Ability of online drug databases to assist in clinical decision-making with infectious disease therapies

<p>Abstract</p> <p>Background</p> <p>Infectious disease (ID) is a dynamic field with new guidelines being adopted at a rapid rate. Clinical decision support tools (CDSTs) have proven beneficial in selecting treatment options to improve outcomes. However, there is a dearth of information on the abilities of CDSTs, such as drug information databases. This study evaluated online drug information databases when answering infectious disease-specific queries.</p> <p>Methods</p> <p>Eight subscription drug information databases: American Hospital Formulary Service Drug Information (AHFS), Clinical Pharmacology (CP), Epocrates Online Premium (EOP), Facts & Comparisons 4.0 Online (FC), Lexi-Comp (LC), Lexi-Comp with AHFS (LC-AHFS), Micromedex (MM), and PEPID PDC (PPDC) and six freely accessible: DailyMed (DM), DIOne (DIO), Epocrates Online Free (EOF), Internet Drug Index (IDI), Johns Hopkins ABX Guide (JHAG), and Medscape Drug Reference (MDR) were evaluated for their scope (presence of an answer) and completeness (on a 3-point scale) in answering 147 infectious disease-specific questions. Questions were divided among five classifications: antibacterial, antiviral, antifungal, antiparasitic, and vaccination/immunization. Classifications were further divided into categories (e.g., dosage, administration, emerging resistance, synergy, and spectrum of activity). Databases were ranked based on scope and completeness scores. ANOVA and Chi-square were used to determine differences between individual databases and between subscription and free databases.</p> <p>Results</p> <p>Scope scores revealed three discrete tiers of database performance: Tier 1 (82-77%), Tier 2 (73-65%) and Tier 3 (56-41%) which were significantly different from each other (p < 0.05). The top tier performers: MM (82%), MDR (81%), LC-AHFS (81%), AHFS (78%), and CP (77%) answered significantly more questions compared to other databases (p < 0.05). Top databases for completeness were: MM (97%), DM (96%), IDI (95%), and MDR (95%). Subscription databases performed better than free databases in all categories (p = 0.03). Databases suffered from 37 erroneous answers for an overall error rate of 1.8%.</p> <p>Conclusion</p> <p>Drug information databases used in ID practice as CDSTs can be valuable resources. MM, MDR, LC-AHFS, AHFS, and CP were shown to be superior in their scope and completeness of information, and MM, AHFS, and MDR provided no erroneous answers. There is room for improvement in all evaluated databases.</p

Assessing circadian rhythms in propofol PK and PD during prolonged infusion in ICU patients

This study evaluates possible circadian rhythms during prolonged propofol infusion in patients in the intensive care unit. Eleven patients were sedated with a constant propofol infusion. The blood samples for the propofol assay were collected every hour during the second day, the third day, and after the termination of the propofol infusion. Values of electroencephalographic bispectral index (BIS), arterial blood pressure, heart rate, blood oxygen saturation and body temperature were recorded every hour at the blood collection time points. A two-compartment model was used to describe propofol pharmacokinetics. Typical values of the central and peripheral volume of distribution and inter-compartmental clearance were VC = 27.7 l, VT = 801 l, and CLD = 2.73 l/min. The systolic blood pressure (SBP) was found to influence the propofol metabolic clearance according to Cl (l/min) = 2.65·(1 − 0.00714·(SBP − 135)). There was no significant circadian rhythm detected with respect to propofol pharmacokinetics. The BIS score was assessed as a direct effect model with EC50 equal 1.98 mg/l. There was no significant circadian rhythm detected within the BIS scores. We concluded that the light–dark cycle did not influence propofol pharmacokinetics and pharmacodynamics in intensive care units patients. The lack of night–day differences was also noted for systolic blood pressure, diastolic blood pressure and blood oxygenation. Circadian rhythms were detected for heart rate and body temperature, however they were severely disturbed from the pattern of healthy patients

Perspectives and attitudes of breastfeeding women using herbal galactagogues during breastfeeding: a qualitative study

Some herbal galactagogues have gained reputation and recognition by the public and health professionals as alternative approaches to increase breast milk supply. This study explores the perspectives and attitudes of breastfeeding women towards the use of herbal galactagogues while breastfeeding, their experiences, and why and how they have chosen an alternative option over conventional treatments to enhance breastfeeding performance. This exploratory research was conducted through in-depth semi-structured interviews with women living in Perth, Western Australia, who were using one or more herbal galactagogues during breastfeeding. Purposeful and subsequent snowball sampling methods were employed to recruit participants. All interviews, facilitated by an interview guide, were audio-recorded, then transcribed verbatim. Thematic analysis was used to analyse qualitative data to construct themes and subthemes.The perspectives and attitudes of the 20 participants are classified under three main headings: i) use of herbal medicines during breastfeeding, ii) available herbal medicines resources, and iii) level of breastfeeding support received. Throughout the interviews, participants described how their perseverance and determination to breastfeed, as well as concerns over breastfed infants’ safety with conventional treatments, influenced their choice of therapy. A sense of self-efficacy and autonomy over their own health needs was seen as influential to their confidence level, supported self-empowerment and provided reassurance throughout the breastfeeding journey. There was also a desire for more evidence-based information and expectations of health professionals to provide credible and reliable information regarding the use of herbal medicines during breastfeeding. This study has enhanced our understanding of the perspectives and attitudes of breastfeeding women towards the use of herbal medicines, in particular galactagogues, while breastfeeding. The positive attitudes of breastfeeding women identified in this study highlight the need for further research into evaluating the safety and efficacy of commonly used herbal galactagogues, whilst the negative views on breastfeeding education should be taken into consideration when implementing or improving breastfeeding-related health policies

The use of herbal medicines during breastfeeding: A population-based survey in Western Australia

Background: Main concerns for lactating women about medications include the safety of their breastfed infants and the potential effects of medication on quantity and quality of breast milk. While medicine treatments include conventional and complementary medicines, most studies to date have focused on evaluating the safety aspect of conventional medicines. Despite increasing popularity of herbal medicines, there are currently limited data available on the pattern of use and safety of these medicines during breastfeeding. This study aimed to identify the pattern of use of herbal medicines during breastfeeding in Perth, Western Australia, and to identify aspects which require further clinical research. Methods: This study was conducted using a self-administered questionnaire validated through two pilot studies. Participants were 18 years or older, breastfeeding or had breastfed in the past 12 months. Participants were recruited from various community and health centres, and through advertising in newspapers. Simple descriptive statistics were used to summarise the demographic profile and attitudes of respondents, using the SPSS statistical software. Results: A total of 304 questionnaires from eligible participants were returned (27.2% response rate) and analysed. Amongst the respondents, 59.9% took at least one herb for medicinal purposes during breastfeeding, whilst 24.3% reported the use of at least one herb to increase breast milk supply. Most commonly used herbs were fenugreek (18.4%), ginger (11.8%), dong quai (7.9%), chamomile (7.2%), garlic (6.6%) and blessed thistle (5.9%). The majority of participants (70.1%) believed that there was a lack of information resources, whilst 43.4% perceived herbal medicines to be safer than conventional medicines. Only 28.6% of users notified their doctor of their decision to use herbal medicine (s) during breastfeeding; 71.6% had previously refused or avoided conventional medicine treatments due to concerns regarding safety of their breastfed infants. Conclusions: The use of herbal medicines is common amongst breastfeeding women, while information supporting their safety and efficacy is lacking. This study has demonstrated the need for further research into commonly used herbal medicines. Evidence-based information should be available to breastfeeding women who wish to consider use of all medicines, including complementary medicines, to avoid unnecessary cessation of breastfeeding or compromising of pharmacotherapy

Blended versus face-to-face: comparing student performance in a therapeutics class

Therapeutics is a very complex subject for every pharmacy student, since it requires the application of knowledge from several other disciplines. The study of therapeutics is often done in case-based learning in order to promote reflective thinking and give a scenario as real as possible. The objective of this study was to compare student performance between faceto-face (n = 54) and blended learning (n = 56) approaches to the teaching of therapeutics. They can confirm that there are statistically significant differences (p < 0.05) between the final exam scores from both groups, being that the b learning group achieved higher scores. Blended learning seems to be an effective way to teach therapeutics, following pre established teaching methods, and above all, does not negatively affect student performance. It also provides new learning environments and strategies, and promotes the development of new skills such as learning and collaborating online, which may be relevant in a networked knowledge society.info:eu-repo/semantics/publishedVersio

Role of the pharmacist in pre-exposure chemoprophylaxis (PrEP) therapy for HIV prevention

With a global estimate of 2.5 million new infections of HIV occurring yearly, discovering novel methods to help stem the spread of the virus is critical. The use of antiretroviral chemoprophylaxis for preventing HIV after accidental or occupational exposure and in maternal to fetal transmission has become a widely accepted method to combat HIV. Based on this success, pre-exposure chemoprophylaxis (PrEP) is being explored in atrisk patient populations such as injecting drug users, female sex workers and men who have sex with men. This off-label and unmonitored use has created a need for education and intervention by pharmacists and other healthcare professionals. Pharmacists should educate themselves on PrEP and be prepared to counsel patients about their means of obtaining it (e.g. borrowing or sharing medications and ordering from disreputable Internet pharmacies). They should also be proactive about medication therapy management in these patients due to clinically important drug interactions with PrEP medications. Only one trial exploring the safety and efficacy of tenofovir as PrEP has been completed thus far. However, five ongoing trials are in various stages and two additional studies are scheduled for the near future. Unfortunately, studies in this arena have met with many challenges that have threatened to derail progress. Ethical controversy surrounding post-trial care of participants who seroconvert during studies, as well as concerns over emerging viral resistance and logistical site problems, have already halted several PrEP trials. Information about these early trials has already filtered down to affected individuals who are experimenting with this unproven therapy as an �evening before pill�. The potential for PrEP is promising; however, more extensive trials are necessary to establish its safety and efficacy. Pharmacists are well-positioned to play a key role in helping patients make choices about PrEP managing their therapy, and developing policy with an eye towards the future.Con una estimación global de 2,5 millones de nuevas infecciones de VIH cada año, es crítico descubrir nuevos métodos para ayudar a detener la extensión del virus. El uso de quimioprofilaxis antirretroviral para prevención del VIH después de una exposición accidental u ocupacional y en transmisión materno-fetal se ha convertido en un método comúnmente aceptado para combatir el VIH. Basando en este éxito, se está explorando la quimioprofilaxis pre-exposición (PrEP) en poblaciones de riesgo tales como drogadictos intravenosos, trabajadoras sexuales, y hombres que tiene sexo con hombres. Este uso no autorizado y no vigilado ha creado la necesidad de educación e intervención de farmacéuticos y otros profesionales de la salud. Los farmacéuticos deberían formarse sobre la PrEP y estar preparados para aconsejar a los pacientes sobre los medios de obtenerla (p.e. prestándose o compartiendo medicaciones y comprándola en farmacias de confianza en Internet). También deberían ser proactivos en el seguimiento de estos pacientes debido a las importantes interacciones de los medicamentos PrEP. Solo se ha completado un ensayo que exploró la seguridad y la eficacia del tenofovir como PrEP. Sin embargo, están programados 5 ensayos en marcha en diversos estadios, y dos estudios adicionales en un futuro próximo. Desafortunadamente, los estudios en este campo se han encontrado con muchos obstáculos que han amenazado interrumpir su progreso. La controversia ética sobre la atención post-ensayo de los pacientes que se seroconvierten durante el estudio, así como las preocupaciones sobre la emergente resistencia viral y los problemas logísticos, ya han interrumpido varios ensayos de PrEP. La información de estos primeros ensayos se ha filtrado e los individuos afectados que están experimentando con este tratamiento no probado como una �píldora de la tarde anterior�. El potencial de la PrEP es prometedor, sin embargo se necesitan ensayos más extensos para establecer su seguridad y eficacia. Los farmacéuticos están bien posicionaos para jugar un papel importante ayudando a los pacientes a tomar mejores decisiones sobre la PrEP, gestionando su tratamiento, y desarrollando políticas con un ojo en el futur

The drivers and strategies of carbon reduction in projects: perceptions of the Australian construction practitioners

The construction sector has been experiencing tension to eradicate their carbon-intensive ways of operations. Furthermore researchers have put forward several strategies to reduce carbon emissions from construction operations. However, the construction sector has not yet changed operational practices. As with any initiative, organizational behavior can be a major barrier to change. This study sought to investigate how carbon reduction strategies are enacted by construction organizations. Data was collected by a survey conducted in Victoria, Australia. The results indicate that most carbon reduction strategies are rarely adopted in construction projects. Such findings are in line with comments made by some scholars on the construction practitioners being apathetic to reduce carbon emissions. While scholars and policy makers endeavour to advance technologies and tighten regulations, the affordability of the affected industry was unfortunately ignored. Effort should be directed to assisting the industry to formulate costs and benefits as a result of carbon reduction