Documenting of extravasation of cytotoxic agents

As a potential complication of a systemic administration of cytotoxic agents, extravasation requires particular caution of all health practitioners involved in treatments of oncological patients. In the light of the fact that more than 100.000 doses of chemotherapy are indicated worldwide and more than 1.000.000 intravenous infusion of cytostatic drugs are administered on daily bases, it is upsetting that in the case of cytostatic administration through peripheral intravenous cannulas extravasation occurs in 0,5 to 6% of oncological patients, while in the case of administration through central venous lines it occurs in 6% of the cases. Each extravasation results in tissue damage and depending on type and features of the administered substance can be manifested in different forms, from skin reaction to tissue necrosis. By highlighting the multiple significance of documenting and accident reporting, the authors state the necessary elements and propose the form of a nurse documenting list for the cases of extravasation of cytostatic agents. A nurse must document the following data on an accident: patient's name and surname, date of birth, name of the clinics, primary oncological diagnosis, date and time of extravasation, name of the cytotoxic drug, symptoms and signs of extravasation and the measures undertaken. The accurate documenting and reporting of accidents are legally binding for health practitioners, particularly nurses, as a result of the need to map the risk factors of their occurrence, to assess compliance of the standard nursing procedures in administration of cytostatic therapy, to follow up the course of the management of complications, outcomes and the undertaken measures but also to improve the existing and develop new preventive strategies

Person-Centred Care Interventions in Pharmaceutical Care

This chapter is divided into four sections. The first section introduces the concept of person-centred care within pharmaceutical care delivery and provides a historical context. The second section focuses on the professionals and explores the role of person-centred pharmaceutical care as part of multi-disciplinary health services delivery teams. The third section focuses on the patient and describes the role of health literacy in the implementation of person-centred pharmaceutical care. The last section examines E-pharmacy services and the implementation of telepharmacy with implications for person-centred care

Ocena i samoocena kompetencija farmaceuta u Srbiji korišćenjem globalnog okvira kompetencija

Background/Aim. Pharmacists' competence represents a dynamic framework of knowledge, skills and abilities to carry out tasks, and it reflects on improving the quality of life and on patients' health. One of the documents for the Evaluation and Competency Development of Pharmacists is the Global Competency Framework (GbCF). The aim of this study was to implement the GBCF document into Serbian pharmacies, to perform assessment and self assessment of the competencies. Methods. The assessment and self-assessment of pharmacists' competencies were performed during the period 2012-13 year in eight community pharmacy chains, in seven cities in Serbia. For assessment and self-assessment of pharmacists competencies the GbCF model was applied, which was adjusted to pharmaceutical practice and legislation in Serbia. External assessment was conducted by teams of pharmacists using the structured observation of the work of pharmacists during regular working hours. Evaluated pharmacists filled out the questionnaire about demographic indicators about the pharmacist and the pharmacy where they work. Results. A total of 123 pharmacists were evaluated. Pharmacists' Professional Competency Cluster (KK1) had the lowest score (average value 2.98), while the cluster Management and Organizational Competency (KK2) had the highest score (average value 3.15). The competence Recognition of the Diagnosis and Patient Counseling (K8), which belonged to the cluster KK1, had the lowest score (average value for assessment and self-assessment were 2.09, and 2.34, respectively) among the all evaluated competencies. Conclusion. GbCF might be considered as an instrument for the competencies' evaluation/self-evaluation and their improvement, accordingly.Uvod/Cilj. Kompetencije farmaceuta predstavljaju dinamični okvir i obuhvataju znanja, veštine i sposobnosti da se izvrše zadaci sa ciljem unapređenja kvaliteta života i zdravlja bolesnika. Jedan od dokumenata za ocenu i razvoj kompetencija farmaceuta je globalni okvir stručnosti - Global Competence Framework (GbCF). Cilj ovog rada bio je primena GbCF u apotekama u Srbiji i ocena i samoocena kompetencije farmaceuta. Metode. U periodu 2012-2013. godine izvršena je ocena i samoocena kompetencije farmaceuta u osam apotekarskih lanaca iz sedam gradova u Srbiji. Za ocenu i samoocenu stručnosti farmaceuta primenjen je model GbCF, prilagođen praksi i zakonodavstvu u Srbiji. Eksternu ocenu izvršili su timovi farmaceuta kroz strukturiranu opservaciju (upotrebom GbCF dokumenta) kompetencija farmaceuta tokom radnog vremena. Ocenjivani farmaceuti su popunili i upitnik o demografskim pokazateljima koji su se odnosili na podatke o samom farmaceutu i apoteci u kojoj radi. Rezultati. Ocenjena su ukupno 123 farmaceuta. Najviša ocena kompetencija farmaceuta zabeležena je za skup 'Upravljanje i organizacija' (KK2) (srednja vrednost 3,15), dok je skup 'Stručno znanje' (KK1) (srednja vrednost 2,98) ocenjen najnižom ocenom. Kompetencija K8 - 'Prepoznavanje dijagnoze i savetovanje bolesnika', koje pripadaju skupu KK1, imale su najniži skor (srednja vrednost u proceni i samoproceni iznosila je 2,09 i 2,34, respektivno) posmatrajući sve, kompetencije. Zaključak. Dokument za ocenu i razvoj kompetencija farmaceuta GbCF može služiti kao instrument za ocenu/samoocenu kompetencije, a samim tim i za njihovo poboljšanje

Analiza, adaptacija i validacija dokumenta za procenu kompetencija farmaceuta

The competency of a pharmacist is one of the fundamental preconditions for high quality pharmaceutical care provision. The General Lever Framework (GLF), which was developed by a group of British experts (Competency Development and Evaluation Group - CoDEG), represents a tool that allows definition, measurement and professional competences development of the pharmacist during pharmaceutical care provision. Community Pharmacy Subotica organized an expert panel in order to analyze, adapt and validate the GLF document, which would be relevant to pharmacy practice in Serbia. The aim of the paper is to present the adaptation process of the GLF document that could be used in community pharmacies in Serbia. Validation of the document was performed using the expert panel methodology. The document was analyzed in terms of relevance, comprehension, compliance with national regulation, and applicability in practice, through anonymous evaluation and discussion of the expert panel participants. Titles and descriptions of each competence (26 in total) were validated. The document for the competence assessment was adapted in accordance with the pharmacy practice and regulations in Serbia. All the competencies of the original document were accepted, with minor modifications in order to accommodate pharmaceutical practices and regulations in Serbia. GLF document, have shown satisfactory properties to be used in the pharmacy practice in Serbia, based on the adaptation carried out by the expert panel.Kompetentnost farmaceuta jedan je od osnovnih preduslova za obezbeđivanje farmaceutske zaštite visokog kvaliteta. Okvir opšteg nivoa (eng. General Level Framework - GLF) koji je razvila grupa britanskih stručnjaka (eng. Competency Development and Evaluation Group - CoDEG) obuhvata odgovarajući upitnik i metode koje omogućavaju definisanje, procenu i razvoj stručne osposobljenosti farmaceuta u pružanju farmaceutske zdravstvene zaštite. U okviru Apoteke Subotica je iniciran i organizovan panel eksperata radi analize, adaptacije i validacije GLF dokumenta za primenu u javnim apotekama u Srbiji. U radu je dat prikaz adaptacije GLF dokumenta za primenu u javnim apotekama u Srbiji. Dokument je analiziran sa aspekta relevantnosti, razumljivosti, nacionalne regulative i primenljivosti u praksi putem anonimnih ocena i diskusije učesnika panela eksperata. Validirani su nazivi i opisi 26 kompetencija farmaceuta identifikovanih u hrvatskoj verziji originalnog dokumenta. Dokument za procenu kompetencija farmaceuta prilagođen je farmaceutskoj praksi i regulativi u Srbiji, pri čemu su, uz odgovarajuće, manje, izmene s ciljem prilagođavanja farmaceutskoj praksi i regulativi u Srbiji, prihvaćene sve kompetencije iz originalnog dokumenta. GLF dokument je, na osnovu adaptacije sprovedene od strane panela eksperata, pokazao zadovoljavajuće karakteristike za primenu u farmaceutskoj praksi u Srbiji

Upotreba antibiotika u terapiji infekcija urinarnog trakta

Antibiotics are the gold standard in treating and preventing recurrent urinary tract infections (UTIs), but their widespread, irrational use leads to the development of antimicrobial resistance (1,2). The aim of this study was to analyze the use of antibiotics in patients with UTIs symptoms. An online survey for patients was disseminated by researchers and community pharmacists during the winter 2020/21. The study was approved by the Ethical Committee of the University of Belgrade – Faculty of Pharmacy. The study included 736 respondents, 31.5 years of age in average, and most of them were women (80.8%). Approximately 40% of patients reported that they experienced symptoms of UTIs in previous years, and 49.3% of patients did not seek a counsel of health care professionals, and rather had used therapy following the advice of friends, family members or by their opinion. A smaller number of patients used antibiotics in therapy (n=178, 24.2%) prescribed by the doctor (79.2% of patients), and in some cases without prior consultation with a doctor (20.8% of patients). Antibiotics successfully treated 70% of UTIs. According to data collected from 133 patients, 17 different antibiotics were used in UTI treatment. The most used antibiotics were: ciprofloxacin (23.3%), cephalexin (17.3%) and fosfomycin (14.3%). Antibiotics used for UTIs treatment didn’t comply with the European Association of Urology guidelines. Considering that the use of medicines could be initiated by patients and therefore be unreported, the use of medicines for UTIs should be analysed both from clinical patients’ data records and individual patients’ reports.Antibiotici predstavljaju zlatni standard u lečenju i prevenciji rekurentnih infekcija urinarnog trakta (IUT), ali njihova učestala, neracionalna upotreba dovodi do razvoja antimikrobne rezistencije (1,2). Cilj ovog istraživanja bio je da se analizira upotreba antibiotika kod pacijenata sa simptomima IUT. Istraživači i farmaceuti u javnim apotekama su distribuirali pacijentima onlajn anketu tokom zime 2020/21. Studiju je odobrila Etička komisija Farmaceutskog fakulteta – Univerziteta u Beogradu. Istraživanjem je obuhvaćeno 736 ispitanika, prosečne starosti 31,5 godina, među kojima su najviše bile žene (80,8%). Približno 40% pacijenata je izjavilo da su imali simptome IUT tokom prethodne godine, od kojih 49,3% pacijenata nije tražilo savet zdravstvenih profesionalaca, već je koristilo terapiju po savetu prijatelja, članova porodice ili po njihovom sopstvenom mišljenju. Manji broj pacijenata koristio je antibiotike u terapiji (n=178, 24,2%) na osnovu lekarskog recepta (79,2% pacijenata), a u pojedinim slučajevima i bez prethodne konsultacije sa lekarom (20,8% pacijenata). Antibiotici su uspešno lečili 70% IUT. Prema podacima prikupljenim od 133 pacijenta, u lečenju IUT korišćeno je 17 različitih antibiotika. Najviše korišćeni antibiotici su: ciprofloksacin (23,3%), cefaleksin (17,3%) i fosfomicin (14,3%). Antibiotici koji su korišćeni za lečenje IUT nisu bili u skladu sa smernicama Evropskog udruženja za urologiju. Budući da pacijenti u nekim slučajevima sami započinju terapiju bez prethodne konsultacije sa lekarima, upotrebu lekova za IUT treba analizirati kako na osnovu kliničkih podataka pacijenata, tako i iz izveštaja pojedinačnih pacijenata.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Diabetes in Serbia: trends in antidiabetic drug consumption from 2012 to 2021

Kao jedan od najvećih javnozdravstvenih izazova diabetes mellitus predstavlja razlog konstantnog unapređenja farmakoterapije (1). Savremena terapija diabetes mellitus-a može promeniti tok bolesti, prevenirati komplikacije i doprineti uštedi u zdravstvu (2). Cilj rada bio je da se analizira potrošnja antidijabetika u Srbiji, u periodu od 2012. do 2021. godine i usklađenost sa preporukama Nacionalnog vodiča. Podaci o potrošnji antidijabetika prikupljeni su iz publikacija Agencije za lekove i medicinska sredstva Srbije. Za svaki internacionalni nezaštićen naziv (INN), praćena je potrošnja izražena u standardizovanoj jedinici - definisanoj dnevnoj dozi na 1000 stanovnika u danu (DDD/1000 stanovnika/dan). Najveća potrošnja antidijabetika tokom ispitivanog perioda primećena je 2020. godine, dok je najniža bila 2012. godine. Potrošnja antidijabetika u 2021. godini iznosila je 92,18 DDD/1000 stanovnika/dan što je za 23,73% više u odnosu na 2012. godinu. Među ovom grupom lekova dominira upotreba oralnih antidijabetika koji se u proseku primenjuju 4,45 puta više u odnosu na insulin i analoge. Najzastupljeniji lekovi u ukupnoj potrošnji antidijabetika do 2017. godine bili su sulfonamidi i derivati sulfonilureje kada su u proseku činili 43,39%. Nakon 2017. godine prvo mesto po potrošnji zauzima metformin, čiji udeo u ukupnoj potrošnji antidijabetika dostiže 48,75% u 2021. godini. Potrošnja novih oralnih antidijabetika je veoma mala i ne prelazi 0,1% ukupne potrošnje tokom ispitivanog perioda. Ipak najveći porast je primećen u upotrebi inhibitora natrijum-glukoznog kotransportera 2 (SGLT2) (3,19 DDD/1000 stanovnika/dan u 2021. godini nasuprot 0,001 DDD/1000 stanovnika/dan u 2015. godini). Rastući trend potrošnje posebno je izražen kod metformina i SGLT2 inhibitora. Rezultati ukazuju na usklađenost primene antidijabetika sa preporukama Nacionalnog vodiča.As one of the biggest public health challenges, diabetes mellitus represents the reason for the constant pharmacotherapy improvement (1). Modern therapy of diabetes mellitus can alter the course of the disease, prevent complications, and contribute to healthcare savings (2). This study aimed to analyze the consumption of antidiabetic drugs in the Republic of Serbia from 2012 to 2021 and compliance with the recommendations of the National Guide. The consumption of all registered antidiabetic drugs was obtained from publications of the Medicines and Medical Devices Agency of Serbia. For each International Nonproprietary Name (INN), consumption was monitored and expressed in a standardized unit-defined daily dose per 1000 inhabitants per day (DDD/1000 inhabitants/day). During the study period, the highest consumption was observed in 2020, while the lowest was in 2012. Antidiabetic drug consumption in 2021 amounted to 92.18 DDD/1000 inhabitants/day, which is 23.73% higher compared to 2012. The consumption of oral antidiabetics was dominant, on average 4.45 times more than insulin and analogs. The most commonly used drugs until 2017 in total antidiabetic consumption were sulfonylureas and sulfonylurea derivatives, constituting an average of 43.39%. After 2017, metformin took the lead in consumption, reaching 48.75% of total antidiabetic consumption in 2021. New oral antidiabetic drugs do not exceed 0.1% of the total consumption during the examined period. However, sodium-glucose cotransporter-2 (SGLT2) inhibitors (3.19 DDD/1000 inhabitants/day in 2021 compared to 0.001 DDD/1000 inhabitants/day in 2015) noted the most significant increase. The increasing consumption trend is particularly pronounced for metformin and SGLT2 inhibitors. The results indicate compliance in the use of antidiabetic drugs with the National Guide recommendations.Treći naučni simpozijum Saveza farmaceutskih udruženja Srbije sa međunarodnim učešćem „Lekovi za specifične populacije pacijenata: inovacijama ka unapređenju zdravstvenih ishoda“, Niš, Srbija, 26. oktobar 2023

The impact of education of breast cancer patients during the use of antineoplastic therapy on anxiety, depression and stress

SAŽETAK Uvod: Karcinom je kompleksno oboljenje sa visokim rizikom za nastanak komorbiditeta, uključujući i mentalne poremećaje, i značajan je javnozdravstveni problem na globalnom nivou. Oboleli od karcinoma, posebno u toku lečenja, imaju povećan rizik za razvoj mentalnih poremećaja u poređenju sa osobama koje su izlečene ili nemaju dijagnozu karcinoma. Savremena epidemiološka istraživanja su pokazala da, u proseku, 1/3 obolelih od karcinoma na hospitalnom lečenju ima neki mentalni poremećaj koji zahteva dalju pažnju i adekvatan tretman. Klinička procena i praćenje obolelih od karcinoma sa mentalnim poremećajima zahteva sistematski pristup i pružanje psihoonkoloških intervencija, uključujući i specifičnu edukaciju bolesnika od strane zdravstvenih radnika. To je od velikog značaja za bolesnike na peroralnoj hemioterapiji, s obzirom na činjenicu da mentalni poremećaji imaju negativan uticaj na komplijantnost/adherentnost bolesnika i ishode njihovog lečenja. Iz tog razloga, postoji potreba za identifikacijom najbolje prakse u ovoj oblasti. Ciljevi ovog istraživanja su bili da se proceni uticaj strukturisane edukacije bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji na anksioznost, depresivnost i stres, da se utvrdi prisustvo anksioznosti, depresivnosti i stresa pre početka hemioterapije (edukacije) i u toku terapije (jedna i tri nedelje nakon edukacije), kao i da se utvrdi njihova povezanost sa sociodemografskim karakteristikama bolesnica. Bolesnici i metode: U istraživanje je uključeno 142 bolesnice sa karcinomom dojke koje se primale peroralnu antineoplastičnu terapiju (kapecitabin) u Institutu za onkologiju i radiologiju Srbije u 2016. i 2017. godini. Bolesnice su randomizovane u dve studijske grupe: eksperimentalna grupa je imala dodatnu, individualnu, strukturisanu, specifičnu edukaciju, pre hemioterapije, prema srpskoj verziji priručnika Multinacionalne asocijacije za suportivnu terapiju karcinoma (Multinational Association of Supportive Care in Cancer-MASCC) za edukaciju bolesnika na oralnoj antineoplastičnoj terapiji (Oral Agent Teaching Tool-OATT)-MOATT V1.0, a kontrolna grupa je imala uobičajenu, standardnu edukaciju. Bolesnice su praćene 3 nedelje, u toku prvog ciklusa hemioterapije. Korišćena su dva instrumenta za prikupljanje podataka: posebno kreiran, za potrebe ovog istraživanja, sociodemografski upitnik i srpska verzija DASS-21 skale(Depression Anxiety Stress Scales-DASS-21) za samoprocenu simptoma depresivnosti, anksioznosti i stresa. Rezultati: Pre početka hemioterapije kapecitabinom i edukacije, bolesnice sa karcinomom dojke su imale simptome depresivnosti (29.58%), anksioznosti (35.92%) i stresa (21.13%), najviše blage i umerene. Ovi simptomi su se smanjili u celoj grupi bolesnica posle prve i treće nedelje od edukacije, sa značajnom razlikom u promeni statusa skora depresivnosti i anksioznosti. Depresivnost, anksioznost i stres značajno su se smanjili u eksperimentalnoj grupi bolesnica od inicijalnog merenja (pre edukacije) do merenja nakon prve i nakon treće nedelje od edukacije, u odnosu na kontrolnu grupu bolesnica. Konstatovana je i značajna povezanost anksioznosti, i/ili depresivnosti, i/ili stresa i životnog doba bolesnica, njihovog nivoa obrazovanja, radnog, bračnog i statusa roditeljstva, samoće, materijalnog stanja, porodičnih odnosa, podrške supruga, kontakata sa rođacima i prijateljima, kao i organizovanja slobodnog vremena. Zaključci: Strukturisana edukacija ima značajan uticaj na smanjenje simptoma depresivnosti, anksioznosti i stresa kod bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji. Rutinska klinička procena simptoma depresivnosti, anksioznosti i stresa kod obolelih od karcinoma dojke poželjna je na početku i u toku hemioterapijskog tretmana. Značajna je identifikacija bolesnica kojima je potrebno dalje stručno praćenje i psihoedukativna podrška. Organizovana, strukturisana, individualna edukacija može imati i javnozdravstveni značaj kroz uvođenje strukturisane edukacije obolelih od karcinoma dojke kao standardne intervencije i posebne zdravstvene usluge, a koja utiče na kvalitet zdravstvene zaštite, bezbednost bolesnika i jačanje zdravstvenog sistema u celini.ABSTRACT Introduction: Cancer is a complex disease with a high risk of developing comorbidities, including mental disorders, and is a significant public health problem globally. Cancer patients, especially those who are undergoing treatment, have an elevated risk of developing mental disorders compared to cancer survivors and persons without cancer. Contemporary epidemiological studies showed that, on average, 1/3 of the cancer patients in hospitals develop some mental disorders which requires further attention and adequate treatment. Clinical assesment and follow up of cancer patients with mental disorders needs a sistematic approach and providing psycho-oncological interventions, including specific patient education by healthcare professionals as well. It is of major importance for patients receiving oral chemotherapy due to the fact that mental disorders have a negative impact on patients compliance/adherence and treatment outcomes. Thus, there is a need for identification the best practice in this area. The aims of this study were to assess the impact of structured education of breast cancer patients receiving oral antineoplastic therapy on anxiety, depression and stress, to identify the presence of anxiety, depression and stress before the start of chemotherapy (education) and during treatment (one and three weeks after education), as well as to determine their association with sociodemographic characteristics of the patients. Patients and methods: The study included 142 breast cancer patients who were receiving oral antineoplastic therapy (capecitabine) at the Institute of Oncology and Radiology of Serbia in 2016 and 2017. Patients were randomized into two study groups: experimental group had additional individual, structured, specific education, before chemotherapy, by using a Serbian version of the Multinational Association of Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT V1.0) and the control group had usual, standard education. Patients were followed up for 3 weeks, during their first chemotherapy cycle. Two instruments were used for data collection: specifically designed, for the purpose of this study, sociodemographic questionnaire and the Serbian version of the Depression Anxiety Stress Scales-21 (DASS 21), self-report questionnaire for depression, anxiety and stress symptoms assessment. Results: Before starting capecitabine chemotherapy and education, breast cancer patients had symptoms of depression (29.58%), anxiety (35.92%) and stress (21.13%), mostly mild and moderate. These symptoms were decreased in the whole group of patients after the first and the third week from education, with significant difference in the status ofdepression and anxiety. Depression, anxiety and stress were decreased significantly in the experimental group of patients from the initial measurement (before education) to the oneweek and three-week follow-up measurements after education, comparing to the control group of patients. A significant association of anxiety and/or depression and/or stress and age of patients, their level of education, employment, marital and parenthood status, loneliness, economic status, family relationships, support from husband, contacts with relatives and friends, as well as the organization of free-time was found. Conclusions: Structured education has a significant impact on decreasing depression, anxiety and stress symptoms of breast cancer patients receiving oral antineoplastic therapy. Routine clinical assessment of depression, anxiety and stress in patients suffering from breast cancer is desirable at the beginning and during a chemotherapy treatment. Identification of patients who need further professional monitoring and psychoeducational support is important. Organized, structured, individual education can have a public health importance through the introduction of structured education of breast cancer patients as standard intervention and specific health service, which have an impact on the quality of the health care, patient safety and strengthening the entire health system

The impact of education of breast cancer patients during the use of antineoplastic therapy on anxiety, depression and stress

SAŽETAK Uvod: Karcinom je kompleksno oboljenje sa visokim rizikom za nastanak komorbiditeta, uključujući i mentalne poremećaje, i značajan je javnozdravstveni problem na globalnom nivou. Oboleli od karcinoma, posebno u toku lečenja, imaju povećan rizik za razvoj mentalnih poremećaja u poređenju sa osobama koje su izlečene ili nemaju dijagnozu karcinoma. Savremena epidemiološka istraživanja su pokazala da, u proseku, 1/3 obolelih od karcinoma na hospitalnom lečenju ima neki mentalni poremećaj koji zahteva dalju pažnju i adekvatan tretman. Klinička procena i praćenje obolelih od karcinoma sa mentalnim poremećajima zahteva sistematski pristup i pružanje psihoonkoloških intervencija, uključujući i specifičnu edukaciju bolesnika od strane zdravstvenih radnika. To je od velikog značaja za bolesnike na peroralnoj hemioterapiji, s obzirom na činjenicu da mentalni poremećaji imaju negativan uticaj na komplijantnost/adherentnost bolesnika i ishode njihovog lečenja. Iz tog razloga, postoji potreba za identifikacijom najbolje prakse u ovoj oblasti. Ciljevi ovog istraživanja su bili da se proceni uticaj strukturisane edukacije bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji na anksioznost, depresivnost i stres, da se utvrdi prisustvo anksioznosti, depresivnosti i stresa pre početka hemioterapije (edukacije) i u toku terapije (jedna i tri nedelje nakon edukacije), kao i da se utvrdi njihova povezanost sa sociodemografskim karakteristikama bolesnica. Bolesnici i metode: U istraživanje je uključeno 142 bolesnice sa karcinomom dojke koje se primale peroralnu antineoplastičnu terapiju (kapecitabin) u Institutu za onkologiju i radiologiju Srbije u 2016. i 2017. godini. Bolesnice su randomizovane u dve studijske grupe: eksperimentalna grupa je imala dodatnu, individualnu, strukturisanu, specifičnu edukaciju, pre hemioterapije, prema srpskoj verziji priručnika Multinacionalne asocijacije za suportivnu terapiju karcinoma (Multinational Association of Supportive Care in Cancer-MASCC) za edukaciju bolesnika na oralnoj antineoplastičnoj terapiji (Oral Agent Teaching Tool-OATT)-MOATT V1.0, a kontrolna grupa je imala uobičajenu, standardnu edukaciju. Bolesnice su praćene 3 nedelje, u toku prvog ciklusa hemioterapije. Korišćena su dva instrumenta za prikupljanje podataka: posebno kreiran, za potrebe ovog istraživanja, sociodemografski upitnik i srpska verzija DASS-21 skale(Depression Anxiety Stress Scales-DASS-21) za samoprocenu simptoma depresivnosti, anksioznosti i stresa. Rezultati: Pre početka hemioterapije kapecitabinom i edukacije, bolesnice sa karcinomom dojke su imale simptome depresivnosti (29.58%), anksioznosti (35.92%) i stresa (21.13%), najviše blage i umerene. Ovi simptomi su se smanjili u celoj grupi bolesnica posle prve i treće nedelje od edukacije, sa značajnom razlikom u promeni statusa skora depresivnosti i anksioznosti. Depresivnost, anksioznost i stres značajno su se smanjili u eksperimentalnoj grupi bolesnica od inicijalnog merenja (pre edukacije) do merenja nakon prve i nakon treće nedelje od edukacije, u odnosu na kontrolnu grupu bolesnica. Konstatovana je i značajna povezanost anksioznosti, i/ili depresivnosti, i/ili stresa i životnog doba bolesnica, njihovog nivoa obrazovanja, radnog, bračnog i statusa roditeljstva, samoće, materijalnog stanja, porodičnih odnosa, podrške supruga, kontakata sa rođacima i prijateljima, kao i organizovanja slobodnog vremena. Zaključci: Strukturisana edukacija ima značajan uticaj na smanjenje simptoma depresivnosti, anksioznosti i stresa kod bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji. Rutinska klinička procena simptoma depresivnosti, anksioznosti i stresa kod obolelih od karcinoma dojke poželjna je na početku i u toku hemioterapijskog tretmana. Značajna je identifikacija bolesnica kojima je potrebno dalje stručno praćenje i psihoedukativna podrška. Organizovana, strukturisana, individualna edukacija može imati i javnozdravstveni značaj kroz uvođenje strukturisane edukacije obolelih od karcinoma dojke kao standardne intervencije i posebne zdravstvene usluge, a koja utiče na kvalitet zdravstvene zaštite, bezbednost bolesnika i jačanje zdravstvenog sistema u celini.ABSTRACT Introduction: Cancer is a complex disease with a high risk of developing comorbidities, including mental disorders, and is a significant public health problem globally. Cancer patients, especially those who are undergoing treatment, have an elevated risk of developing mental disorders compared to cancer survivors and persons without cancer. Contemporary epidemiological studies showed that, on average, 1/3 of the cancer patients in hospitals develop some mental disorders which requires further attention and adequate treatment. Clinical assesment and follow up of cancer patients with mental disorders needs a sistematic approach and providing psycho-oncological interventions, including specific patient education by healthcare professionals as well. It is of major importance for patients receiving oral chemotherapy due to the fact that mental disorders have a negative impact on patients compliance/adherence and treatment outcomes. Thus, there is a need for identification the best practice in this area. The aims of this study were to assess the impact of structured education of breast cancer patients receiving oral antineoplastic therapy on anxiety, depression and stress, to identify the presence of anxiety, depression and stress before the start of chemotherapy (education) and during treatment (one and three weeks after education), as well as to determine their association with sociodemographic characteristics of the patients. Patients and methods: The study included 142 breast cancer patients who were receiving oral antineoplastic therapy (capecitabine) at the Institute of Oncology and Radiology of Serbia in 2016 and 2017. Patients were randomized into two study groups: experimental group had additional individual, structured, specific education, before chemotherapy, by using a Serbian version of the Multinational Association of Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT V1.0) and the control group had usual, standard education. Patients were followed up for 3 weeks, during their first chemotherapy cycle. Two instruments were used for data collection: specifically designed, for the purpose of this study, sociodemographic questionnaire and the Serbian version of the Depression Anxiety Stress Scales-21 (DASS 21), self-report questionnaire for depression, anxiety and stress symptoms assessment. Results: Before starting capecitabine chemotherapy and education, breast cancer patients had symptoms of depression (29.58%), anxiety (35.92%) and stress (21.13%), mostly mild and moderate. These symptoms were decreased in the whole group of patients after the first and the third week from education, with significant difference in the status ofdepression and anxiety. Depression, anxiety and stress were decreased significantly in the experimental group of patients from the initial measurement (before education) to the oneweek and three-week follow-up measurements after education, comparing to the control group of patients. A significant association of anxiety and/or depression and/or stress and age of patients, their level of education, employment, marital and parenthood status, loneliness, economic status, family relationships, support from husband, contacts with relatives and friends, as well as the organization of free-time was found. Conclusions: Structured education has a significant impact on decreasing depression, anxiety and stress symptoms of breast cancer patients receiving oral antineoplastic therapy. Routine clinical assessment of depression, anxiety and stress in patients suffering from breast cancer is desirable at the beginning and during a chemotherapy treatment. Identification of patients who need further professional monitoring and psychoeducational support is important. Organized, structured, individual education can have a public health importance through the introduction of structured education of breast cancer patients as standard intervention and specific health service, which have an impact on the quality of the health care, patient safety and strengthening the entire health system

Community pharmacists’ stress: factors of influence—variation over time

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice” 8-11th February 2023, Hilleroed, Denmar