Evaluating the Impact of Pharmacist Counselling for Asthmatic Children at Karbala Teaching Hospital for Children: An Interventional Prospective Study (Conference Paper )#

Asthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them, what are the rescue medication and the controller one, proper inhaler techniques, and how to monitor asthma control. Patient education accounts for 90% of success and this can be achieved by an active collaboration among health care providers. This is a prospective interventional study that aims at evaluating pharmacist counseling for asthmatic children. The study involved 105 participants whose consent was taken and underwent a face-to-face interview about asthma counseling and inhaler technique for those who use it. Ninety-two eligible participants remained. Their CACT was recorded at the first visit and then followed up weekly for one month either by phone or physical to assess asthma control. In the fourth week, a CACT was recorded and compared to the first one before intervention. There was a significant improvement in CACT after providing the counselling and weekly follow up.

Lonkan tekonivelleikkauksen jälkeinen fysioterapeuttinen ohjaus fysioterapeuttien kuvaamana

Lonkan tekonivelleikkausten sekä leikkauksen jälkeistä fysioterapiaa tarvitsevien määrä kasvaa väestön ikääntyessä. Kuntoutumisen kannalta fysioterapeuttinen ohjaus on tärkeää. Tämän tutkimuksen tarkoituksena oli tarkastella fysioterapeuttien käsityksiä lonkan tekonivelleikkauksen jälkeisestä fysioterapeuttisesta ohjauksesta. Laadullisen tutkimuksen aineistona oli fysioterapeuttisten ohjaustilanteiden (n=7) kuvanauhojen pohjalta tehdyt recall-haastattelut. Aineiston fenomenografisessa analyysissä muodostettiin kolme hierarkkista kuvauskategoriaa, jotka olivat suppeammasta laajempaan: asiantuntijalähtöinen fysioterapeuttinen ohjaus, potilaan yksilöllisyyttä arvostava fysioterapeuttinen ohjaus sekä fysioterapeuttinen ohjaus osana potilaan kuntoutumista. Nämä kategoriat sisälsivät kuusi ohjaustilanteita kuvaavaa teemaa ja niiden variaatiot: potilaan osallistuminen, kehollinen ohjaus, eettisyys ohjaussuhteessa, fysioterapeutin asiantuntijuus, yhteistyö ja terveydenhuoltojärjestelmän eettisyys. Fysioterapeuttisen ohjauksen onnistumisen kannalta kriittiset tekijät fysioterapeuttien ohjauskäsityksissä olivat potilaskeskeisyys, moniammatillinen yhteistyö ja kuntoutumisprosessin jatkuvuus. Abstract Physiotherapists’ perceptions of patient counseling after total hip arthroplasty (THA) The number of total hip arthroplasties is growing due to the fact that THA is a cost-effective procedure moving people quickly from poor to good functional capacity. The aim of the qualitative study was to explore physiotherapists’ perceptions of post-operative patient counseling. The data of this study consisted of seven physiotherapy situations with inpatients in hospital setting. Data were collected by open recall-interviews based on videotapes of patient counseling situations. The data were analyzed according to phenomenographic approach, which revealed three hierarchical categories: therapist-centered patient counseling, patient counseling which values patient’ individuality and patient counseling as part of individual rehabilitation process. Six themes that varied hierarchically in three categories describing different ways of understanding patient counseling were found: patients’ active participation, counseling for movement awareness, ethical counseling relationship, physiotherapy expertise, cooperation, and ethicality of national health care system. The critical variation between categories manifested as patient-centeredness, multiprofessional cooperation and the continuity of rehabilitation process.

Prognostic Utility of Optical Coherence Tomography for Visual Outcome After Extended Endoscopic Endonasal Surgery for Adult Craniopharyngiomas

IntroductionOwing to the close vicinity of the optic chiasma, visual dysfunction is known as one of the most common surgical indications and postoperative complications in adult patients with craniopharyngiomas, probably leading to poor quality of life. Historically, very few consistent predictive factors associated with the visual outcome are identified, which may not be helpful for patient counseling and preoperative decision making. Recently, optical coherence tomography (OCT) serving as a novel high-resolution imaging technique can assess the retinal morphology by measuring the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex thickness. However, few studies have examined the prognostic utility of OCT parameters for visual outcome after surgery for craniopharyngiomas. This study aims to use the largest series to evaluate the association between OCT parameters and visual outcome after extended endoscopic endonasal surgery (EEES) for primary craniopharyngiomas in adults.Material and MethodsFrom October 2018 to October 2020, one hundred and seventy eyes in 88 adult patients with newly confirmed craniopharyngiomas were retrospectively reviewed and pertinent prognostic factors were analyzed.ResultsGross total resection was performed in 82 (93.2%) patients. The median postoperative follow-up time was 10.9 months. Multiple logistic regression analysis showed that increased temporal cpRNFL thickness was associated with higher odds of visual acuity (VA) improvement and maintenance (OR = 1.070; 95% CI, 1.005–1.140; p = 0.035), and greater inferior cpRNFL thickness was significantly associated with visual field (VF) improvement and maintenance (OR = 1.034; 95% CI, 1.001–1.068; p = 0.046). Furthermore, tight adhesion between optic nerves and craniopharyngiomas was demonstrated as an independent adverse factor for either postoperative VA or VF (p = 0.048, p = 0.030, respectively). The ROC results further verified the robustness of the prediction model either in VA (AUC = 0.843; 95% CI, 0.734–0.952; p < 0.001) or VF (AUC = 0.849; 95% CI, 0.741–0.958; p < 0.001).ConclusionPreoperative OCT can effectively predict visual outcome after EEES for adult craniopharyngiomas. It can also serve as a reliable alternative to evaluate preoperative visual field defects, especially for patients with lower compliance. Tight adhesion was confirmed as an independent risk factor for postoperative visual outcome. The OCT-based multivariable prediction models developed in the present study may contribute to patient counseling on visual prognosis.

Expert opinion on current trends in hyperpigmentation management: Indian perspective

<p class="abstract">Hyperpigmentation is a common pigmentary disorder characterized by increased production of melanin. It is present in Asian skin phototypes, with a higher prevalence in the Indian population. Skin heterogeneity is seen in more than 80% of individuals of all age groups and genders in several cities across India. In children, the prevalence of hyperpigmentary disorders accounts for 1.54 per 1000 children.Sixty expert dermatologists participated in expert group meetings via teleconference webinar to elaborate on the current trends in the management of hyperpigmentary disorders. The major reasons for hyperpigmentary disorders in India include melanocyte function followed by exposure to ultraviolet radiation, race, ethnicity, use of medications, pregnancy, and use of cosmetic. There are wide varieties of skin-lightening or depigmenting agents and skin resurfacing procedures that aid in the management of hyperpigmentation. However, treatment becomes challenging due to compliance issues related to affordability, complexity of prescriptions, and treatment duration. Compliance increases only if the patient sees any improvement or discontinues treatment due to higher expectations. Hence, the success of the treatment lies in patient adherence. This article summarizes expert opinions on identifying, diagnosing, and managing hyperpigmentation with the help of topical depigmenting agents in the Indian scenario. It also emphasizes treatment adherence issues along with the role of patient counseling and education regarding disease awareness and treatment strategies.</p>

Nature and extent of counseling practice in community pharmacies in Sulaimani city, Iraq: A cross-sectional study

Background and objective: Community pharmacists play an important role in the best use of drugs and in improving patient outcomes. Evidence demonstrates that pharmacists' counseling improves the quality of life, clinical outcomes, and drug and disease knowledge and reduces the utilization of health services. This study aimed to investigate the nature and extent of counseling practices of community pharmacists in community pharmacies in Sulaimani region of Kurdistan, Iraq. Methods: A cross-sectional survey was conducted in community pharmacies in Sulaimani city, in a one-month duration from November to December 2020. The sample size was 100 community pharmacies, which were selected randomly. The data were stored and analyzed using Excel 2016 and expressed as frequencies and percentages. Results: According to the completed questionnaires, about 78.8% of pharmacists would do counseling spontaneously each time they dispense any drug. Only 61% of the pharmacists would ask the patients if they understood what was said during their communication to assess the understanding of advice given to their patients. The most common barrier observed during patient counseling was the patient's lack of time. Conclusion: This study indicates that community pharmacists counsel the patients in an appropriate way. They provide information orally and in written form. However, further research is needed to evaluate the quality of patient counseling by using different methods like pseudo-patient methodology to gain real counseling data. Keywords: Counselling; Community pharmacist; Community pharmacy; Counselling barriers.

Radiological Correlates of pT3a Kidney Cancer: Importance of Irregular Tumor Sinus Border

Purpose: Preoperative assessment of T3a renal-cell-carcinoma (RCC) in absence of main renal vein involvement or lymph node enlargement is challenging but has potential implications for counseling and prognosis. Materials and Methods: A retrospective review of 1129 cT1-T3aN0M0 RCC patients managed with partial/radical nephrectomy (PN/RN) in our institution (2012-2014) was performed. Exclusion criteria included radiological evidence of main renal vein involvement or substantial lymphadenopathy. Eleven radiological findings suggestive of aggressive tumor biology or invasive phenotype based on prior literature were assessed for correlation with pT3a status. These included perinephric-findings (stranding, enhancing-nodule, collateral-vessels, or irregular-perinephric-tumor-contour), findings within the sinus (stranding, collecting-system invasion, branch-vein enlargement, or irregular-tumor-sinus-border [ITSB]), and tumor-necrosis, infiltrative-features, and tumor-size. Radiological assessment was blinded to final pathology. Sensitivity/specificity and logistic-regression analyses assessed the performance of each imaging-finding for detecting pT3a tumors. Results: Median tumor-size was 4.0cm and R.E.N.A.L. was 8. Median follow-up was 53 months (IQR:28-64). pT3a tumors were found in 281 patients (25%) and strongly correlated with local and systemic recurrence (p<0.02). ITSB was found in 350 patients (31%) and was the strongest predictor of pT3a status. Sensitivity/specificity/PPV/NPV/OR/C-Index for ITSB were 75%/84%/61%/91%/15.8(11.4-21.9)/0.80, for correlation with pT3a, respectively. The best predictive model included ITSB(yes/no) and tumor-size as a continuous variable (C-index=0.84). Addition of other imaging-findings did not improve the model (C-index=0.84). ITSB was the strongest contributor in all multivariable-models and also strongly correlated with recurrence-free-survival. Inter/intra-observer correlations for assessment of ITSB were 0.89/0.98, respectively. Conclusions: Our data suggest that ITSB and tumor-size associate with pT3a RCC, which could impact patient counseling.

Breast Cancer Risk with Progestin Subdermal Implants: A Challenge in Patients Counseling

There is a steady global rise in the use of progestin subdermal implants, where use has increased by more than 20 times in the past two decades. BC risk has been reported with the older progestin only methods such as oral pills, injectables, and intrauterine devices, however, little is known about the risk with subdermal implants. In this review, we aim to update clinicians and researchers on the current evidence to support patient counseling and to inform future research directions. The available evidence of the association between the use of progestin subdermal implants and BC risk is discussed. We provide an overview of the potential role of endogenous progesterone in BC development. The chemical structure and molecular targets of synthetic progestins of relevance are summarized together with the preclinical and clinical evidence on their association with BC risk. We review all studies that investigated the action of the specific progestins included in subdermal implants. As well, we discuss the potential effect of the use of subdermal implants in women at increased BC risk, including carriers of BC susceptibility genetic mutations.

Actual 10-Year Survival after Resection of Perihilar Cholangiocarcinoma: What Factors Preclude a Chance for Cure?

Complete resection of perihilar cholangiocarcinoma (pCCA) is the only potentially curative treatment. Long-term survival data is rare and prognostic analyses are hindered by the rarity of the disease. This study aimed to determine the cure rate and to identify clinicopathological factors that may preclude cure. All consecutive resections for pathologically confirmed pCCA between 2000 and 2009 in 22 centers worldwide were included in a retrospective cohort study. Each center included its retrospective data series. A total of 460 patients were included with a median follow-up of 10 years for patients alive at last follow-up. Median overall survival (OS) was 29.9 months and 10-year OS was 12.8%. Twenty-nine (6%) patients reached 10-year OS. The observed cure rate was 5%. Factors that virtually precluded cure (i.e., below 1%) according to the mixture cure model included age above 70, Bismuth-Corlette type IV tumors, hepatic artery reconstruction, and positive resection margins. Cure was unlikely (i.e., below 3%) in patients with positive lymph nodes or poor tumor differentiation. These factors need to be considered in patient counseling and long-term follow-up after surgery.

Community Pharmacists' Attitudes and Practice in the Management of Minor Ailments

This study aimed to know the attitudes and practice of pharmacists regarding the management of minor ailments in Iraqi community pharmacies. A cross-sectional study for 320 community pharmacists was conducted during February 2020 using a newly developed and validated questionnaire. Only 4.4% of pharmacists prefer not to deal with minor ailment cases. Minority (15.6%) of participated pharmacists refer more than half of minor ailment cases they face to the physician. Regarding the assessment of minor ailments using WWHAM technique, what are the symptoms are the most commonly asked questions by pharmacists. Only 49.1% mentioned that they ask all WWHAM questions. On the other hand, most pharmacists (90%) educate their patients about the dosing regimen. Meanwhile, less than 10% of pharmacists provide their patients with all possible information about their medications. All demographic factors had no effect on the pharmacists' usage of WWHAM technique and in pharmacist's role in patient counseling or education. In conclusion minor ailment services that provided by community pharmacists' in Iraq was poor at which most pharmacists don't use WWHAM technique appropriately and also fail to provide their patients with the required medication counseling and education.

Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia

Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3–6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08–2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists’ EC counseling.