Factors influencing palliative care in advanced dementia : A systematic review

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background: Dementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs. Aim: To investigate the factors influencing provision of PC services for people with advanced dementia. Methods: A systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data. Key findings: In total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning. Conclusions: Even though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.Peer reviewe

WHO AWaRe Classification for Antibiotic Stewardship: Tackling Antimicrobial Resistance - A Descriptive Study from an English NHS Foundation Trust Prior to and During the COVID-19 Pandemic

© 2023 Abdelsalam Elshenawy, Umaru and Aslanpour. This is an open-access accepted manuscript version of an article which has been published in final form at https://doi.org/10.3389/fmicb.2023.1298858Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO’s AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of “Watch” category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.Peer reviewe

Medicines Related Problems (MRPs) originating in Primary care settings in Older Adults - A Systematic Review

© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.Peer reviewe

A systematic review of counterfeit and substandard medicines in field quality surveys

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpCounterfeit and substandard medicines pose a great threat to public health and the economy worldwide. Reports suggest their prevalence is increasing and can no longer be ignored. A detailed account on the current nature of the problem and identification of knowledge limitations in terms of geographical location, medicine classes, and type of medicine analysis performed is not available. Our objective was to systematically review articles that have reported investigations of counterfeit and substandard medicinesPeer reviewe

Optimising medicines use by South Asian and Middle Eastern groups in a primary care setting in the UK: validation of a tool to identify medicine-related problems

The ethnic minority groups (EMGs) are perceived to be more prone to medicine-related problems (MRPs) than the general population in United Kingdom. There is, therefore, a need for improved detection and prevention of MRPs in EMGs, such as South Asians (SA) and Middle Eastern (ME) populations, to avoid unnecessary GP visits and potential hospital admissions. In this cross-sectional study, the data were collected in 80 face-to-face semi-structured interviews using Gordon’s MRPs tool from seven pharmacies in London. The study involved patients aged over 18 from SA/ME origins who were prescribed three or more medicines. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon’s coding frame and Nvivo 10. All issues under each of the main themes were explored and compared in an attempt to systematically adapt the Gordon’s MRPs tool for SA/ME populations. Some modifications were made to the original Gordon’s MRPs questionnaire to capture patients’ views regarding the use of medicines and the access to services. This also helped in identifying MRPs specific to SA/ME populations and proposing recommendations to address them. This included targeted medication use reviews (MURs), and tailored interventions to patients’ needs in improving medication use and access to services

Status and trends of e-Health tools in Kuwait: A narrative review

Background: Kuwait is witnessing an alarming increase in diabetes and high prevalence of multi-drug resistant strains. E-Health solutions have the potential to deliver timely, quality and cost-effective solutions to these public health challenges. However, little is known about the existing e-health solutions in Kuwait. Aims: This study aims to explore the current e-health tools and applications in Kuwait, and the factors that affect their adoption and implementation. Methods: A literature search was carried out for articles on e-health in Kuwait using the following electronic databases: PubMed, Google Scholar, Scopus, Web of Science, CINAHL, Medline and Proquest. Reference lists of all included items were additionally searched. A manual search was also conducted using WHO EMRO Virtual Health Sciences Library and MOH policies and standards. Results: 1121 papers were retrieved from databases and 29 papers were added from manual searching of reference lists. 495 papers were considered for review after the removal of duplicates. Thirty studies met the inclusion/exclusion criteria. Implementing electronic health records and establishing a childhood-onset diabetes registry are the main e-Health achievements to date. Implementing e-Health tools has been hindered by various socio-political, financial, infrastructural, organizational, technical and individual barriers. Conclusion: The modest e-Health achievements warrant bigger and faster implementation steps focusing on developing an e-Health policy framework and drawing an implementation road-map that is evidence based and research informed

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

© 2019 International Society for Chemotherapy of Infection and Cancer Objectives: This study explored antimicrobial stewardship programme (ASP) team members’ perspectives regarding factors influencing the adoption and implementation of these programmes in Saudi hospitals. Methods: This was a qualitative study based on face-to-face semistructured interviews with healthcare professionals involved in ASPs and activities across three Ministry of Health (MoH) hospitals in Saudi Arabia (n = 18). Interviews were also conducted with two representatives of a General Directorate of Health Affairs in a Saudi region and two representatives of the Saudi MoH (n = 4) between January–February 2017. Results: Despite the existence of a national strategy to implement ASPs in Saudi MoH hospitals, their adoption and implementation remains low. Hospitals have their own antimicrobial stewardship policies, but adherence to these is poor. ASP team members highlight that lack of enforcement of policies and guidelines from the MoH and hospital administration is a significant barrier to ASP adoption and implementation. Other barriers include disintegration of teams, poor communication, lack of recruitment/shortage of ASP team members, lack of education and training, and lack of health information technology (IT). Physicians’ fears and concerns in relation to liability are also a barrier to their adoption of ASPs. Conclusion: This is the first qualitative study exploring barriers to ASP adoption and implementation in Saudi hospitals from the perspective of ASP team members. Formal endorsement of ASPs from the MoH as well as hospital enforcement of policies and provision of human and health IT resources would improve the adoption and implementation of ASPs in Saudi hospitals

Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Introduction: Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). Aim: This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. Design and setting: Systematic literature review of primary studies on AMS implementation in acute care settings. Methods: Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. Results: There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. Conclusion: This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.Peer reviewe

Evaluation of a clinical pharmacy programme Japan-UK collaboration

The development of Clinical Pharmacy in the United Kingdom (UK) has been established since the 1980's. The concept of pharmaceutical care has developed over the past 30 years and more recently the pharmacists role in medicines optimisation and safety was endorsed by the UK government 2010.The University of Hertfordshire (UH) established a memorandum of understanding with Meiji Pharmaceutical University (MPU) in 2009. Staff exchange and the delivery of clinical pharmacy and patient safety seminars was established in 2009. A unique six week student clinical pharmacy programme was launched in 2010.Tutors at MPU identified students who had completed the 4/5th year of the pharmacy programme and had the appropriate level of language skills to benefit from the programme. MPU identified students were selected through interview with UH tutors. The goal of the clinical programme was to enable students from MPU experience UK educational methods of learning, interaction with UK students and develop a portfolio of clinical practice. The students also had first hand observational experience of a wide range of UK clinical practice. The aim was to evaluate the achievements of this programme.Peer reviewe

Factors Contributing to Medicine-Related Problems in Adult Patients with Diabetes and/or Cardiovascular diseases in Saudi Arabia: A qualitative study

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives To investigate the factors contributing to medicine related problems among cardiovascular and diabetic patients in Saudi Arabia. Design Qualitative semi-structured interviews were conducted. Interviews were audio-recorded then transcribed into Microsoft Word. The transcribed interviews were then imported into the qualitative analysis software NVivo where thematic analysis was applied. Thematic synthesis was achieved by coding and developing subthemes/themes from the findings of the interviews. Setting Five healthcare centres in Najran, Saudi Arabia. Participants 25 adult patients with diabetes and/or cardiovascular diseases. Results The study cohort included 16 males and nine females with a median age of 61.8 years (40 – 85 years). Diabetes was the main condition encountered among 23 patients and cardiovascular diseases were reported among 18 patients. Perceived factors leading to medicine related problems were of four types and related to: patient-, healthcare system-, clinical (condition-), and medicine-related factors. Patient-related factors were related to living situation, religious practices, diet/exercise and patients’ behaviour towards the condition and medicines. Healthcare system related factors comprised sources and availability of medicines, ease of access to healthcare system, and patient satisfaction with healthcare providers. Clinical (condition-) related factors associated with both the knowledge and control over condition, and effects of the condition among medicines intake. Medicine-related factors included lack of knowledge about medicines and medicine use. Conclusions The results of this study uncovered many factors associated with medicine related problems among cardiovascular and diabetic patients in Saudi Arabia, especially in reference to lifestyle and medicine use. Improving communication with healthcare professional alongside the introduction of national clinical guidance would mitigate the unwanted health complications related to medicine use.Peer reviewedFinal Published versio