Effects of a grape seed oil (Vitis vinifera L.) loaded dermocosmetic nanoemulgel on biophysical parameters of facial skin: A prospective, randomized, placebo-controlled, single-blind, and split-face study

Background Grape seed oil contains different bioactive constituents like carotenoids, resveratrol, catechin, epicatechin, gallic acid, flavonoids, procyanidin, and anthocyanins that can have protective effects on the human skin. Nanoemulgels are novel delivery systems that can be used to delivery bioactive compounds that are often extracted from plants to the human skin. Aims This prospective, randomized, placebo-controlled, single-blind, and split-face study will be conducted to develop and evaluate the effects of a grape seed oil (Vitis vinifera L.) loaded dermocosmetic nanoemulgel on biophysical parameters of facial skin. Methods This study will be conducted in a prospective, randomized, placebo-controlled, single-blind, and split-face design. Healthy volunteers will be recruited for this prospective study based on the following inclusion criteria: - Health - Absence of skin abnormalities/diseases - 18-26 years old Subjects with sin diseases will be excluded from the study. The grape seed oil (Vitis vinifera L.) loaded dermocosmetic nanoemulgel will be developed and tested on the facial skin of the volunteers. A nanoemulgel without grape seed oil (Vitis vinifera L.) loading will be used as a placebo. Measure of outcomes The following outcomes will be measured in this study: - Skin erythema - Melanin levels - Production of sebum - Facial pores - Moisture contents - Skin elasticity Significance Findings of this study could be interesting to developers of cosmetic products

Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders

Background. In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities. Methods. A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case. Results. Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7%  ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7%  ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3%  ± 5.2%). Conclusions. Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients

Quality Indicators of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: Findings of a Qualitative Study among Stakeholders

Background. Recently, there has been shifts from providing large volumes to providing higher quality of healthcare services. This qualitative exploratory study was conducted to explore the views of different stakeholders on activities and services that could serve as quality indicators of pharmaceutical care in Palestinian integrative healthcare facilities. Methods. A judgmental sampling technique was used to invite and recruit stakeholders for this study. Semistructured in-depth interviews were conducted with the stakeholders. Data collected during the interviews were qualitatively analyzed using the interpretive description methodology. Themes, subthemes, and patterns were recognized using the Qualitative Analysis Guide of Leuven. The data were coded using RQDA software. Results. Interviews (n = 22) were conducted with 9 complementary and alternative medicine practitioners, 8 pharmacists, 2 physicians, 2 nurses, and 1 risk/quality assurance manager. The interview median duration was 41 with an IQR of 22 min. Following the thematic analysis adopted to achieve the objectives of this study, six major themes emerged from the data collected from the interviews. The themes emerged from the data were (1) provision of collaborative, direct, and comprehensive patient care services; (2) common services and activities at the time of admission, during stay, at transition between wards/services/hospitals, and at discharge to home or community care; (3) screening for, identifying, and resolving problems; (4) collaboration with other healthcare providers; (5) professional development; and (6) performance and efficiency. Conclusions. Quality indicators are invaluable for informing decisions relevant to justifying allocation of scarce resources, securing funds, and demonstrating value in activities and services within integrative healthcare facilities. Further studies are still needed to develop a set of measurable indicators to measure the impact of pharmaceutical care in integrative healthcare facilities

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

Background. Recently, measuring and benchmarking provision of healthcare services has drawn a considerable attention. This scoping review was conducted to identify, describe, and summarize studies in which the Delphi technique was used to develop quality indicators of pharmaceutical care. The study also aimed to identify activities and services that could be used to capture the impact of pharmacist in integrative medicine. Methods. Databases were searched from inception to February 2020 using key terms that were combined using Boolean operators. Studies were included if they were relevant to development of quality indicators of pharmaceutical care with regard to medications or complementary and alternative medicine (CAM) modalities. Full text of the selected studies was imported into EndNote. Studies were screened and data were extracted into a standard extraction form. Results. Data were extracted from 31 studies. Of those, 24 (77.4%) were related to provision of pharmaceutical services relevant to medications and 7 (22.6%) were related to provision of care using CAM modalities. Most of the studies (67.7%) were published in 2010 and beyond. Almost half of the studies (48.4%) originated from the United States, United Kingdom, and Canada. A total of 42 different activities and services that could be used as quality indicators were identified from the studies included in this review. Activities and services were related to history taking, performing reconciliations, identifying and resolving therapy problems, providing collaborative care, designing care plans, optimal performance, and continuing education. Conclusions. Although there is an increasing interest in improving healthcare delivery, quality indicators of pharmaceutical services and those relevant to CAM provision in healthcare facilities adopting the integrated healthcare paradigm are still limited. Future studies are needed to develop validated quality indicators that could be successfully used in measuring and benchmarking quality of services in integrated healthcare facilities

A systematic scoping review to understand how to capture impact of pharmacists in hospitals through the electronic health record systems

Protocol: A systematic scoping review to understand how to capture impact of pharmacists in hospitals through the electronic health record systems Author: Ramzi Shawahna, Hazem Salem -------------------------------------------------- PROTOCOL -------------------------------------------- Background Electronic health record systems are increasingly used in many healthcare systems around the world. Pharmacists are important healthcare providers in all healthcare systems (Shawahna 2019a, 2020a). Currently, many of the electronic health record systems do not capture the impact of pharmacists in providing healthcare services to hospitalized patients (Shawahna 2019b). Objectives In this systematic scoping review, we aim to collect, describe, and summarize documents reporting on the impact of pharmacists in healthcare systems as shown through electronic health record systems. The other objectives were to identify and describe the pharmaceutical services that could be collected and captured through the electronic health record systems and how the current electronic health record systems can be upgraded to collect and capture the impact of pharmacist in providing healthcare services to hospitalized patients. Methods Strategy of the literature search Databases MEDLINE/PUBMED, COCHRANE, CInAHL/EBESCO, EMBASE, PsycINFO, and SCOPUS will be searched. Keywords Keywords relevant to pharmacist, pharmaceutical care/services/activities and electronic health/patient record/system will be used. The Boolean operators “OR” and “AND” will be used to combine the keywords. The results will be filtered for those published in English. Google Scholar database will be searched to identify documents from the gray literature. References of the collected studies will be searched manually. Study selection The identified studies will be screened by at least two researchers independently. Studies will be imported as Research Information Systems (RIS) and Comma Separated Values (CSV) files. Duplicates will be removed. Discrepancies will be resolved by discussion and consensus. Inclusion criteria - Documents reporting on the development of electronic health record systems to capture pharmaceutical services - Documents reporting on the use of electronic health record systems - Documents reporting on the impact of pharmacists through electronic health record systems Exclusion Criteria - Documents reported in languages other than English - Documents lacking data relevant to the impact of pharmacist electronic health record systems Data extraction and data synthesis At least two researchers will independently extract data into standardized data extraction form in Microsoft Excel Spreadsheet. Pharmaceutical services that could be collected and captured through the electronic health record systems will be collected. The data will be synthesized qualitatively (Shawahna 2020b, Shawahna et al. 2021). Discrepancies will be resolved by discussion and consensus. Discussion This is the first systematic scoping review that will be conducted to collect, describe, and summarize documents reporting on the impact of pharmacists in healthcare systems as shown through electronic health record systems. This systematic scoping review will also identify and describe the pharmaceutical services that could be collected and captured through the electronic health record systems and how the current electronic health record systems can be upgraded to collect and capture the impact of pharmacist in providing healthcare services to hospitalized patients. Findings of this study are expected to inform decision makers in healthcare and designers/developers of electronic health record systems to upgrade the current systems to allow capturing the impact of pharmacists and improving healthcare delivery to the hospitalized patients. References Shawahna R (2019a): Development of key performance indicators to capture in measuring the impact of pharmacists in caring for patients with epilepsy in primary healthcare: A Delphi consensual study. Epilepsy Behav 98, 129-138. Shawahna R (2019b): Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study. BMC Med Inform Decis Mak 19, 216. Shawahna R (2020a): Development of Key Performance Indicators for Capturing Impact of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: A Delphi Consensus Study. Evid Based Complement Alternat Med 2020, 7527543. Shawahna R (2020b): Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique. Evid Based Complement Alternat Med 2020, 9131850. Shawahna R, Batta A, Asa'ad M, Jomaah M &amp; Abdelhaq I (2021): Exercise as a complementary medicine intervention in type 2 diabetes mellitus: A systematic review with narrative and qualitative synthesis of evidence. Diabetes Metab Syndr 15, 273-286

Development of Key Performance Indicators for Capturing Impact of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: A Delphi Consensus Study

Background. The current study was performed to develop a consensus-based core inventory of key performance indicators (KPIs) to be used in capturing the impact of pharmaceutical care in healthcare facilities that employ integrative medicine paradigm in Palestine. Methods. A panel of healthcare professionals and risk/quality assurance managers was composed employing a judgmental sampling technique. The study tool was a questionnaire. Views and opinions of the panelists on the roles of pharmacists in caring for patients admitted to or visiting healthcare facilities that employ integrative medicine were collected using 11 statements. An initial inventory of activities and services that potentially can be used as KPIs was compiled from the literature and interviews with key contact experts in the domain. Three iterative Delphi rounds were conducted among the panelists (n = 50) to achieve formal consensus on the KPIs that should be used. The consensus-based KPIs were ordered by the scores of the panelists. Results. A total of 8 consensus-based KPIs were developed. The KPIs related to the number of problems related to medications and complementary and alternative medicine (CAM) that were resolved by pharmacists and CAM practitioners (p < 0.0001), number of patients for whom reconciliations were documented (p < 0.0001), number of patients receiving direct, comprehensive, and/or collaborative care (p < 0.0001), and number of patients for whom pharmacists and CAM practitioners were involved in implementing a therapeutic plan (p < 0.05) were rated significantly higher than the KPI (#8) related to the participation in multi-healthcare provider discussions/deliberations. Conclusions. Consensus-based KPIs that can be used in capturing the impact of evidence-based CAM and pharmaceutical care of patients in healthcare facilities that employ integrative medicine paradigm were developed. Future studies are still needed to investigate if implementing these KPIs might promote evidence-based CAM and pharmaceutical care in healthcare facilities that employ the integrative medicine paradigm

Expression génomique et protéomique quantitative des transporteurs et des enzymes du métabolisme au niveau de la barrière hémato-encéphalique humaine

Le passage des médicaments dans le cerveau est un processus qui implique souvent des transporteurs éventuellement couplés avec des enzymes du métabolisme. Au niveau de la barrière hémato-encéphalique (BHE), ces transporteurs et enzymes contribuent à modifier la pharmacocinétique cérébrale des médicaments. Leurs activités sont souvent corrélées a leur niveau d expression protéique. Dans la première étude, nous avons réalisé une quantification relativement exhaustive de l expression génomique et protéomique de 71 transporteurs SLC et OST, 34 transporteurs ABC, et 51 enzymes des les phases I et II dans des microvaisseaux cérébraux humain fraîchement isolées. Notre étude a montré que les transporteurs du glucose et des acides aminés sont les principaux transporteurs exprimés. La protéine ABCG2/BCRP était 1,6 fois plus exprimée que l ABCB1/MDR1. Les CYP1B1 et CYP2U1 étaient quantifiables au niveau génomique et protéomique. Les GSTs sont fortement exprimées, dans les microvaisseaux cérébraux alors que les UGTs n ont pu être détectées. Dans la seconde étude, nous avons quantifié l'expression relative des gènes marqueurs de type cellulaire, les transporteurs SLC et ABC, les enzymes de la phase I et la phase II et certains facteurs de transcription dans un modèle in vitro optimisé de la BHE humaine : la lignée hCMEC/D3. Les cellules hCMEC/D3 sont moins fenêstrées par rapport aux cellules non-cérébrales (HUVEC) : en effet, PLVAP, marqueur de la fenestration, est 70,7 fois moins exprimé dans la lignée hCMEC/D3. Comme les microvaisseaux cérébraux humains, les cellules hCMEC/D3 expriment fortement les transporteurs du glucose et des acides aminés. Le traitement avec le chlorure de lithium (LiCl), agoniste de signalisation Wnt/b-caténine, enrichit l'expression de l ABCG2/BCRP et l ABCC5/MRP5 et du CYP1A1 de 5,6 fois, 2,5 fois et 9,1 fois, respectivement. Tout comme les microvaisseaux cérébraux, les cellules hCMEC/D3 expriment fortement les GSTs et le facteur de transcription AhR.Drug entry and distribution into the brain is a delicate process as modulated by the interaction between the drug molecule with influx and/or efflux drug transporters as well as metabolizing enzymes at the blood-brain barrier (BBB). The transport and metabolic activities of transporters and enzymes are often correlated with their protein amounts. In the first study, we are reporting a relatively exhaustive quantitative gene expression and absolute protein quantification of 71 solute carrier (SLC) and organic solute (OST) transporters, 34 ATP-binding cassette (ABC) transporters, and 51 phase I and phase II metabolizing enzymes in freshly isolated human brain microvessels. Our study showed that glucose and amino acid transporters were the main uptake transporters expressed. Interestingly, our study showed that ABCG2/BCRP protein was 1.6-fold more than ABCB1/MDR1. CYP1B1 and CYP2U1 were quantifiable at both gene and protein levels. Interestingly, microvessels highly expressed GSTs, whereas, UGTs were completely absent. In the second study, we quantitatively investigated the gene expression of cell type markers, SLC and ABC transporters, phase I and phase II metabolizing enzymes and some transcriptional factors in an optimized in vitro human BBB model (hCMEC/D3). The hCMEC/D3 cells were less fenestrated as compared to non-cerebral (HUVEC) cells as shown by PLVAP which was less expressed by 70.7-fold in hCMEC/D3 cells. In accordance with human brain microvessels, hCMEC/D3 expressed glucose and amino acids transporters. Treatment with the Wnt/b-catenin agonist, lithium chloride (LiCl), enriched the gene expression of ABCG2/BCRP and ABCC5/MRP5 and CYP1A1 by 5.6-fold, 2.5-fold and 9.1-fold, respectively. Similar to microvessels hCMEC/D3 cells highly expressed GSTs and the transcriptional factor AhR.PARIS-BIUP (751062107) / SudocSudocFranceF

Which Benefits and Harms of Using Fenugreek as a Galactogogue Need to Be Discussed during Clinical Consultations? A Delphi Study among Breastfeeding Women, Gynecologists, Pediatricians, Family Physicians, Lactation Consultants, and Pharmacists

Background. Breastfeeding women with hypogalactia are commonly recommended to use fenugreek as a galactogogue. This study aimed to achieve formal consensus among breastfeeding women and healthcare providers on which potential harms and benefits of using fenugreek need to be communicated and discussed during clinical consultations. Methods. A two-iterative round Delphi technique was used in two separate panels of breastfeeding women (n=65) and healthcare providers (n=56) to achieve formal consensus on a list of 24 and 16 items related to potential harms and benefits of fenugreek. Results. About 70% of the healthcare providers recommended quite often herbal remedies for breastfeeding women and about 68% of the women had been recommended to use herbal remedies many times by their healthcare providers. Consensus was achieved on 21 potential harms and 14 potential benefits of using fenugreek to enhance human milk supply that need to be discussed with breastfeeding women during consultations. Conclusion. Probably, potential harms and benefits of recommending fenugreek as herbal galactogogue for breastfeeding women seeking recommendations to increase their human milk supply need to be discussed during clinical consultations. Further observational studies are needed to assess what is being discussed in daily consultations when herbal remedies are recommended