Role of clinical pharmacist in the palliative care of adults and elderly patients with cancer: A scoping review

Objective: We conducted this scoping review to map and summarize scientific evidence on the role of clinical pharmacists in the palliative care of adults and elderly patients with cancer. Data Sources: A literature search was performed in MEDLINE, PubMed Central, Embase, Web of Science, Scopus, and BVS/BIREME for studies published until November 22nd, 2020. Studies that reported work experiences adopted by clinical pharmacists in the palliative care of adults and elderly patients with cancer were included. Two independent authors performed study selection and data extraction. Any disagreements were resolved by discussion with the third and fourth authors. The pharmacist interventions identified in the included studies were described based on key domains in the DEPICT v.2. Data Summary: A total of 586 records were identified, of which 14 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 5) and Canada (n = 5) and described the workplace of the pharmacist in clinic/ambulatory (n = 10). Clinical pharmacists performed several activities and provided services, highlighting medication review (n = 12), patient and caregivers education (n = 12), medication histories and-or medication reconciliation (n = 6). The pharmacist interventions were mostly conducted for patients/caregivers (n = 13), by one-on-one contact (n = 14), and by face-to-face (n = 13). Pharmacists were responsible mainly for change or suggestion for change in therapy (n = 12) and patient counselling (n = 12). Pharmacist interventions were well accepted by the clinical team. Overall, studies showed that pharmacists, within an interdisciplinary team, had significant impacts on measured outcomes. Conclusions: In recent years, there have been advances in the role of the pharmacist in palliative care of patients with cancer and there are great opportunities in this field. They play an important role in managing cancer pain and other symptoms, as well as resolving drug related problems. We encourage more research to be carried out to strengthen this field and to benefit patients with advanced cancer with higher quality of life.

A Randomized, Single Centered, Parallel and Open labelled Interventional Study on Effectiveness of Clinical Pharmacists on Adverse Event Following Immunization (AEFI) in Pediatric Population

Background: Adverse events are a major threat to any immunization programs, which in turn have proven to be a boon for developing nations like India. Hindering factors, such as inadequate knowledge, inappropriate attitude, incorrect practices, etc., of the guardian affect the vaccination rate. Aim: This study aims to assess the effectiveness of clinical pharmacist intervention on an adverse event following immunization in the pediatric population receiving immunization. Materials and Methods: Pediatric subjects <5 yrs of both genders receiving immunization in a tertiary care hospital during the period of 8 months were considered. Subjects were randomized into control and interventional groups. Pharmaceutical intervention was done in interventional group in the form of patient counselling, and a patient information leaflet. Adverse event following immunization was recorded and analysed for both groups along with Knowledge, Attitude, and Practice scores of guardians’ pre and post intervention through customized data collection forms. Microsoft excel and statistical software SPSS IBM version 22 was used to analyse the data. Results: The study was conducted on a total of 88 subjects (n) in which 79 were <2 years, 1 and 8 were between 2-4 years and 4-5 years respectively. Forty-ninesubjects (55.69%) were female, while 39 were male (44.31%) with a response and completion rate of 91.66%. 97.7% subjects received Bacillus Calmette-Guerin vaccination (majority), while 8.88% received pneumococcal special vaccine (minority). Adverse event following immunization was recorded in 31(35.22%) cases. Knowledge, Attitude and Practice scores increased by 42.17%, 52% and 12.67%, respectively in guardians after clinical pharmacist intervention. Conclusion: This studydemonstrates that educational inputs, awareness programs, and proper medical professional intervention can act as a helping factor to fight against AEFI and towards the success of an immunization program.

Cyberchondria and Medical Student Syndrome

Health anxiety is a disorder that can be very distressful and cause unnecessary examinations. A doctor is expected to handle health anxiety in terms of examination, diagnosis, therapy, and counselling processes. To provide optimal patient counselling, a doctor needs confidence, empathy, and good mental health. However, the process to become a medical doctor requires a student to read through a large amount of medical information, which arguably might induce “medical student's syndrome,” or health anxiety. Contradicting research findings exist about such conditions, however, most of them use traditional measures of health anxiety and do not consider students' online behaviour. The authors hypothesized that a medical student is susceptible to cyberchondria, a form of health anxiety due to excessive internet use. Some studies have shown that there may be higher cyberchondria scores among medical students compared to the general population. Cyberchondria needs to be studied further to improve the mental health condition of medical students and to provide optimal future healthcare for patients.

The Impact of Endoscopy Sedation Information Sheets on the Level of Concern Regarding Possible Awareness in Patients Undergoing Endoscopy Sedation

Sedation encompasses a continuum from complete unconsciousness to drowsiness and anxiolysis where some awareness might be expected. Most patients undergoing endoscopy sedation expect to be completely unconscious during the procedure and thus have unmet expectations regarding their state of consciousness. This study aimed to evaluate whether endoscopy sedation information sheets reduce the level of concern regarding possible awareness during endoscopy sedation at a major regional hospital. Our findings were that 28.8% of patients who received the endoscopy sedation information sheet (n = 82) were concerned about awareness during the procedure, compared to 36.5% of patients in the control group (n = 105). However, the difference was not statistically significant. We also found that the incidence of awareness was higher (13.9%) in the intervention group compared to 8.8% in the control group but, again, not statistically different. This study allowed us to elucidate the level of concern regarding possible awareness during sedation and the incidence of awareness during endoscopy sedation. This will enable future work investigating the role of endoscopy sedation information methods involving written and video material in assisting pre-procedure patient counselling.

Expert opinion on current and emerging treatments in dermatophytosis

<p class="abstract">Dermatophytosis continues to be a worldwide public health problem, predominantly in developing countries like India. Early diagnosis and appropriate management are imperative to enhance patient outcomes and improve quality of life of individuals with dermatophytosis. Multiple focused group discussions involving 76 dermatologists across 36 cities in India were conducted to provide a consensus clinical viewpoint of expert dermatologists to gain insights toward effective diagnosis and management of Indian subjects with dermatophytosis. These discussions mainly aimed at reviewing current literature on prevalence, etiology, diagnosis and management of dermatophytosis and highlighting variations in diagnostic and treatment approaches in routine clinical practice. The current article summarizes the experts’ clinical viewpoint on overall management of dermatophytosis. Diagnosis of dermatophytosis involves clinical observation, microscopic examination and dermoscopy. Molecular techniques have certain advantages over conventional microscopy and culture methods but are associated with issues of cost and technique complexity. Oral itraconazole 200 mg–400 mg daily and terbinafine 500 mg/day could be considered for recalcitrant tinea infections. Topical azoles like luliconazole, sertaconazole, and terbinafine could be beneficial. A combination of oral and topical antifungal drugs is effective in patients with steroid-modified and difficult-to-treat tinea infections. Also, patient counselling and use of adjunctive therapies like antihistamines, retinoids, and moisturizers are essential for managing tinea infections. </p><p class="abstract"> </p>

Patient Counselling and Medicolegal Aspects of Hair Transplant Surgery

Hair transplantation being an elective aesthetic surgery, the importance of informed consent cannot be overstated. Explaining the condition of hair loss, the causes, progress, prognosis, and all available treatment options is a part of this process. Providing conflict-free information, ensuring that the patient comprehends this information, and allowing him/her to make the decision to authorize the surgeon to perform the procedure is the moral obligation of the hair transplant surgeon. The benefits of this approach are noticeable and one of the most effective ways to have a satisfied patient and reduce the possibility of claims.

Therapeutic strategies and challenges in the management of craniospinal tumours in pregnancy: a 10-year retrospective tertiary centre study, systematic review, and proposal of treatment algorithms

Objectives: The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that influence the management along with their influence on maternal & foetal outcomes. Materials and Methods:A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results:Thirty-three patients were identified with a mean age of 31 years. 91%(n=30) had cranial lesions and 9%(n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identified 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions:Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Fractures of Tibia Diaphysis Managed with Internal Fixation by Elastic Nails: An Alternative Approach

Background: Intramedullary nailing techniques specially using elastic nails like Enders nail are a good treatment option, owing to their cost effectiveness, less use of fluroscopy and ease of procedure with short learning curve. This study is aimed to bring evidence to the hypothesis that Ender nails can be used successfully in tibia shaft fractures under certain indications. Due to the economic nature and easy procedure, we aimed specifically to demonstrate that elastic IM nailing, esp. Ender nails can be a good alternative to interlock nailing for select cases of diaphyseal fractures. The study aims at evaluating outcome of Enders nail in diaphyseal tibia fractures. Material and Methods: This study was carried on in the Department of Orthopaedics, tertiary care hospital during the period of April 2019 to March 2020. It is a prospective type of study. Patients were evaluated based on functionality and radiology, post-surgery. Results: A total of 30 patients of tibial shaft fractures were selected and managed with closed reduction and internal fixation with Enders nail. Male to female ratio was 4:1. 24 (80%) patients sustained injury from motor vehicular accidents. 40% patients with open fracture and 60% closed fracture patients were involved. 60% if the patients showed clinic-radiological union in 12-14 weeks, while 50% of the patients achieved a post operative knee range of movement of 0 to 131-140 degrees. Conclusion: Closed reduction with internal fixation by Enders nail can be a good alternative for management of tibia diaphysis fractures, when performed after proper patient selection and patient counselling.

A Prospective Observational Study on Diabetic Induced Complications and their Prone towards Surgery

Background: This study was mainly aimed to find out the diabetic complications that had been lead to surgey. The Diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate,fat and protein metabolism resulting from defects in insulin secretion,insulin action, or both.The effects of diabetes mellitus include long-term damage,dysfunction and failure of various organs. Materials and Methods: A prospective observational study was conducted in the Santhiram college & general hospital for 6 months (December 2020 – May 2021)to assess the macro vascular and micro vascular complications of diabetes mellitus and prone to surgery of diabetic complications by using case sheets, prescriptions in tertiary care teaching hospital. Results: A total of 150 patients are included in this study.In patients with diabetic complications we have observed: Diabetic ulcer with cellulitis in 19, gangrene in 19, peripheral vascular disease in 6, gangrene with cellulitis in 11,Non healing diabetes foot ulcer in 35, Coronary artery disease 24, diabetic retinopathy 25, MI in 11 patients.Among all complications, non healing diabetic foot was observed to be more when compared to other diabetic complications.In the study performed in diabetic induced complications of patients, debridement was performed in 30% patients, Amputation were performed in 13%, skin grating was performed in 13% patients, Angioplasty were performed in 23% patients and lasix surgery performed in 13% patients. Conclusion: In our study we conclude that out of 150 cases, male patients are more prone to diabetic complications than females.The patient counselling should involve in minimizing the incidence and prevalence of diabetes by conducting the continuing health education and other health programms.