Background
Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly ...increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan.
Methods
A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS).
Results
Of the 602 patients included in the analyses, 59.5% (
n
= 358) reported no impairment in self-care, while 63.1% (
n
= 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age > 50 years; having primary and secondary education; > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART.
Conclusions
The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.
Abstract
Objectives
To describe the implementation and assess whether an objective structured clinical examination (OSCE) is a viable assessment tool for testing Antimicrobial Stewardship (AMS) ...principles.
Methods
A three-station OSCE set in a hospital and community pharmacy was designed and mapped to the World Health Organisation’s AMS intervention practical guide. This OSCE comprised 39 unique cases and was implemented across two campuses (Malaysia and Australia) at one institute. Stations were 8 min long and consisted of problem-solving and applying AMS principles to drug therapy management (Station 1), counselling on key antimicrobials (Station 2) or managing infectious diseases in primary care (Station 3). Primary outcome measure to assess viability was the proportion of students who were able to pass each case.
Key findings
Other than three cases with pass rates of 50, 52.8 and 66. 7%, all cases had pass rates of 75% or more. Students were most confident with referral to medical practitioner cases and switching from intravenous to oral or empirical to directed therapy.
Conclusions
An AMS-based OSCE is a viable assessment tool in pharmacy education. Further research should explore whether similar assessments can help improve students’ confidence at recognising opportunities for AMS intervention in the workplace.
The irrational use, "over the counter supply", and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate ...antimicrobials usage to prevent resistance and reduce health care burden.
To assess the knowledge and practice of pharmacists' working in various healthcare settings toward antimicrobial stewardship in Pakistan.
A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017.
A total of 181 pharmacists participated, of whom (
= 145, 80.1%) were males. The majority of participants were in the 20⁻30 age group (
= 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that "antimicrobial stewardship is essential to improve patient care"; while (
= 159, 87.8%) pharmacists agreed that "pharmacist should be trained on the use of antimicrobial". Close to 90% of pharmacists agreed that "adequate training should be provided to pharmacists on antimicrobial use". Regarding the practice of antimicrobial stewardship, (
= 72, 39.8%) pharmacists often/always "make efforts to prevent or reduce the transmission of infections within the community"; (
= 58, 32%) pharmacists never "dispense antimicrobials without a prescription"; and (
= 60, 32%) pharmacist often/always "communicate with prescribers if unsure about the appropriateness of an antibiotic prescription".
: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.
Background
The use of cosmetics is growing among both male and female consumers due to the availability of different brands. While there is an increase in the usage of cosmetic products, it is ...concerning whether the consumers are aware of the safety of the products.
Aims
This study aimed to widely explore consumers’ perceptions and attitudes toward cosmetics within the context of the COVID‐19 pandemic.
Methods
A cross‐sectional study was carried out among adults in Selangor, Malaysia. Thirty‐three questions divided into three dimensions (socio‐demographic parameters, assessment of perception, and assessment of attitude) were developed and validated to be answered by cosmetics consumers. Descriptive and inferential statistical analysis was done using SPSS.
Results
A response rate of 87% was achieved, and the mean age of participants was 33 ± 7.2. The overall perception of consumers indicates low levels of perception and moderate level of attitude toward cosmetic products. There was a positive correlation and high relationship between participants’ perception and attitude (p = 0.001, r = 0.72). A significant association was observed between demographic data of respondents and their attitude and perception toward cosmetic products. Participants were unaware that sharing of cosmetic products could lead to bacterial infection and possibly increased the chance of contracting COVID‐19.
Conclusion
This study displayed a nonchalant perception and attitude of Malaysian adults toward cosmetic products by focusing on aesthetics rather than health safety. Therefore, it is recommended to raise awareness on the composition and effects of cosmetic products, increase the practice of hygiene and dissuade the sharing of cosmetics to reduce transmissions of COVID‐19.
Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. ...However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists' services on the ECHO of patients in South Asian countries.
We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists' services, from both hospital and community settings, were included.
The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle.
This systematic review suggests that pharmacists have essential roles in improving patients' ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated.
Evidence-based services to support cancer patients with pain via clinical pharmacy services are currently lacking. Therefore, there is a need to undertake a randomized controlled trial (RCT) to ...explore the effectiveness of clinical pharmacists (CPs)' input into the multidisciplinary team (MDT) in providing better therapeutic outcomes for cancer pain management.
The main aim of this pilot RCT is to determine the feasibility and preliminary efficacy of integrating CPs into the MDT for cancer pain management on the clinical outcomes of cancer patients experiencing pain.
This study protocol outlines two-armed multicenter pilot RCT. Cancer patients suffering from pain will be randomly allocated to receive either clinical pharmacy services, i.e., PharmaCAP trial intervention from the CP, or the usual standard care (i.e., control group). Patients will be recruited consecutively from two hospitals in Kathmandu valley, Nepal. The outcomes will be assessed at baseline (pre-intervention) and 4 weeks post-intervention. The primary feasibility outcomes will include eligibility rate, recruitment rate, willingness to participate, acceptability of screening procedures and random allocation, possible contamination between the groups, intervention fidelity and compliance, treatment satisfaction, and patient understanding of the provided interventions. Subsequently, the primary clinical outcome, i.e., pain intensity of cancer patients, will be assessed. The secondary clinical outcomes will include health-related quality of life (HRQoL), anxiety, depression, adverse drug reactions, and patient medication compliance following the integration of CP into the healthcare team.
The feasibility and potential for integrating CP involvement in MDT to improve clinical outcomes of cancer patients with pain will be evaluated through the PharmaCAP trial.
ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.
The engagement of pharmacists in research activities is pivotal in the advancement of the pharmacy practice. The study aims to evaluate the confidence and competence of Malaysian hospital pharmacists ...in conducting clinical and practice-based research.
A cross-sectional study was carried out between September 2019 and April 2020 using an online survey. Pharmacists from eight different hospitals in Malaysia were involved in the study. The survey link was sent to all pharmacists of the included hospitals via email. Data were analysed using SPSS version 25.
A total of 226 pharmacists participated in this study, and their average age was 28 years old. About 82 % of the participants reported that they did not have any previous research experience, and around 62% of them indicated that the research training during their undergraduate study was inadequate. At least 60% of the participants reported inadequate competence and/or confidence in developing research protocols, critically appraising the literature, undertaking and applying appropriate statistical techniques, and interpreting research findings.
There is an urgent need to reinforce undergraduate and postgraduate research training in the institutions among potential and current pharmacists to build competence in research techniques such as literature reviews and scholarly participation.
Purpose: Several studies have shown that polypharmacy is the main cause of drug interactions, and the prevalence and the level of the severity varied with the duration of stay in the hospital, sex ...and race of the patients. The aims of this investigation were to identify the drug-drug interactions in hospitalized pediatric patients associated with polypharmacy, and to categorize the drug interactions in pharmacokinetic or pharmacodynamic interactions according to their level of severity. Methods: A cross-sectional, prospective analytical study was performed at a pediatric tertiary care hospital in Lahore, Pakistan for the duration of 4 months, which included prescription orders for 300 patients. Data were collected from patient medical files about previous and current medication history. Drug interactions were analyzed using interaction checker on Medscape and categorized according to the severity levels. Results: Out of 300 patients, the occurrence of drug interactions was found in 157 (52.3%) patients, while in 143 (47.7%), no interaction was found. Among these interactions, 50.7% were pharmacodynamic interactions, and 49.30% were pharmacokinetic interactions. Eighty-one percent of prescription orders with drug interactions contained more than three drugs, and 11.9% of interactions were severe. The majority of interactions were of amikacin-vancomycin, piroxicam-captopril and captopril-ciprofloxacin. Conclusion: Most of the interactions were moderate among patients with multiple drug prescriptions. The drug interactions can be minimized by providing special patient monitoring and adequate management with prior knowledge of these drug interaction.
Appropriate medication use is one of the most significant challenges among the older population. Although medication use problems are well documented at the secondary and tertiary health care level, ...the evidence at the primary care level of OECD region is limited. A narrative review of existing literature was conducted through a nonsystematic search for original articles through electronic search databases, Ovid Medline, Google Scholar from 2001 to 2021, and a combination of citation references. Medication use problems are prevalent in older adults at the primary care level. The main issues of medication use identified were as follows; nonadherence, adverse drug events, accessibility, polypharmacy, inappropriate medications, belief about medications, lack of knowledge and awareness, and lack of deprescribing. In addition, the current review has identified the possibilities of the problems: many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications. This review found that various medication use problems subclusters were identified to impact the health care need among older adults. Therefore, effective interventions targeting these issues need to be developed to reduce medication use problems among older adults at a primary care level.
Possibilities of many medications, forgetfulness, lack of deprescribing, lack of communication, poor understanding, and limited awareness of inappropriate medications among older adults related to medication use problems. The evidence suggests that appropriate interventions are needed to improve the medication use services at the primary care level in the OECD regions.
Background. The frequent expansion of the energy drinks (EDs) market has caused an extensive increase in the consumption of EDs, especially among younger populations. However, the lack of knowledge ...on EDs and their perceived beneficial effects could lead to excessive EDs consumption, which is strongly associated with serious side effects. This study aimed to assess the knowledge and perceived beneficial effects of EDs consumers and determine the consumption patterns and side effects experienced by different EDs consumers among the Malaysian population. Methods. A descriptive cross-sectional study was conducted in Malaysia from February to April 2021. A structured and validated questionnaire, consisting of 5 sections with 46 items, was distributed online. Only 515 out of 591 invited participants agreed to participate in the study. Descriptive and inferential analysis were done using SPSS. Results. The median age of participants was 23 ± 7.3 years. The majority of participants (65%) were unaware of the active ingredients of EDs, and approximately 40% of them had no idea that EDs contain caffeine. The main reason for consuming EDs was to stay awake (43%), and Red Bull was the most preferred brand (57%). Lack of rest (57%), headache (53%), and nervousness (49%) were the most experienced side effects. A significant difference was observed between consumption patterns and knowledge and perceived beneficial effects (p<0.05). Our data showed a significant association between respondents’ demographic data (e.g., coffee intake, smoking, and alcohol status) and their consumption pattern. Conclusion. ED consumers in Malaysia were found to have limited knowledge on EDs. Therefore, attention should be drawn to the Ministry of Health regarding the significant side effects such as palpitation and nervousness experienced by ED consumers. Hence, awareness ought to be raised by adopting regulations or policies to regulate the sales and warning labels of EDs in Malaysia.
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