa possiamo imparare dal passato?

L'impatto della crisi pandemica causata dal COVID-19 sui flussi turistici è senza precedenti in termini di rapidità e severità. In questo articolo, cerchiamo di ipotizzare un possibile scenario futuro nel settore turistico, valutando gli effetti di medio termine delle pandemie passate sugli arrivi turistici. I risultati mostrano che le pandemie portano a un declino persistente degli arrivi turistici internazionali, con effetti più intensi nei paesi emergenti e in via di sviluppo. Inoltre, le conseguenze negative legate agli eventi pandemici sono eterogenee sia tra paesi sia tra episodi e dipendono da diverse condizioni economiche come la performance del sistema sanitario, la severità dello shock e l'incertezza indotta dall'evento pandemico

Multislice computed tomography in an asymptomatic high-risk population

Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with >or=1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. In conclusion, MSCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk asymptomatic patients with inconclusive or unfeasible noninvasive stress test results

Polymerase chain reaction in the diagnosis and prognosis of Mediterranean visceral leishmaniasis in immunocompetent children

OBJECTIVE: To assess the usefulness of a polymerase chain reaction (PCR) assay amplifying the small subunit rRNA coding region of Leishmania species performed on peripheral blood (PB) and bone marrow (BM) aspirates for the diagnosis and follow-up of visceral leishmaniasis (VL) in children living in the Mediterranean basin. DESIGN: A prospective study was conducted on children consecutively hospitalized over a 1-year period at our Infectious Diseases Department in Sicily (Italy) presenting with fever, hepatosplenomegaly, and/or pancytopenia and a positive Leishmania serology (> or =1:40). RESULTS: Among the 14 patients hospitalized with signs and symptoms suggestive of the disease and a positive serology, we identified 10 cases of Mediterranean VL. PCR performed on PB and BM aspirates was positive in all cases and concordant with microscopy and/or culture performed on BM. Leishmania DNA was cleared from PB a median of 6 days after the start of treatment; during follow-up (median: 9 months; range: 6-12 months) 1 child relapsed. In this case, BM PCR remained positive with rapid reappearance of a positive signal also in PB. CONCLUSIONS: PB PCR allows a rapid and noninvasive parasitologic diagnosis of Mediterranean VL among immunocompetent children and is at least as sensitive as a diagnosis made on the basis of BM aspirates. The lack of disappearance from BM and the reappearance of positive PCR on PB is predictive of clinical relapse. Qualitative and semiquantitative PCR may be the standard method for monitoring response to therapy in immunocompetent childre