Clinical and Organizational Impacts of Medical Ordering Settings on Patient Pathway and Community Pharmacy Dispensing Process: The Prospective ORDHOSPIVILLE Study

During the dispensing process of medical orders (MOs), community pharmacists (CPs) can manage drug-related problems (DRPs) by performing pharmacist interventions (PIs). There is little evidence that the PI rate is higher with MOs from hospitals (MOHs) than ambulatory (MOAs) settings, and their impact on the patient and community pharmacy is unknown. The primary objective of this study was to compare the MOH and MOA PI rates. The secondary objective was to describe PIs and their clinical and organizational impacts on patient and community pharmacy workflow. A total of 120 CPs participated in a prospective study. Each CP included 10 MOH and 10 MOA between January and June 2020. DRP and PI description and clinical and organizational impacts between MOH and MOA were assessed and compared. We analyzed 2325 MOs. PIs were significantly more frequent in MOH than in MOA (9.7% versus 4.7%; p < 0.001). The most reported PI was the difficulty of contacting hospital prescribers (n = 45; 52.2%). MOHs were associated with a longer dispensing process time and a greater impact on patient pathway and community pharmacy workflow than MOAs. Lack of communication between hospital and primary care settings partly explains the results. Implementation of clinical pharmacy activities at patient discharge could alleviate these impacts.

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Feasibility of laparoscopy in management of ectopic pregnancy: experience from a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181901 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1778

Author(s):

Jyoti Meena ◽

Richa Vatsa ◽

Sunesh Kumar ◽

Kallol K. Roy ◽

Anshu Yadav ◽

...

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Surgical Management ◽

Tertiary Care ◽

Primary Objective ◽

Diagnostic Methods ◽

New Delhi ◽

Care Hospital ◽

Secondary Objective ◽

A Prospective Study

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality. For surgical management, laparoscopy is preferred option. In developing world for ruptured ectopic pregnancy laparotomy is done at most of places. In this study we have assessed feasibility of laparoscopic management in both ruptured and unruptured ectopic pregnancy.Methods: A prospective study, conducted over period of 1 year from July 2014 to July 2015 in Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. In 110 patients of ectopic pregnancy parameters studied were age and parity, symptoms, risk factors, diagnostic methods, site of ectopic, management and its outcome. Primary objective was to evaluate management outcome of ectopic pregnancy and to assess feasibility of laparoscopy in ectopic pregnancy. Ruptured ectopic pregnancy with massive hemoperitoneum were analyzed separately. Secondary objective was to study demographic characters and risk factors of ectopic pregnancy.Results: Surgical management was required in 93.6% patients, out of which 86.4% were managed laparoscopically. Unruptured ectopic pregnancy was managed successfully by laparoscopy in 96.6% (29/30) patients. Ectopic was ruptured in 73 (66.3%) cases, laparoscopy was attempted in 91.7% (67/73). In 10.4% (7/67) patients laparoscopy had to be converted to laparotomy and it was successful in 89.5%. Out of 16 patients with massive hemoperitoneum, 12(75%) were managed laparoscopically. There was no mortality.Conclusions: In most of cases laparoscopy is safe and successful. Laparoscopy is feasible in ruptured ectopic cases including selected cases with massive hemoperitoneum thus avoiding unnecessary laparotomy and associated morbidity. Timely diagnosis and management prevents mortality.

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Strategy to Improve Efficiency of Comprehensive Medication Reviews in a Community Pharmacy

Journal of Pharmacy Technology ◽

10.1177/8755122519849118 ◽

2019 ◽

Vol 35 (5) ◽

pp. 194-202

Author(s):

Diana Ching ◽

Hussein El-Khatib ◽

Anthony J. Pattin

Keyword(s):

Community Pharmacy ◽

Primary Objective ◽

Support Staff ◽

Rank Tests ◽

Signed Rank ◽

Before And After ◽

New Strategy ◽

Medication Reviews ◽

Secondary Objective ◽

Pharmacy Data

Background: Comprehensive medication reviews (CMRs) provide opportunities for pharmacists to perform clinical services to their patients. However, pharmacists are often not able to perform CMRs due to time constraints. Studies have shown that incorporating support staff into the CMR workflow may lead to increases in the completion of CMRs. Objective: The primary objective was to examine the change in the number of CMRs completed at the pharmacy after a new strategy was implemented to perform and prepare for CMRs. The secondary objective was to examine the changes in the revenue generated from CMRs. Methods: This study was a pre-post retrospective, observational study performed at an independent pharmacy. Data were collected and analyzed 10 months before and after implementation of a new strategy. The new strategy called for pharmacy interns to use a template for working up patients prior to CMRs. Wilcoxon signed-rank tests were run on IBM SPSS, Version 24.0, to determine the significance of the changes. Results that generated P values <.05 were considered statistically significant. Results: The total number of CMRs completed increased from 29 before the intervention to 158 after the intervention ( P = .009). The revenue generated from CMRs improved statistically ( P = .007). Conclusions: Implementing a strategic workflow that uses pharmacy interns and a patient workup template can significantly increase the number of CMRs completed in a community pharmacy. Appropriate delegation of such tasks may allow more time for pharmacists to deliver more CMRs. Additional benefits include increased compensation from delivering more CMRs.

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The Role of Community Pharmacists in the Detection of Clinically Relevant Drug-Related Problems in Chronic Kidney Disease Patients

Pharmacy ◽

10.3390/pharmacy8020089 ◽

2020 ◽

Vol 8 (2) ◽

pp. 89

Author(s):

Céline Mongaret ◽

Léa Aubert ◽

Amélie Lestrille ◽

Victorine Albaut ◽

Pierre Kreit ◽

...

Keyword(s):

Clinical Relevance ◽

Positive Impact ◽

Community Pharmacists ◽

Primary Objective ◽

Drug Related Problems ◽

Health Records ◽

Detection Rates ◽

Problem Detection ◽

Medication Dispensing

Community pharmacists (CPs) have traditionally had limited access to patients’ estimated glomerular filtration rate (eGFR) during the medication-dispensing process. The increasing access to shared electronic health records is making eGFR available, but the skills needed to detect and manage clinically relevant drug-related problems (DRPs) are poorly documented. The primary objective of this study was to investigate the role of CPs in the medication-dispensation process for elderly patients with renal impairment. A total of 70 CPs participated in this 6 month study. Community pharmacists asked all patients ≥65 years to bring their laboratory test values for the next medication-dispensing process. Drug-related problem detection rates were compared between CPs (prospective period) and expert pharmacists (retrospectively). The clinical relevance of each DRP was assessed by nephrologists and general practitioners using an appropriate tool. Community pharmacists recruited n = 442 patients with eGFR < 60 mL/min/1.73 m2 and detected n = 99 DRPs, whereas expert pharmacists detected n = 184 DRPs. The most frequently detected DRPs were dosage problems and contraindications. According to assessment by clinicians, CPs and expert pharmacists identified 54.0% and 84.7% of clinically relevant DRPs, respectively. This study suggests a positive impact of the systematic availability of eGFR to CPs on the detection of several DRPs with clinical relevance.

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The Extent of Community Pharmacists’ Involvement in Detecting and Resolving Drug Related Problems (DRPs) in Prescriptions - A Cross Sectional Study in a Community Pharmacy Setting From Sri Lanka

10.21203/rs.3.rs-109512/v1 ◽

2020 ◽

Author(s):

Tharmalinga Sharma Jegath Janani ◽

Rafaideen Risla ◽

Lelwala Guruge Thushani Shanika ◽

Nithushi Rajitha Samaranayake

Keyword(s):

Sri Lanka ◽

Community Pharmacy ◽

Community Pharmacists ◽

Cross Sectional Study ◽

Inappropriate Drug ◽

Drug Related Problems ◽

Sectional Study ◽

Duration Of Treatment ◽

Dose Selection ◽

Cross Sectional

Abstract Background: Drug Related Problems (DRPs) in prescriptions could harm patients.Purpose: To assess, the prevalence of DRPs in prescriptions, and the ability of community pharmacists to detect and correct DRPs in prescriptions dispensed in a selected community pharmacy. Methods: A prospective, cross-sectional study was conducted in a selected community pharmacy in Colombo, Sri Lanka, where one researcher reviewed for DRPs in systematically selected prescriptions (N=400), and another directly observed the proportion of DRPs identified by community pharmacists in the same set of prescriptions. Actions taken by pharmacists on resolving DRPs were also documented. DRPs were classified according to a slightly modified version of Pharmaceutical Care Network Europe classification V8.01. Results: Among 1986 drugs, 1211 DRPs were identified by researchers, and 441 by community pharmacists (N=24). Drug selection (N=15), dose selection (N=817), duration of treatment (N=128), incomplete prescriptions (N=128), and in-house classification such as outdated prescriptions, missing unit of measurements, and ambiguous names of medicines that cannot be read by both community pharmacists and researcher (N=122) were the most common DRPs identified by researchers, of which only 1 (p<0.001), 394 (p<0.001), 13 (p=0.006), 5 (p<0.001), and 27 (p<0.001) respectively were identified by pharmacists. DRP identification by researcher and pharmacist did not significantly differ for inappropriate drug form (p=0.550). Among 441 DRPs identified by pharmacists, 406 were corrected by them (p=0.92). Most DRPs were self-resolved by pharmacists themselves (366/406) (p=0.90), while patients were also sent back to prescriber (14/406) (p=0.03) and refused to dispense drugs (9/406) (p=0.02).Conclusion: Among DRPs frequently observed in prescriptions in the community, pharmacists missed some, including incomplete prescriptions that had potential to harm. Pharmacist resolved most of the DRPs detected.

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The Student Room Survey: Changes in the Post Graduate Study for Cardiothoracic Surgery

Journal of Surgical Sciences ◽

10.3329/jss.v23i2.46113 ◽

2020 ◽

Vol 23 (2) ◽

pp. 71-74

Author(s):

Md Faizus Sazzad ◽

Mohammed Moniruzzaman ◽

Dewan Iftakher Raza Choudhury ◽

Arif Ahmed Mohiuddin ◽

Raafi Rahman ◽

...

Keyword(s):

Thoracic Surgery ◽

Retrospective Analysis ◽

Primary Objective ◽

Graduate Study ◽

Postgraduate Students ◽

Depth Interview ◽

Secondary Objective ◽

Cardio Vascular ◽

The University ◽

Day By Day

Background: The number of postgraduate students in Cardiac surgical discipline is increasing day by day with incremental proportion are measurably suffering from the unnecessary lingering of the present course curriculum. The primary objective of this study was to find out the last 5 years’ of results of Masters in Surgery course under the University of Dhaka from a student room survey. A secondary objective was to find out positive changes that could show us the way of a step toward up-gradation. Methods: It is a retrospective analysis of all examination results of Cardio-vascular & Thoracic Surgery published since January 2008 to January 2013 from the University of Dhaka with in depth interview of 11 participants. Results: 85.24% students failed to pass part-I of Masters in Surgery for Cardio-vascular & Thoracic Surgery course while, 82.18% in part-II and 71.28% failed to pass the final part. Average 2.51 attempts needed to complete each part of the designed course resulted into lingering of course duration for 42.18 months/student. In the thoracic surgery discipline the number of students alarmingly reduced up to 0% in the recent academic sessions. Conclusions: Masters in Surgery is resulting in unnecessary prolongation of the course. We should step forward to meet the next generation challenge. Journal of Surgical Sciences (2019) Vol. 23(2): 71-74

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Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-20-0628 ◽

2021 ◽

Vol 184 (1) ◽

pp. 19-28

Author(s):

Alexander A Leung ◽

Janice L Pasieka ◽

Martin D Hyrcza ◽

Danièle Pacaud ◽

Yuan Dong ◽

...

Keyword(s):

Cohort Study ◽

Administrative Data ◽

Laboratory Data ◽

Population Based ◽

Incidence Rates ◽

Primary Objective ◽

Administrative Databases ◽

Secondary Objective ◽

True Frequency ◽

Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

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Incidência da utilização de protetores bucais em diversos esportes de contato

Full Dentistry in Science ◽

10.24077/2020;1245-118122 ◽

2020 ◽

Vol 12 (45) ◽

pp. 118-122

Author(s):

Victor Paes Dias Gonçalves ◽

Hugo Leonardo Matias Nahmias ◽

Marcus Menezes Alves Azevedo

Keyword(s):

Martial Arts ◽

Rio De Janeiro ◽

Dental Trauma ◽

Primary Objective ◽

Type Ii ◽

Contact Sports ◽

The Face ◽

Secondary Objective ◽

The City

Among contact sports, the practice of martial arts offers a greater risk of causing dental trauma and fractures as contact with the face is more frequent. The primary objective of the research is to evaluate the incidence of mouthguard use, and the secondary objective is to verify which type has a greater predominance and the difficulties in its use correlating to the type of mouthguard used. A documentary study was carried out with 273 athletes of different contact sports, among them: MMA, Boxing, Muay Thai, Jiu-Jitsu, and Taekwondo of the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. It was concluded that the most commonly used mouthguard is PB Boils and Bites - Type II and its level of approval is poor, interfering with the athletes’ performance, mainly in relation to the breathing factor.

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COUNSELLING ACTIVITIES OF DRUG USE IN 58 COMMUNITY PHARMACIES AT HUE CITY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.3.11 ◽

2017 ◽

pp. 75-80

Author(s):

Quoc Duong Doan ◽

Thi Ha Vo

Keyword(s):

Blood Pressure ◽

Drug Use ◽

Community Pharmacy ◽

Key Words ◽

Community Pharmacists ◽

Community Pharmacies ◽

Cough Headache ◽

Rational Drug ◽

Question Survey

Background: Community pharmacists play an important role in counseling of rational drug use for population. The study aimed to characterize counselling activities of drug use and demand of counselling tools at some community pharmacies at Hue City. Materials and method: A 17-question survey were asked to fill pharmacy staffs of a convenient sample of 100 community pharmacies at Hue City from 2/2017 to 7/2017. Results: There were 58 pharmacies (58.0%) answered this survey. Cough, headache, fever, high blood pressure and diabetes were the most popular symptoms/diseases presented in pharmacies. Patients often need counselling about dose (82.8%) and when to take medicine (79.3%). The main bariers for counselling were a lack of time (53.4%), and of skills/medthods for counseling (31.7%). About 96.6% pharmacies demanded counselling tools and favorite formats were book (32.9%) or pocket handbook (29.3%). Conclusion: Most pharmacies demanded counselling tools. Other studies should be conducted to develop supporting tools for counseling and to assess the quality of counseling in pharmacies. Key words: community pharmacy, counseling of drug use, pharmacist, Hue

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Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10070763 ◽

2021 ◽

Vol 10 (7) ◽

pp. 763

Author(s):

Daniele Roberto Giacobbe ◽

Chiara Russo ◽

Veronica Martini ◽

Silvia Dettori ◽

Federica Briano ◽

...

Keyword(s):

Bacterial Infections ◽

Bloodstream Infections ◽

Cross Sectional Study ◽

Primary Objective ◽

Sectional Study ◽

Cross Sectional ◽

First Line Therapy ◽

Large Teaching Hospital ◽

Secondary Objective ◽

Medical Wards

A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response.

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Exploring the independent prescribing role of the community pharmacists in Wales

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.042 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i35-i35

Author(s):

S S Alghamdi ◽

R Deslandes ◽

S White ◽

K Hodson ◽

A Mackridge ◽

...

Keyword(s):

Community Pharmacy ◽

Community Pharmacists ◽

Community Pharmacies ◽

Committee Report ◽

Independent Prescribing ◽

General Practices ◽

The Government ◽

Clinical Records ◽

The Impact

Abstract Introduction Since 2019, the role of independent pharmacist prescribers (IPPs) in primary care has extended to community pharmacies in Wales [1]. This was in response to a Welsh Pharmaceutical Committee report in 2019 that outlined a plan to include an IPP in each community pharmacy in Wales by 2030. This aimed to relieve pressure on general practices, enhance patient care and reduce referral and admission rates to secondary care [2]. As funding was provided by the Government, the number of community pharmacists completing the independent prescribing course increased and many have implemented their prescribing role. Aim To explore the views of community IPPs regarding their prescribing role within community pharmacies in Wales. Methods Semi-structured face-to-face and telephone interviews were conducted with community IPPs from all seven health boards (HBs) in Wales. Ethical approval was obtained from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University and the School of Pharmacy and Bioengineering at Keele University. Purposive sampling was used to identify potential participants. Gatekeepers (HB community pharmacy leads and directors of IPP courses in Wales) sent invitation emails, participant information sheet and consent form to potential participants. Written consent was obtained. Interviews were audio-recorded and transcribed ad verbatim. Thematic analysis was used to analyse the data. Results Thirteen community IPPs across Wales participated. Six themes were identified, including the utilisation of their role as community IPPs, their experiences with their independent prescribing training, motivation to obtain their prescribing qualification and utilise it, the impact, barriers and facilitators to implement and utilise their role. Participants practised as IPPs in the management of minor ailments and some other conditions, such as respiratory and sexual health. The course and training for community IPPs was helpful, but there was a need to focus more on therapeutic and clinical examination skills. The main impact of the role was that it helped to improve communication between community pharmacies and general practices and relieved some pressure on general practices. The main barriers were the lack of appropriate funding by the Government to develop the role, lack of access to patients’ medical records, lack of support and high workload. “One of the areas identified as high risk is for pharmacy prescribers is the lack of access to clinical records. How can you [as community IPPs] make any sensible decisions with half the information?” IPP6 Facilitators included that some services were already in place and the drive from the 2030 vision. Conclusion This is the first study that explored the views of community IPPs regarding their prescribing role in community pharmacies in Wales. It provided an insight into this new role that can be considered by the Welsh Government to achieve the 2030 vision for this role. A limitation to this study was that the role is still new in community pharmacies, which may affect the views of the community IPPs. Many of them have obtained their prescribing qualification but have not started to utilise it yet. Further work is needed to explore a wider population of community IPPs’ experiences as the role develops. References 1. Wickware, C. 2019. All community pharmacies in Wales to have an independent prescriber as part of long-term plan for Welsh pharmacy. Available at: https://www.pharmaceutical-journal.com/news-and-analysis/news/all-community-pharmacies. 2. Welsh Pharmaceutical Committee. 2019. Pharmacy: Delivering a Healthier Wales. Available at: https://www.rpharms.com/Portals/0/RPS%2.

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