Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

Discharge prescriptions for heart failure (HF) patients may not adhere to the clinical practice guidelines. This study aimed to assess the impact of the clinical pharmacist as a member of a multidisciplinary team on the quality of prescribing to HF patients at discharge from a Critical Care Unit (CCU) in Egypt. This was a retrospective cohort study of HF patients discharged from the CCU between January 2013 and December 2017. Guideline Adherence Index (GAI-3) was used to assess guideline-directed prescribing at discharge. Multidisciplinary care was introduced to the CCU on 1 January 2016. The study included 284 HF patients, mean (±SD) age 66.7 ± 11.5 years, 53.2% male. Heart failure with reduced ejection fraction affected 100 patients (35.2%). At discharge, loop diuretics were prescribed to 85.2% of patients; mineralocorticoid receptor antagonists to 54.9%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to 51.4%; and β-blockers to 29.9%. Population Guideline Adherence Index (GAI-3) was 45.5%. High-GAI was prescribed to 136 patients (47.9%). Patients with High-GAI were younger; less affected by chronic kidney disease and had fewer comorbidities than those without High-GAI. Prescription of β-blocker increased (24.1% vs. 38.6%, p < 0.001) and digoxin utilization decreased (34.7% vs. 23.7%, p < 0.049) after the introduction of the multidisciplinary care. The inclusion of a clinical pharmacist in the multidisciplinary care team may have a role in optimizing the prescribing of HF guideline-directed therapies at discharge from this setting.

The potency of Immunoglobulin Y anti Porphyromonas gingivalis to inhibit the adherence ability of Porphyromonas gingivalis on enterocytes

Background: Pophyromonas gingivalis (P. gingivalis) bacteria are the main type of bacterium that cause chronic periodontitis. Immunoglobulin Y (IgY) is a type of immunoglobulin found in poultry, such as chickens and birds. IgY can be used as an alternative method of preventing the accumulation of plaque that causes chronic periodontitis. Purpose: To determine the ability of IgY anti P. gingivalis to inhibit adherence of P. gingivalis. Methods: The samples were divided into eight groups, each group containing 10 ml of IgY anti P. gingivalis and 50 ml of enterocyte cells. The control group contained 50 ml of IgY anti P. gingivalis, and 50 ml of enterocyte cells. Serial dilution was carried out to the first seven groups, with the first group containing 90 ml phosphate-buffered saline (PBS) and 10 ml IgY anti P. gingivalis, and the second to seventh groups containing 50 ml PBS before adding 50 ml of enterocyte cells and 50 ml of bacterial suspension per group. The number of bacteria was calculated as an adherence index value using a light microscope. Results: This study shows that IgY anti P. gingivalis significantly reduces the adherence index value of P. gingivalis. Conclusion: IgY anti P. gingivalis has potency to inhibit the adherence of P. gingivalis.

Antiretroviral therapy adherence and predictors to adherence in Albania: a cross-sectional study

Introduction: The possibility of an HIV/AIDS epidemic in southeastern Europe (SEE) is not improbable. Thus, an understanding of the current issues surrounding HIV/AIDS care, specifically antiretroviral therapy (ART) adherence, in countries within SEE is critical. This study was conducted to determine the ART adherence characteristics of Albania’s HIV-positive population. Methodology: This cross-sectional study reports initial demographic and adherence characteristics of patients receiving HIV/AIDS treatment in Albania. Retrospective review of pharmacy medications dispensed supplemented reported adherence behavior. Further, an adherence index was utilized to explore adherence more thoroughly. Results: Patient-reported adherence and pharmacy review showed adherence levels of 98.9±4.4% and 97.7±4.7%, respectively. Assessment by adherence index revealed an index level of 91.7±6.7. Factors associated with a score of < 95 on the adherence index were: being partnered (OR = 0.29, 95% CI = 0.09 – 0.98), history of depression (OR = 0.24, 95% CI = 0.08 – 0.76), increased number of barriers to care (OR = 0.80, 95% CI = 0.66 – 0.97), and increased number of current social and medical needs (OR = 0.72, 95% CI = 0.58 – 0.91). Conclusions: Interventions aimed at reducing barriers to care, addressing current medical and social needs, and treating mental health issues may help improve adherence to ART in patients with HIV/AIDS in Albania. With little known about HIV/AIDS in SEE, this study provides guidance on how SEE countries can help prevent a possible rise in the prevalence of HIV given the close link of ART adherence and spread of HIV.

Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet

ObjectiveTo compare and evaluate the reliability of several indexes of adherence to the Mediterranean diet.DesignThe ten indexes included in the analysis were: Mediterranean Diet Score (MDS), Mediterranean Score (MS), Dietary Score (DS), Mediterranean-Dietary Quality Index (Med-DQI), Mediterranean Dietary Pattern adherence index (MDP), Mediterranean Adequacy Index (MAI), Mediterranean Style Dietary Pattern Score (MSDPS), Mediterranean food pattern PREDIMED Study (MeDiet-PREDIMED), relative Mediterranean diet (rMED) and Cardioprotective Mediterranean diet index. Factor analysis using the correlations between indexes was applied. The correlation with factors and the reliability coefficient were calculated.SettingA total of 324 healthy undergraduates at the University of Barcelona, Spain, were surveyed.ResultsThe highest correlations were observed between MDP adherence index and MAI (0·82); MAI and MSDPS (0·80); and MDS and rMED (0·77). Factor analysis showed a hidden common factor that explained over 70 % of the variability (71·03 %). This factor is understood as ‘adherence to the Mediterranean diet’. The indexes that showed the highest correlation with this factor were Med-DQI (0·85), MDS (0·84), rMED (0·80) and MAI (0·80). These indexes showed acceptable performance in measuring the adherence to the Mediterranean diet. The components that correlated strongly with this factor were monounsaturated-to-saturated fatty acid ratio (MS ratio), fruit and vegetables. Furthermore, a second common factor was found explaining 18 % of the variability. This second factor is highly positive related to dairy products and lean meat, and negative related to MS ratio.ConclusionsThe indexes showed satisfactory performance in assessing adherence to the Mediterranean diet. However, in order to improve the reliability and concordance between the indexes, further studies are required to select the components, the number of components, and the scoring criteria of the indexes to improve their internal consistency.