scholarly journals Evaluation of the knowledge of Health Care Professionals regarding Therapeutic Drug Monitoring in Public Hospitals of Lahore, Pakistan

2020 ◽  
Vol V (I) ◽  
pp. 9-16
Author(s):  
Anam Arshad ◽  
Malik Irfan Zulfiqar ◽  
Zahra Hassan Kiani ◽  
Maria Hassan Kiani ◽  
Muhammad Rauf ul Hassan

A cross sectional study was performed among 250 health care professionals from Children Hospital, Jinnah hospital and Services Institute of Medical science Lahore, through a self-designed questionnaire to assess the knowledge of therapeutic drug monitoring (TDM). A total 300 questionnaires were distributed and 250 were returned, giving a response 83%. Out of 300 health care professionals 50 participants do not even know the term TDM. Only 40% participants strongly agreed that TDM is done for all patients. Only 26.8% participants agreed that TDM is carried out for all drugs. Only 63.2% participants agreed that the TDM is very costly process. Only 38.4% strongly agreed that TDM requires extra time of health care professionals and only 36% participants remain neutral to the perception that TDM is requested by patient rather than health care professionals. Limited resources and lack of technical skills are barriers in performing TDM in under-developed country like Pakistan.

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Belete Kassa Alemu ◽  
Tessema Tsehay Biru

Background. The role of health care professionals among other stakeholders in early detection, assessment, documentation, and reporting as well as preventing suspected adverse reactions is very crucial to mitigate drug-related problems in health facilities. Previous reports from literatures have indicated that adverse drug reaction reporting is highly linked to the knowledge and attitude of the health care professionals. Objective. To assess knowledge, attitude, and practice of health care professionals about adverse drug reactions and the associated factors at selected public hospitals in Northeast Ethiopia. Methods. A hospital-based quantitative cross-sectional study design was employed. A structured self-administered questionnaire was used to collect data on KAP of selected health care providers by the convenience sampling method. Data were entered into Epi info version 3.5.3 and analyzed using SPSS Version 20. Association between dependent and independent variables was found by using bivariate and multivariate logistic regression analysis where p<0.05 was considered to be statistically significant. Results. Out of 120 questionnaires distributed, 114 respondents filled and returned, giving a 95% response rate. From total, 49 (43%) were nurses, 26 (22.8%) physicians, 17 (14.9%) pharmacy professionals, 12 (10.5%) health officers, and 10 (8.8%) midwives. About 86 (75.44%) study participants had an inadequate knowledge towards ADR reporting, and half of participants failed to report the adverse drug reactions they encountered. But the majority of participants (84, 73.68%) had a favorable attitude towards ADR reporting. Nurses [AOR = 0.069, 95% CI (0.018–0.275)], health officers [AOR = 0.10, 95% CI (0.015–0.647)], and physicians [AOR = 0.14, 95% CI (0.03–0.64)] were found to be less likely to have adequate knowledge on ADR reporting compared to pharmacy professionals. Conclusion. Even though the majority of health care professionals had a positive attitude, they had inadequate knowledge and poor practice towards ADR reporting.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S339-S339
Author(s):  
M Van de Meeberg ◽  
M Lin ◽  
M Seinen ◽  
H Fidder ◽  
B Oldenburg ◽  
...  

Abstract Background Methotrexate (MTX) is an immunomodulatory drug for patients with Crohn’s Disease (CD), used as first-line therapy, as a second-line in case of failure to thiopurine, and concomitantly with anti-TNFα agents to decrease production of anti-drug antibodies. Nevertheless, MTX is underutilised in the treatment of CD, despite its proven efficacy and good safety profile. This is for a large part due to the lack of therapeutic drug monitoring (TDM) of MTX because no stable plasma MTX levels are reached. Intracellular MTX-polyglutamates (MTX-PGs), formed after folylpolyglutamate synthetase attaches glutamate residues to MTX, could be used as a TDM tool as MTX-PG is thought to mediate MTX’s efficacy. We present the results of our cross-sectional study in CD patients, aiming to gain insight into erythrocyte MTX-PG levels. Methods CD adults on MTX treatment who visited the outpatient clinic of Amsterdam UMC between May 2019 and February 2020 were included consecutively. An established LC-ESI-MS/MS method1 was used to measure erythrocyte MTX-PGs. Results Nineteen patients were included. Mean disease duration was 17 years (SD±13.7). Montreal disease location and behaviour were as follows (n=): L1 = 2, L2 = 4, L3 = 13; B1 = 11, B2 = 5, B3 = 3. Only 4 patients had a flare according to Physician Global Assessment. Twelve patients received MTX monotherapy, whereas 7 patients were on concomitant anti-TNFα agents. The mean dose of MTX was 15.5 mg (SD±2.8) and 12 (63%) patients had subcutaneous (sc.) MTX. We successfully measured MTX-PG2-5 in 18 patients, showing substantial variability in measured concentrations of total MTX-PG(tot) and the individual species. The median MTX-PGtot was 117.1 nmol/L [min:46.4-max:358.7] with preferential accumulation of MTX-PG3 (43.1 [15.3-96.1]); the least predominant species being MTX-PG5 (9.4 [1.1-24.1]). Patients on sc. compared to oral MTX had higher MTX-PGtot levels (177.8 [58.8-358.7] vs. 93.2 [46.4-120.8] nmol/L, p=0.067) and significantly higher long-chain MTX-PG4-5 levels (55 [3.7-84.3] vs. 8.9 [2.4-15.0] nmol/L, p=0.010); see figure. Conclusion We showed that erythrocyte MTX-PGs can be measured in CD patients by tandem MS. Large variability in concentrations was demonstrated, similar to our previously published results in rheumatoid and juvenile arthritis2,3 which is a pre-requisite for MTX-PG use as a TDM tool. We showed for the first time that MTX-PG accumulation was higher in sc. MTX vs. oral MTX treatment. This work provides the first step towards establishing TDM for MTX in CD, a goal we aim to realize in our upcoming longitudinal study. References


2018 ◽  
Vol 11 ◽  
pp. 175628481878361 ◽  
Author(s):  
Irene Pérez ◽  
Lidia Fernández ◽  
Silvia Sánchez-Ramón ◽  
Cristina Alba ◽  
Ana Zatarain ◽  
...  

Background: The aim of this study was to evaluate reliability of four different assays for measuring infliximab trough levels and antibodies to infliximab (ATI). Methods: In this non-interventional, cross-sectional study including IBD patients, infliximab levels and ATI were measured using four different assays: Lisa-Tracker, Promonitor, Q-Inflixi and Sanquin. Reliability and agreement for infliximab levels was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman plots. Qualitative agreement for infliximab (based on a pre-established target window of trough levels between 3 µg/ml and 7 µg/ml) and for ATI were estimated by Cohen’s kappa. Results: Serum samples of 84 IBD patients were evaluated for infliximab using the four assays. Reliability was ‘substantial’ between Lisa-Tracker versus Promonitor and ‘almost perfect’ between the remaining assay pairs, with ICCs [95% confidence interval (CI)] ranging from 0.93 (0.70–0.97) for Lisa-Tracker versus Promonitor to 0.97 (0.95–0.98) for Q-Inflixi versus Sanquin. Bland–Altman plots showed significant bias between assays except Promonitor versus Q-Inflixi, which had excellent agreement. The greatest differences in mean infliximab were found between Promonitor versus Lisa-Tracker (–0.91 µg/ml) and Lisa-Tracker versus Q-Inflixi (0.69 µg/ml). Qualitative agreement for infliximab was ‘almost perfect’ for Promonitor versus Q-Inflixi (kappa 0.84) and Q-Inflixi versus Sanquin (kappa 0.81), and ‘substantial’ for the remaining pairs. More than 10% of patients who had infliximab levels within the target interval by Lisa-Tracker had suboptimal concentrations (<3 µg/ml) with Promonitor and Q-Inflixi. Furthermore, 11% of patients within the target interval by Q-Inflixi had supra-optimal levels (>7 µg/ml) by Lisa-Tracker. In the remaining paired comparisons, fewer than 5% of patients were placed in different subgroups. Qualitative agreement for ATI fluctuated between ‘moderate’ and ‘almost perfect’. Conclusions: All four assays seem suitable for therapeutic drug monitoring of infliximab. Promonitor and Q-Inflixi had the best agreement, making those assays fully interchangeable. Systematic biases between Lisa-Tracker with Promonitor and Q-Inflixi suggest that these assays should not be interchanged during the follow up of an individual patient.


Author(s):  
Poovizhi Bharathi Rajaduraivelpandian ◽  
Padmaja Udaykumar

Background: Therapeutic drug monitoring (TDM) is used to optimize drug’s therapeutic effect. Aim of this study is to assess the knowledge, attitude and practice of TDM in health care professionals.Methods: This was a questionnaire-based cross-sectional study. Questionnaires were distributed to 610 nursing staff and 20 lab technicians. Questionnaires had queries on demography, knowledge, attitude and practice. Descriptive statistics and Pearson correlation were used to analyse the data.Results: Among nurses, 7% had good, 60.9% had   fair and 32.2% had poor knowledge of TDM. Among lab technicians 18.2% had good and 81.8% had fair knowledge on TDM. 79.3% of nurses and all lab technicians had favourable attitude towards TDM. Weak positive correlation is seen between knowledge and attitude among nurses. 15.9% of nurses have sent request for TDM on phenytoin, sodium valproate, carbamazepine, methotrexate, lithium, clozapine, risperidone, tigecycline, vancomycin, gentamicin, digoxin and amiodarone. 100% lab technicians have estimated levels of methotrexate and lithium drug sample during the last one year.Conclusions: Though knowledge on indication and pharmacological basis of TDM is lacking among participants, their knowledge on sample collection and sample type is good. They have a positive attitude towards TDM. Nurses have requested TDM for only 12 drugs. TDM of only two drugs was done by lab technicians. Future training should focus on pharmacological basis, selection of appropriate drug candidate and indication for TDM service. TDM service should be made available in all tertiary care institutions.


2020 ◽  
Vol 1 (1) ◽  
pp. 57-63
Author(s):  
Silke Heuse ◽  
Cathrin Dietze ◽  
Daniel Fodor ◽  
Edgar Voltmer

Background: Future health-care professionals face stress both during education and in later professional life. Next to educational trainings, many students are forced to assume part-time employment. Objective: Applying the Job Demands-Resources Model to the educational context, we investigate which role part-time employment plays next to health-care professional students’ education-specific demands and resources in the prediction of perceived stress. Method: In this cross-sectional study, data from N = 161 health-care students were analysed, testing moderation models. Results: Education-specific demands were associated with higher and education-specific resources with lower amounts of perceived stress. Part-time employment functioned as moderator, i.e. demands were less associated with stress experiences in students who were employed part-time. Conclusion: Identifying part-time employment as a resource rather than a demand illustrates the need to understand students’ individual influences on stress. Both educators and students will benefit from reflecting these resources to support students’ stress management.


Author(s):  
Desmond Chee ◽  
Rachel Nice ◽  
Ben Hamilton ◽  
Edward Jones ◽  
Sarah Hawkins ◽  
...  

Abstract Background & Aims Because of COVID-19 public health restrictions, telemedicine has replaced conventional outpatient follow up for most patients with chronic immune-mediated inflammatory disorders treated with biologic drugs. Innovative solutions to facilitate remote therapeutic drug monitoring are therefore required. Low-volume intracapillary blood sampling can be undertaken by patients at home and samples returned by post to central laboratories. We sought to report the effect of the COVID-19 pandemic on requests for therapeutic drug monitoring and the equivalence, acceptability and effectiveness of low volume Patient-led Remote IntraCapillary pharmacoKinetic Sampling (fingerPRICKS) compared to conventional venepuncture. Methods We undertook a cross-sectional blood sampling methods comparison study and compared sample types using linear regression models. Drug and antidrug antibody levels were measured using standard ELISAs. Acceptability was assessed using a purpose-designed questionnaire. Results Therapeutic drug monitoring requests for adalimumab (96.5 [70.5 - 106] per week to 52 [33.5 - 57.0], p &lt; 0.001) but not infliximab (184.5 [161.2 - 214.2] to 161 [135 – 197.5], p = 0.34) reduced during the first UK stay-at-home lockdown compared with the preceding six months. Fingerprick sampling was equivalent to conventional venepuncture for adalimumab, infliximab, vedolizumab, and ustekinumab drug, and anti-adalimumab and -infliximab antibody levels. The median (IQR) volume of serum obtained using intracapillary sampling was 195µL (130-210). More than 87% (90/103) patients agreed that intracapillary testing was easy and 69% (71/103) preferred it to conventional venepuncture. In routine care, 75.3% (58/77) patients returned two blood samples within 14 days to permit remote assessment of biologic therapeutic drug monitoring. Conclusions Therapeutic drug monitoring can be undertaken using patient-led remote intracapillary blood sampling and has the potential to be a key adjunct to telemedicine in patients with immune-mediated inflammatory diseases.


Author(s):  
Amarjot Singh Gill ◽  
Nistara Singh Chawla ◽  
Sandeep Singh Saini

Background: The practices of various health-care professionals have been improvised to accommodate the on-going covid-19 pandemic situation. Different guidelines have been set in place to ease the process of re-opening of non-elective healthcare services like out-patient physiotherapy clinics. Although the measures taken should be guided by evidence based information, major consensus amongst practicing therapists needs to guide the India physiotherapy clinics. Objective: To identify and present the opinions of different physiotherapists about the various strategies for re-opening the out-patient physiotherapy clinics. Methods: An online cross-sectional survey was conducted. Over 169 participants were selected to participate in the survey according to the pre-decided inclusion and exclusion criteria. The data was collected and saved via google forms. Result and conclusion: A majority of respondents had a consensus over different strategies for re-opening the physiotherapy OPDs. These were regarding different measures to be adapted including modifications in the clinic infrastructure and the practice pattern. This would help in smoothly re-instating the physiotherapy services post the covid-19 lockdown.


Author(s):  
Sushma I. ◽  
Nivin Simon ◽  
A. J. S. Pravin ◽  
M. K. Padmaprasad ◽  
M. Vijayabharathi ◽  
...  

<p class="abstract"><strong>Background: </strong>Mask induced dermatitis is common among health care workers now because of the obligatory use of facemask for a longer period during COVID-19, the clinical features vary. Very few studies could be conducted due to the COVID induced constraints. Studies regarding reactions to face masks in health workers published to date are limited and hence we decided to do this study. The objective of this study was to find out the clinical presentations of mask induced dermatitis due to long term use of facemask on healthcare workers during COVID-19 pandemic.</p><p class="abstract"><strong>Methods:</strong> A cross sectional study was conducted among 40 healthcare workers attend our OPD with face mask for 6 months. After getting informed written consent clinical evaluation was made by history and dermatologic examination.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total 40 health care professionals between the age group of 21-50 years (17 females and 23 males) came to our OPD with complaints of itching and dryness with signs of erythema, scaling, papules for 6 months duration. Out of them, 15 (37.5%) patients had exacerbation of pre-existing dermatoses like atopic dermatitis, seborrheic dermatitis, chronic urticaria, acne. 10 patients (25%) had irritant contact dermatitis 7 patients (17.5%) had sweat-induced dermatitis, 4 patients (10%) had dermatitis due to sponge strip at the nasal bridge, 4 patients (10%) had dermatitis due to vehement use of ear loop involving retroauricular region.</p><p class="abstract"><strong>Conclusions:</strong> This study showed that wearing face masks results in the development and aggravation of other skin diseases due to various causes. Itch can induce scratching and thus lead to inappropriate use of face masks, which could compromise their function.</p>


2020 ◽  
pp. 1-3
Author(s):  
Syed Waseem Tahir ◽  
Sahila Nabi ◽  
Shazia Javaid

Background: Hand hygiene is one of the most effective ways to control health care related infection. Every year millions of patients around the world are affected by infections that are transmitted by the health-care professionals(HCPs).(2)(3). Rationale: Nurses and physicians are the main health care workers contacting with patients, representing the vector in the chain of infection. Thus, assessing their knowledge, attitude and practice regarding hand hygiene is very important to decrease the incidence of health care related infection and to improve quality of care. Objective: The objective of our study was to assess the knowledge, attitude and practices of handwashing among healthcare professionals of Kashmir Division. Methods: This study was an institutional based cross sectional study, conducted in various healthcare institutions of Kashmir Division which were selected randomly. A predesigned questionnaire was used to collect the data from the participants. The questionnaires contained questions about four different parts which included sociodemographic characteristics, knowledge of hand washing, attitude and practice of hand washing among healthcare professionals. The questionnaires were distributed to various healthcare professionals working in wards, emergency department, laboratories, outpatient departments, injection and dressing rooms, EPI unit and others. The distributed questionnaires were then collected back. Results: A total of 110 participants were included. Out of total 110 participants,53% were male ,36% were nurses 36% of health professionals were working in IPD (In Patient Department). 89% of the participants agreed that, direct or indirect contacts are the most important routes for transmission of hospital-acquired infections,97% agreed that
 proper and consistent hand washing prevents infections in health facilities,100% agreed that health professionals should always wash their hands immediately when they arrive at health institutions,98% said that they knew steps of handwashing(WHO)/rules of hand hygiene,91% agreed that hand washing is the single most effective mechanism to prevent spread of infection and 95% agreed that wearing jewellery, artificial fingernails, damaged skin and regular use of hand cream are associated with increased likelihood of colonisation of hands with harmful germs. 83% of the participants said that they are committed to the proper rules of hand hygiene all the time,78% said they comply with rules of hand hygiene even in emergencies,80% said that they think when they are wearing gloves it is not necessary to wash hands,92% feel irritated when others don’t follow hand hygiene rules,95% advice others to follow the rules of hand hygiene and 97% said it is easy for you to follow rules of hand hygiene. 40%(each) of the participants said that they always and usually wash hands before touching a patient,100% of the participants said that they always wash hands before performing aseptic and clean procedures, 100% of the participants said that they always wash hands after being at risk of exposure to body fluids and 95% of patients said that they wash hands after coming to and before leaving the hospital. DISCUSSION In this study we had a total of 110 participants. Health professionals had a satisfactory knowledge of hand hygiene but some lacunae are still there as is evident in the result part. Thus from this study we conclude adherence to handwashing is lacking among health professionals, so we need to have regular handwashing sessions for health professionals which will regularly sensitize them, also we need to address the reasons of this poor adherence both at the administrative and personal level. We also recommend to conduct more studies in this field so as to highlight the shortcomings in hand hygiene and then to improve upon them.


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