1,721,148 research outputs found
Effect of a Pharmacist-Led Program on Improving Outcomes in Patients with Type 2 Diabetes Mellitus from Northern Cyprus: A Randomized Controlled Trial
No full textBACKGROUND: The management of type 2 diabetes mellitus is complex, requiring continuous medical care by health care professionals and considerable self-care efforts by patients. Pharmacist-led care programs have been shown to help patients with diabetes succeed in achieving treatment goals and improving outcomes. Pharmacist-led care is a new health care concept in Northern Cyprus. OBJECTIVE: To evaluate the effect of a pharmacist-led care program on glycemic control, determined by hemoglobin A1c (A1c), and secondarily on blood pressure, lipid profile, body mass index (BMI), waist circumference, medication adherence, and self-care activities, for patients with type 2 diabetes over a 12-month period. METHODS: This was a prospective, randomized controlled study conducted in a public hospital's outpatient diabetes clinic, with 152 patients who had been diagnosed with type 2 diabetes. Of these, 75 patients were in the intervention group, and 77 patients were in the usual care group. The intervention group participated in a pharmacist-led care program with a clinical pharmacist who provided 5 face-to-face educational sessions over a period of 12 months. The main outcome measure was change in A1c, and secondary outcome measures were changes in fasting blood glucose, systolic and diastolic blood pressure, lipid values (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and serum levels of triglycerides [TGs]), BMI, waist circumference, self-reported medication adherence (Morisky-Green test), and self-care activities. Changes in outcome measures from baseline to the end of the study were assessed using the Mann-Whitney U-test and Wilcoxon test. RESULTS: At the end of the 12-month study period, the intervention patients showed a greater reduction in A1c values than the usual care patients (-0.74% vs. -0.04%; P < 0.001). Both groups showed significant reductions in fasting blood glucose levels between baseline and the end of 12 months; the difference between the groups was statistically nonsignificant (P=0.410). When comparing the intervention and usual care groups, there was a significant decrease in systolic (P=0.01) and diastolic blood pressure (P=0.04) at the end of the trial. No significant differences were found between the groups in LDL-C, HDL-C, or TG values; however, total cholesterol levels did decrease significantly (P= 0.063, 0.331, 0.896, and 0.04, respectively). Significant reductions occurred in BMI (P < 0.001) and waist circumference (P < 0.001), and improvements were observed in self-reported medication adherence and self-care activities in the intervention group. CONCLUSIONS: A clinical pharmacist-led care program in a public hospital's outpatient diabetes clinic was associated with significant improvements in reducing A1c and other secondary outcomes in a 12-month randomized controlled study
Impact of Clinical Pharmacist-led Interventions in Turkey
No full textDetecting drug-related problems (DRPs) is important in pharmaceutical care in for better therapeutic outcomes. Clinical pharmacists-led comprehensive medication management plays a crucial role in the rational use of drugs by preventing, identifying, and resolving DRPs. In this review, we aimed to determine the effect of interventions on patient outcomes performed by clinical pharmacists in Turkey. A systematic literature search was performed on PubMed, Google Scholar, EMBASE, Cochrane Library, and Turkish databases (ULAKBIM, Dergipark). The main categories were clinical pharmacist, intervention, and Turkey. Two reviewers reviewed each article independently. Two independent reviewers screened all records and extracted datadisagreements were resolved through a consensus. Randomized controlled studies, pre- to post-intervention comparison studies, and cross-sectional studies including pharmacist-led interventions were included in the review. This review included 15 articles evaluating clinical pharmacist interventions. Ten studies (66.7%) focused on DRPs and pharmacist interventions to these problems, while the remaining 5 (33.3%) studies focused on patient education and adherence issues. Studies were conducted in oncology (33.3%), geriatrics (20.0%), chest diseases (13.3%), psychiatry (6.7%), cardiology (6.7%), and infectious diseases (6.7%) clinics. When results of studies are reviewed, most of the interventions were made at the prescriber level followed by the drug level and patient level. Problems were solved in 54.2-93.2% of DRPs, and adherence, patient knowledge, or skills were improved in most of the studies. Most of the studies were carried out within the scope of a postgraduate or doctorate thesis and yet various positive outcomes such as the prevention of side effects, increased quality of life, and decreased duration of hospital stay were observed with high positive rates of interventions, which indicate that other healthcare workers are ready to collaborate with the clinical pharmacists in Turkey
Ertapenem for the treatment of urinary tract infections caused by extended-spectrum beta-lactamase-producing bacteria in children
No full textBackground: Urinary tract infections (UTIs) are a problem frequently encountered by paediatric healthcare providers. Recent data suggest that extended-spectrum beta-lactamase (ESBL)-producing bacteria are an emerging cause of UTIs in non-hospitalized patients. We report our experience of ertapenem use in 50 patients with complicated UTIs, mainly pyelonephritis, caused by ESBL-producing organisms. Methods: Fifty patients aged < 16 y who had a complicated UTI caused by ESBL-producing organisms and who were treated with ertapenem at our hospital from 1 January 2009 to 31 December 2009, were included in the study. Results: There were 20 (40%) males and 30 (60%) females with a mean +/- standard deviation age of 38.6 +/- 36.9 months (range 6-156 months). Twenty-eight patients had no urological abnormality. In 40 patients ertapenem was initiated after results of microbiological cultures became available. Ertapenem was initiated empirically for 10 patients known to be colonized with ESBL-producing bacteria. Urine cultures were negative at 3.3 +/- 0.7 days (range 2-5 days) after starting ertapenem treatment. The mean duration of ertapenem treatment was 7.8 +/- 1.2 days (range 7-14 days). No laboratory or clinical side effects were observed. Conclusions: Ertapenem is promising for the culture-guided treatment of ESBL-producing Gram-negative complicated UTIs. Well-designed prospective studies are needed to define the role of ertapenem in treating complicated paediatric UTIs, especially upper UTIs
Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients
No full textDrug related-problems pose additional worse outcomes in cancer patients treated with chemotherapy. A vital role of the clinical pharmacist is the detection and prevention of drug-related problems. The provision of patient education is an important step to reduce and prevent drug-related problems during chemotherapy administration. The objective of this study was to assess the occurrence of drug-related problems and the importance of effective provision of patient education and appropriate recommendations by the clinical pharmacist in reducing and solving of these problems in diabetic patients suffering from cancer. A prospective study carried out on 50 diabetic patients as a single group with new diagnosis of diverse cancer types eligible for chemotherapy adminitration recruited between September 2014 and April 2015 at the oncology unit in one of the Teaching and Research Hospital (Istanbul-Turkey). Drug-related problems were evaluated, and proper patient education alongside pharmacist recommendation regarding chemotherapy was provided during the required chemotherapy protocol schedule. (n = 65) of the drug-related problems were contributed to inappropriate IV fluid selection; (n = 33) were attributed to low drug dose prescribed, and (n = 30) to high drug dose prescribed. Drug-related problems totally solved due to clinical pharmacist recommendations were 69.57% (n = 80). There was a significant increase in the occurrence of paleness (P = 0.0001); urinary frequency (P = 0.003); loss of appetite (P = 0.0001), nausea (P = 0.0001), vomiting (P = 0.0001); and numbness (P = 0.0001). A significant decrease in the occurrence and severity of chemotherapy-related adverse effects was observed as a mild urinary frequency (P = 0.0001) and mild vomiting (P = 0.0001) after the clinical pharmacist recommendations and provision of patient education. Results of this study revealed that diabetic cancer patients are definitly prone to the occurrence of drug-related problems and adverse drug reactions. Clinical pharmacist is expected to provide a well-defined education and care to those patients and the outcomes of pharmacist recommendations may diminish and prevent many drug-related problems and adverse drug reactions and by this, influence patients' desire to complete the course of chemotherapy
Comparison of non-burn-specific systemic inflammatory response syndrome criteria and burn-specific American Burn Association systemic inflammatory response syndrome criteria in paediatric burned patients
No full textAim We aim to investigate the diagnostic value of newly defined criteria for the systemic inflammatory response syndrome (SIRS) for paediatric burn patients by the American Burn Association (ABA) by comparing the non-burn-specific SIRS criteria for children. Methods A total of 147 paediatric burn patients were included in this study. Patients diagnosed with sepsis were included in the sepsis group. Clinical parameters were obtained from the electronic medical records at the time of preliminary sepsis diagnosis. Both the non-burn-specific SIRS criteria and the burn-specific ABA SIRS criteria were applied to both the sepsis group and the non-sepsis group. Results Of 147 patients, 50 had sepsis according to the non-burn-specific sepsis criteria. When the 50-patient sepsis group was compared to the 97-patient non-sepsis group, the sepsis group had a significantly higher duration of hospitalisation, burn percentage, burn state and abbreviated burn scoring index (ABSI) (P < 0.05). The specificity of the two scales was 29.9% for the non-burn-specific SIRS and 74.2% for the burn-specific ABA SIRS. The sensitivity for the burn-specific ABA SIRS was calculated as 58%, the sensitivity for the non-burn-specific SIRS was 100%. While positive predictive value was calculated as 42.4% for the non-burn-specific SIRS, this value was found as 53.7% for the burn-specific ABA SIRS criteria. The correlation coefficient between the non-burn-specific SIRS and the burn-specific ABA SIRS was 0.378 (P < 0.001). Conclusions Our study underlines the need for widespread use of more specific and sensitive burn-specific clinical criteria to early diagnosis of infection in burn patients to prevent unnecessary antibiotic usage
Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey
Full text linkBackground Drug-related problems (DRPs) interfere with patient optimal therapeutic outcomes and may be associated with higher morbidity, mortality and healthcare expenditures. Objective This study aimed to identify DRPs and their causes in a Turkish hospital. Setting Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Internal Medicine Ward, Istanbul, Turkey. Method Cross-sectional study included a total of 100 patients. Patient demographics, medications, and history were evaluated. Data regarding recent medications were analyzed by two clinical pharmacists and an Internal Medicine physician. The DRPs were identified via V7.0 PCNE classification. Lexicomp(A (R)) was used to assess the drug-drug interactions. UpToDate(A (R)) recommendations and national guidelines were applied in the assessment of compliance with approved medication procedures. Main outcome measures Number and causes of the potential DRPs. Results At least one potential DRP was seen in 80% of the patients and 163 potential DRPs were identified (average = 1.6 DRPs/patient). The most common causes of DRPs were errors in drug selection (44.78%), dose selection (27.61%) and medication procedures (21.47%). There were significant correlations (p < 0.05) between DRPs and age (r = 0.4), number of drugs used (r = 0.32), duration of hospitalization (r = 0.25), renal impairment (r = - 0.34) and inflammation (r = 0.31). Conclusion The majority of the patients had DRPs. Patients with renal impairment, inflammation, polypharmacy or an extended hospital stay had a much higher chance of developing DRPs
Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings
No full textPurpose This study aimed to determine whether there is a relationship between the lack of medication knowledge and the self-reported rates of patient medication adherence. Methods Patients eligible to participate in the study had been taking oral medication at least once daily over the course of a minimum of three consecutive months before recruitment to the study. All participants were older than 18 years. The level of each patient's knowledge of his or her medication was randomly assessed by a trained fifth-year pharmacy student through an adapted questionnaire. In addition, patient adherence was evaluated via utilization of the Morisky Medication Adherence Scale. Results Of the 765 study participants (mean +/- SD age = 55.45 +/- 15.05 years, range = 2091 years, 56.2% women), 58.0% reported adherence to their medication regimen and 64.5% professed optimal knowledge of their medication. The mean duration of medication utilization was 26.77 +/- 40.62 months (range = 3504 years). A statistically significant correlation exists between the total medication knowledge score on the questionnaire and the level of medication adherence (r=0.964, p<0.001). Conclusion Improvement in the patient's knowledge of medications taken would bear a positive effect on medication adherence. Copyright (c) 2012 John Wiley & Sons, Ltd
Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting
No full textIntroduction The simultaneous occurrence of diabetes and cancer may complicate the management of both conditions resulting in poor prognosis and more deterioration of patient-related outcomes. Objective To assess the effective provision of clinical pharmacy services and pharmacist-led counselling program on improving patient-related outcomes among patients with diabetes and newly diagnosed with cancer during chemotherapy administration. Methods A single-centre, prospective, randomised, controlled study was carried out on patients with diabetes newly diagnosed with cancer during chemotherapy administration at the outpatient oncology setting. Patients were assigned as a normal care group receiving only normal care by the oncology care providers and an intervention group receiving both normal and clinical pharmacy care through an extensive oral and written patient education, pharmacotherapy optimisation and regular recommendations for diabetic self-care activities with three-month follow-up. Results Patients within the intervention group showed a better glycaemic control (p = .049), a significant increase in medication adherence (p = .0049), a significant increase in diabetes self-care activities, including diet (p = .037), self-monitoring of blood glucose (p = .027) and foot care (p = .0085) and reported a lower deterioration in quality of life. Conclusion Patients with diabetes and cancer receiving chemotherapy experienced improved patient-related outcomes after clinical pharmacy intervention and counselling program compared to the normal care group
Evaluation of knowledge and attitude of pharmacist and pharmacy technicians on emergency contraception method in Istanbul, Turkey
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