A Survey on the Asheville Project as a Successful Model of Efficient Role of Pharmacist in the Management of Chronic Diseases and the Available Opportunities for Achieving the Same Results in Iranian Health Society

Introduction Launched in 1997 by the city of Asheville, North Carolina, the Asheville project was a breakthrough in showing the importance of pharmacist role in pharmacotherapy process and management of chronic diseases. With the pharmaceutical care based concept and emphasizing on medication therapy management idea, they were successful on their main hypothesis.it is clear that having a system similar to Asheville project could help Iranian health care system in many aspects and also improve the role of pharmacists in therapeutic process. Methods and Results We studied different aspects of Asheville project including their interventions, their understudied parameters, and their methods for completing the connections between patients, pharmacists and physicians and their system for follow-up patients. After this analysis we go through Iran’s health care system to find out our opportunities for designing an efficient MTM system according to our available resources.Asheville project focused on four type of most common chronic disease: diabetes, hypertension, asthma and hyperlipidemia. The common and always efficient intervention is patient education on self-management, for example in monitoring of blood sugar in diabetes and use of peak flow meter in asthma. Managing the polypharmacy and drug interactions, and consulting for referring to physicians in urgent situations was another intervention. After all , they got a big impact on improving clinical parameters like A1C, FEV1, HDL and LDL. They also experience reduction of the total health care costs and increase satisfaction with pharmacist services among patients. Their efficient follow-up system was the key of their successful experience. ConclusionToday in Iran we are facing the fast growing in the incidence of chronic diseases which demand an efficient system to follow-up patients and help them with different complications that they may experience.In addition to this facts, lowering the total cost of health care system and reducing the number of unnecessary clinical visits and clinical tests is important for economic aspects of our health care system. According to the successful experience of Asheville project and the current situation of chronic diseases in Iran, we can strongly suggest that working on MTM clinics and emphasizing on the role of pharmacist could help our system for managing this situation

Medication Therapy Management Service; Why We Need it?

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Effect of probiotics in diarrhea and GE Reflux in pediatrics.

Probiotics are defined as nonpathogenic bacterial depravities (Lactobacillus GG Enterococcus faecium,Lactobacilus acidophilus & Bifidobacterium bifidum) that provides better ,and normal intestinal floral and  function ,which balances Intestinal micro-organism and supports the immune system. One of the most common form of diarrhea is Antibiotic induced diarrhea, in which probiotics are used as preservative therapy. A significant number of patients with diarrhea are children (infant –toddler), who have underdeveloped immune system and diarrhea may cause life-threatening event. GE reflux is a common disease in infants. probiotics are now taking a part in the treatment of these children but it is not approved by FDA, although some surveys have shown its benefits. Introduction: The aim of this study is to see the role of probiotics in prevention and treatment of diarrhea and control of GE reflux, versus its high cost. Methods and Results: Four groups were studied in this analysis. The first group had diarrhea without probiotic treatment, the second group were patients with GE Reflux without probiotic treatment. The third group had diarrhea treated with probiotics, and the fourth group had GE reflux and were treated with probiotics. We used patients precise age, weight. variables were sex(female/male)age, (months), weight duration of disease with and without probiotics. In this study mean age was 24 months ,the minimum was 6 months and maximum was 78 months.58%of them were male and 42% were female. The mean treatment duration in group1 was 10 days. In third group was 7days which was reduced by 3 days. The mean treatment duration in group 2 was nearby 26 days. In third group was  near 25 days. Conclusions: Probiotics have significantly reduced the duration of diarrhea but there has not been a prominent improvement in duration of disease in GE Reflux

Polypharmacy and the Use of Beers Criteria in Iranian Geriatric Patients: A Review of Published Literature

The senior population in Iran is growing, and polypharmacy is common among them. Certain drugs are considered inappropriate in elderly due to age related changes and awareness of clinicians in this area is crucial. The Beers criteria is the most evidence based reference for proper drug selection in geriatric patients. This study reviews the scholarly articles published in English or Farsi that had studied potentially inappropriate medications (PIMs) according to beers criteria and polypharmacy in the Iranian geriatric population.By searching Pubmed, Scopus and Google scholar databases from 1989-2016, all studies in Farsi or English with key terms polypharmacy, drug-drug interactions, Beers, medication, drug, prescribing, older adult, geriatric, elderly, aging, pharmacotherapy, persian and Iran were evaluated. 11 studies were found: 5 studies on polypharmacy, 3 studies on polypharmacy and PIMs, one study on PIMs, one study on drug drug interactions and PIMs, and only one study on polypharmacy, PIMs and drug-drug interactions. The majority of these studies were published in Farsi (8 articles). The oldest found article was conducted in 2005 and the most recent published study was in 2016. Studies in aging population in Iran are very few. This growing patient group with the highest number of drug consumption seems to be under-researched in Iran     

Optimizing Outpatient Medication Management: The Impact of Clinical Pharmacists on Identifying and Addressing Drug-Related Problems

Medication Therapy Management Services (MTMS) are effective strategies to reduce Drug-Related Problems (DRPs) and associated healthcare costs. Given the high prevalence of DRPs in outpatient settings and the lack of an effective process to detect such problems in Iran, we decided to evaluate the type and number of DRPs identified by clinical pharmacists in a university-affiliated Pharmacotherapy Clinic in Khuzestan province, South of Iran. In this cross-sectional study, 150 eligible outpatients were included. At a university-affiliated pharmacotherapy clinic, pharmacy students took patients' histories and referred them to clinical pharmacists for DRP evaluation and detection. Appropriate interventions were then implemented in collaboration with patients and their healthcare providers to resolve the problems. Approximately 3.56 DRPs per patient were identified during a nine-month study period. The most prevalent DRPs were lack of education or information (32.40% [174/537]), undertreated indications (17.31% [93/537]), and patient compliance (15.27% [82/537]). Clinical pharmacists detected 537 DRPs, implemented 525 interventions, and performed 0.977 interventions per DRP. The provision of information (57.52% [302/525]) and change of therapy (21.71% [114/525]) were the most frequent types of clinical pharmacist interventions. This study revealed deficiencies and limitations in our healthcare services, resulting in a significant prevalence of DRPs. Implementing pharmaceutical care practice models, such as Pharmacotherapy Clinics, where clinical pharmacists integrate their experience and knowledge in a patient-centered manner, is the most effective method for preventing and managing these issue

Antibiotic Resistance Pattern of Pathogens Isolated from Clinical Specimens of a Hematology-Oncology Hospital, Ahvaz, 2016-17

Background:Resistance to antibiotics exists around the world. In patients with various types of cancer and also in patients undergoing bone marrow transplantation, infections and febrile neutropenia can be very dangerous. Administration of intravenous ceftazidime alone or in combination with other antibiotics is one of the first empirical treatment regimens. The present study was carried out to determine the resistance pattern of various gram – and gram + microorganisms to different antibiotics at shafa hospital in Ahvaz. Method:This retrospective descriptive cross-sectional study was conducted for a period of one year including all referral clinical specimens from patients with malignancies to Shafa Hospital's Microbiology Laboratory. Isolated bacteria were tested for sensitive antibiotics used in clinics, especially ceftazidime, using a disc diffusion method. Results:After reviewing the records of all patients with malignancies admitted to Shafa hospital from July 2016 toJuly 2017, 310 patients had a recorded culture result (438 cultures in total). The patients were between 1 -85 years old (mean ± SD: 29.96±24.63 years). 50.64% of the patients were male and 49.35% female, mostly admitted to emergency pediatric hematology ward(25.806%). The most common type of malignancy was acute lymphoblastic leukemia(27.096%).Pseudomonasaeroginosa was the most commonisolated pathogen (34.0182%). Only 63 positive cultures containing pseudomonas were tested for antimicrobial resistance, and among these cultures, 55.55% were resistant and 42.85% were sensitive to ceftazidime. Among 9 isolated E.coli cultures, 66.6% were resistant and 33.33% were sensitive to ceftazidime.For Acintobacter and Staph epidermidis, only1 positive culture (out of 33 and 34 respectively) was tested,and in both cases was resistant to ceftazidime. Conclusion:Pseudomonas was the most common pathogen among isolated pathogensand about 56% of positive cultures were resistant or had intermediate sensitivity. Itseems that ceftazidime empiric therapy of infections in patients with malignancies atHematology-Oncology hospital might face high resistance

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services

The Need for Reform and Standardization of Pharmacy Clerkship Training

#No Abstract

Evaluation of Academic Performance, Academic Motivation, Hope for the Future and Life Satisfaction of Pharmacy Students of a Medical School

Background: This study sought to investigate the evaluation of academic achievement, academic motivation and hope for the future and life satisfaction of Pharmacy Students of the Medical Sciences University of Ahvaz and their relationship with the school years passed. Methods: The samples in this study were all pharmacy students studying in the College of Pharmacy, the Medical University of Ahvaz in the year 93-94. Moreover, standard questionnaires were used by this study for collecting data. In order to collect data with regard to hope, life satisfaction, motivation and academic satisfaction, the questionnaire of Snyder hope Scale (1991), Satisfaction with Life Scale questionnaire (SWLS), lepper motivation scale (2005) and Bahrani and Jokar questionnaire (1378) were used respectively.Moreover, data on Academic performance were acquired using the score of the students and the number of students dropping out in each entry and the data were analysed by using SPSS 20. Results: The results did not indicate any significant different in an investigation of five class of students and from four variables of hope, Academic motivation, academic achievement, life satisfaction. But contrast test for combined group showed that academic motivation and academic performance in freshmen students are significantly higher than the other four inputs. Third-year students possess less Academic motivation than other students.Senior students' Academic performance was also significantly lower than of students from other school years. Conclusion: freshmen students face challenges of the new environment, and this affects their academic performance. Besides in the third year of pharmacy school curriculum, pharmacy students pass the basic exam and the main pharmaceutical courses start for them, this might be the reason that their intrinsic motivation increase

A Review of Integrated Courses in Pharmacy Education and Impact of Integration in Pharm D Curricula

Today, due to ever-increasing knowledge and large volumes of information, educational planners of various fields around the world, have been seeking to establish a better and faster refresh for learning. Integration can be a good educational strategy by blending different subjects and contents when presented to students. The aim of this study is to evaluate the medical literature about integration in the curriculum; its process, importance, necessity and different types of it. This review article was prepared by searching the PubMed database, Google Scholar and science direct websites, national and international journals in the field of medical education curricula. The keywords were educational planning, curriculum integration, and medical education with integration and incorporation. Integration and its eleven steps can be an important strategy in educational planning. According to various studies, integration can enhance the students’ learning and skills in medicinal and pharmaceutical care. It also improves the satisfaction of faculty and students, the quality of education and increases the students’ grades at their examinations. Considering the proper planning, cooperation and co-teaching of faculty members, focus on the desired performance of students and correct assessment of the fundamental principles of integration are crucial to this strategy