Pharmacy Practice is a full-text peer-reviewed journal with a scope on pharmacy practice. Pharmacy Practice is published quarterly.
Incidence and pattern of anticoagulation in patients with atrialfibrillation and atrial flutter at tertiary hospital in Oman
Background: Atrial fibrillation (AF) and atrial flutter (AFL) are the two most common cardiac arrhythmias encountered in clinical practice. Anticoagulants are the cornerstone in cerebrovascular accident prevention in these patients. Despite their role in reducing stroke risk, emergency room visits, and overall treatment costs, studies have shown that oral anticoagulants (OAC) are underutilized, even in high-risk patients. Objective: The aim of this study is to explore the appropriateness and pattern of anticoagulant prescriptions in patients with AF and/or AFL in a tertiary hospital as recommended by the international guidelines. Method: This retrospective observational study was conducted by reviewing the electronic medical records of 389 adult patients with either AF or AFL in Sultan Qaboos University Hospital (SQUH) between July 2018 and July 2020. The appropriateness of oral anticoagulation was assessed according to international guidelines, namely, 2020 Canadian Cardiology Society (CCS), 2020 European Society of Cardiology (ESC), and 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS). Analysis was performed using univariate statistics (Chi-square and percentages) to report categorical data. Results: Oral anticoagulants were prescribed appropriately in 91% of the patients according to CCS guidelines, and 92% and 96% according to ESC and (AHA/ACC/HRS) class Ia and IIa recommendations, respectively. Among non-anticoagulated patients (28 patients, 9%) had proper justification. On the other hand, 38 patients (9.8%) out of the whole cohort (389) had a CHADS-65 score of zero but received OAC mostly due to cardioversion, rheumatic heart disease, or mechanical heart valve prosthesis. Novel oral anticoagulants (NOACs) were the most commonly used OAC 251/336 (75%), with rivaroxaban being the main drug used 234/250 (92%) of all NOAC prescriptions. 75% of patients with eGFR<50 ml/min received the proper dose of rivaroxaban. Bleeding was the most frequently reported side effect of OAC in 52 (13.4%) of the entire cohort. Conclusion: Nearly 91% of patients with AF/AFL followed at SQUH were prescribed an appropriate anticoagulant as per international guidelines. The decisions to anticoagulate a patient with AF/AFL and the type of anticoagulant used were appropriate.
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The impact of evidence-based interventions on depression in survivors of intimate partner violence: A Systematic review and meta-analysis
Background: Intimate partner violence (IPV) is a pervasive global issue that substantially increases the risk of depression, post-traumatic stress disorder (PTSD), and substance use disorders among survivors. Despite the known mental health consequences, there is limited synthesis of evidence regarding the effectiveness of therapeutic interventions targeting depression in this population. Objectives: To evaluate the effectiveness of pharmacological and psychosocial interventions in reducing depressive symptoms among survivors of IPV through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted in PubMed, PsycINFO, Scopus, Web of Science, and CINAHL for studies published between 2008 and 2025. Eligible studies included randomized controlled trials and quasi-experimental designs evaluating depression outcomes in IPV survivors aged ≥16 years. Data extraction and quality assessment were performed independently by two reviewers using standardized tools (RoB 2, ROBINS-I, and Newcastle-Ottawa Scale). Meta-analyses were conducted using random-effects models, with subgroup and meta-regression analyses to explore heterogeneity. Results: Eight studies met inclusion criteria, comprising six psychosocial and two combined psychosocial-pharmacological interventions. The pooled mean difference (MD) was -1.22 (95% CI: -1.27 to -1.18; p < 0.001), indicating a significant reduction in depressive symptoms. Digital interventions yielded a MD of -1.29 (95% CI: -1.87 to -0.70), while participatory models showed a MD of -0.79 (95% CI: -1.42 to -0.16). High heterogeneity was observed (I² = 99.58%). Metaregression revealed digital interventions were significantly associated with reduced depressive symptoms (coefficient = -1.41, p = 0.014). Conclusions: Evidence-based interventions, particularly digital and participatory models, can effectively reduce depression among IPV survivors. However, standalone interventions often yield limited outcomes. Integration with pharmacological treatments and long-term trauma-informed care is critical to enhance mental health recovery. Future research should focus on tailoring interventions to diverse populations and ensuring methodological rigor in evaluating long-term efficacy.
Integration of community pharmacy in primary health care
Outcomes of Pharmacist-led Diabetes Care Intervention in Lao PDR: a randomized controlled trial
Objective: Pharmaceutical care for diabetic patients has demonstrated benefits in many countries. Nevertheless, in Laos, diabetes care has been provided without pharmacists’ involvement. This study aimed to evaluate the outcomes of pharmacist-led interventions in diabetes care in Laos. Methods: A single-blinded randomized controlled trial with pre-test and post-test was designed. The study was undertaken in type 2 diabetes patients registered at a hospital from June 2019 to July 2020. Patients in the intervention group received pharmaceutical care in six months, while the control group received standard care. Primary outcomes were hemoglobin A1c (HbA1c) and fasting plasma glucose. Secondary outcomes included blood pressure, lipid profiles, renal function, 10-year risk, patient satisfaction, and quality of life. Intention-to-treat analysis was applied. Results: One hundred forty-four diabetes patients were recruited and randomly assigned to groups (73 intervention, 71 control); 121 were included in the analysis (64 intervention, 57 control). Of the 67 pharmacist interventions, adding statin/aspirin (doctor acceptance rate of 79.10%) was predominant. After six months, achievement of hemoglobin A1c and LDL goals showed improvement (OR 1.31, 95%CI .50- 3.43, p.589; OR 1.35, 95%CI .61-3.01, p=.465), however, no statistically significant differences in clinical outcomes were found between groups. Compared to the pretest, the intervention group showed significant improvements in HbA1c, cholesterol, and low-density lipoprotein levels (p<.05). Nevertheless, the control group also showed significant improvement in HbA1c (p<.05). Patient satisfaction with pharmacists’ competency was statistically significantly higher in the intervention group than the control group (p=.010). Conclusion: Pharmacist-led diabetes care could provide clinical benefits and improve patient satisfaction due to pharmacists’ competency. Although pharmacists' intervention did not yield statistically better clinical outcomes than usual care, there was a trend toward better HbA1c and cholesterol controls. Continuous pharmacists’ contributions to diabetes care, including advancing the collaborative protocol, should be further supported.
Knowledge, attitude, and perception of antibiotic resistance among the United Arab Emirates residents after COVID-19 pandemic: A nationwide cross-sectional study
Objectives: to provide insights into public knowledge and practices toward antibiotic resistance as well as common behaviours related to antibiotic use and resistance in the UAE. Methods: This study is a cross-sectional, observational investigation into the knowledge, and attitudes, of UAE residents toward antibiotic resistance, using a convenience sampling approach. From May to June 2022, the survey was distributed throughout the seven emirates of the UAE. The methodology was adapted from the WHO's "Antibiotic Resistance: Multi-Country Public Awareness Survey". The study followed the Strengthening Reporting of Obser-vational Studies in Epidemiology reporting (STROBE) guideline for cross-sectional studies. Results: A total of 1074 individuals completed the survey. Approximately two thirds of the respondents (66.0%) were familiar with the term “Antibiotic resistance”. The percentage of respondents who believed that antibiotics could be effective against viral infections decreased from 57.8% to 45.4% after the COVID-19 pandemic period. Additionally, 79.1% of respondents incorrectly believed that antibiotic resistance occurs when their bodies become resistant to antibiotics. Studying in the medical field and having a postgraduate degree were significant predictors of adequate knowledge (Odds ratios were 2.15 and 1.77, respectively). Conclusion: The participants in this study were generally aware of antibiotic resistance; however, incorrect descriptions of antibiotic resistance were frequently encountered. Respondents involved in the medical sector during their studies and those with higher educational degree were more likely to possess adequate knowledge about antibiotic resistance. This evidence can be used to contextualize and enhance the efficiency, effectiveness and success of antimicrobial resistance interventions.
Prevalence, severity, and treatment of dry eye disease among patients presenting at community pharmacies in Klang Valley, Malaysia
Background: A healthy tear film ensures ocular comfort, high-quality vision, corneal protection from irritants, and facilitates wound healing. Disruption in the tear film causes dry eye disease (DED), a condition affecting millions globally. Untreated DED produces symptoms such as gritty sensations, ocular discomfort, visual impairment, and reduced quality of life. Pharmacological treatment is necessary if symptoms persist after first-line, non-pharmacological therapies. The Asia Dry Eye Society formulated different dry eye classifications based on abnormal components in the surface epithelium and bilayered tear film, to allow pharmacists to implement tear film-oriented therapy. These include artificial tears, diquafosol sodium, ophthalmic ointments, and rebamipide. Community pharmacists facilitate alternative, convenient and increased access to DED treatments. Although DED is widespread in Malaysia, national data on DED identification and management by community pharmacists is limited. Objectives: To investigate the prevalence, severity, and treatment options for dry eye disease (DED) among patients presenting at community pharmacies in Klang Valley, Malaysia. Methods: This cross-sectional Ocular Surface Disease Index (OSDI) questionnaire-based study surveyed customers visiting community pharmacies and the retail pharmacists working in these pharmacies in Klang Valley, Malaysia. Results: Of the 217 participants included in this study, DED prevalence was found to increase with age ( 65 years: 80%; <18 years: 25%, p<0.05). Prevalence was highest in Malay participants (49.23%; p<0.05) and significantly higher in those in urban areas (p=0.002). Furthermore, education was associated with DED prevalence in Klang Valley, Malaysia. The most common symptoms reported by DED patients were sensitivity to light (74.39%) and blurry vision (70.73%). Most participants experienced problems with night driving (87.80%) and reading (79.27%). Additionally, 76.83% of patients felt uncomfortable in air-conditioned and low humidity areas, while 73.17% experienced discomfort under windy conditions. The most recommended management options for DED were Systane hydration UD eye drops and supplements (e.g., fish oil and Eyegard®). Conclusions: DED prevalence in Klang Valley, Malaysia, was 37.78%, with the disease being either mild (40.34%), moderate (30.49%) or severe (29.27%). Supplements and artificial tears with high viscosity and pH between 6.6 to 7.8 are frequently recommended to these patients by community pharmacists.
Impact of Granulocyte colony-stimulating factor (filgrastim) on absolute neutrophil count after receiving filgrastim in cancer patients with febrile neutropenia: A 5-year retrospective cohort study.
Background: Chemotherapy-induced febrile neutropenia (CIFN) remains a critical complication in cancer treatment, often necessitating granulocyte colony-stimulating factor (G-CSF) support with filgrastim to expedite neutrophil recovery and minimize infection risk. While filgrastim has shown efficacy, recovery rates vary significantly by cancer type, which may impact patient outcomes and healthcare burden. Objective: To evaluate the impact of filgrastim on ANC recovery time in CIFN patients and assess the association between cancer type and clinical outcomes, including hospital stay and infection rates. Methods: This 5-year retrospective cohort study reviewed 473 CIFN patients treated with filgrastim at a tertiary care center. Patients received standardized doses of filgrastim subcutaneously until reaching ANC recovery (≥1500 cells/µL). Key outcomes assessed were ANC recovery time, duration of hospital stay, infection rates, and treatment-related adverse events. Linear regression analysis examined the relationship between ANC recovery time and clinical outcomes. Results: Filgrastim significantly reduced ANC recovery time, with 85% of patients achieving ANC recovery within five days (median: 3.7 days, IQR: 2–5 days). Patients with solid tumors demonstrated a notably faster recovery than those with hematologic malignancies (median: 3.2 vs. 4.5 days; p < 0.01), emphasizing the potential need for tailored filgrastim protocols by cancer type. Importantly, delayed ANC recovery was associated with prolonged hospitalizations (r² = 0.42, p < 0.001) and an elevated infection risk (r² = 0.16, p = 0.045). Filgrastim was well-tolerated, with only mild, transient bone pain reported in 9% of patients. Conclusion: This study highlights the effectiveness of filgrastim in achieving rapid ANC recovery in CIFN patients, with marked differences in recovery rates between cancer types. The strong association between timely ANC recovery and reduced hospital stays underscores the clinical benefits of filgrastim, supporting its strategic use in CIFN management to optimize patient outcomes. Our findings suggest that individualized filgrastim administration protocols may further enhance recovery, particularly for hematologic malignancy patients.
Leadership Style and ‎Lean Management ‎Capabilities in ‎Improving ‎Service ‎Quality: ‎Insights from ‎Mediclinic Parkview ‎Hospital, United Arab ‎Emirates
Objective This study focuses on the pivotal role of hospital pharmacy leadership and Lean Management practices in transforming pharmacy operations at Mediclinic Parkview Hospital in Dubai, United Arab Emirates (UAE). Methods Lean Leadership was vital in executing Lean Six Sigma (LSS) in the hospital pharmacy, promoting a patient-focused approach emphasizing quality, improvement, and staff engagement. The study employed the LSS DMAIC (Define, Measure, Analyze, Improve, Control) method to identify inefficiencies and improve overall performance, statistical analyses, and Sigma-level calculations. Results Implementing Lean Six Sigma methodologies led to substantial enhancements in three Critical-to-Quality (CTQ) Key Performance Indicators (KPIs). Waiting times were reduced by 76%, patient satisfaction, as measured by Net Promoter Score (NPS), increased by 136%, and employee engagement scores improved by 28%. These advancements increased operational efficiency, improved patient retention, and decreased staff turnover. Additionally, the research utilized a validated questionnaire to examine the influence of DMAIC constructs on service quality using the SERVQUAL instrument across five dimensions: agility, empathy, assurance reliability, and responsiveness. The findings revealed significant improvements across all models, indicated by p-values less than 0.001, confirming the reliability of the results. Adjusted R-squared values ranging from 0.386 to 0.638 indicate that a substantial portion of service quality improvements can be attributed to these methods. Conclusion The “Improve” and “Control” constructs demonstrated positive effects, highlighting their critical role in enhancing service quality and supporting the practical application of DMAIC in healthcare settings. This research improves hospital pharmacy operations management using the LSS framework, focusing on specialized training, Lean Leadership, and customized DMAIC elements.
The journey of Sotagliflozin: from its status as a withdrawn candidate for the treatment of diabetes mellitus, to its repurposing as a groundbreaking drug for the management of heart failure.
Sotagloflozin is a member of the antidiabetic class of sodium-dependent glucose cotransporter protein inhibitors. It is unique in its class due to its dual inhibitory action, as it can target and inhibit both type 1 and type 2 isoforms of the sodium glucose co-transporter (SGLT). SGLT inhibitors are small-molecule antagonists whose design was inspired by the natural product phlorizin. In May 2023, the United States Food and Drug Administration (U.S. FDA) approved sotagliflozin for the treatment of heart failure. The journey towards the discovery and optimization of this compound, as well as its ultimate repurposing in the setting of heart failure, is intriguing and continues to arouse interest and concern with regard to the safety and applicability of this repositioned candidate. This review offers an in-depth critical report of the journey of this compound, which has been marked by moments of both success and failure, towards its ultimate reproposing and a reported groundbreaking role in the scope of heart failure management.
Association of medication use with falls among older adults
Introduction: Falls are an increasing public health problem because of ageing populations worldwide. One-third of people aged over 65 years live with comorbidities and take five or more regular medicines (polypharmacy). There is clear evidence that polypharmacy and the use of psychotropic drugs as well as in combination with cardiovascular medications increase the risk of falls. Objective: The aim of this study was to explore how polypharmacy, defined by the number of medications used is associated with the incidence of falls and related consequences and to examine associations with fall riskincreasing drugs (FRIDs) use with falls. Methods: We performed a cross-sectional study of 125 residents from nursing homes. Data collection and clinical assessments for the present study was conducted between June 1 2024 and October 15 2024. The participants were interviewed using a structured questionnaire, which contained questions on demographic, lifestyle, and medical variables. Participant characteristics were described for the whole group and subgroups were categorized according to fallers and non-fallers. Primary outcome measures were incidence of falls as well as numbers of FRIDs in fallers and non-fallers. Results: The mean age of the participants was 76.52 (SD 7.83) years and 66% of included patients were women. The most frequent number of falls within the previous 6 months was 1 (IQR 1–2). Twenty-six percent of these patients reported at least one fall in the six months prior to the evaluation. More women (N = 49) reported falls during the past six months as compared to men (N = 18), but this difference was not significant, χ2 (4, N = 125) = 6.79, p = .15. A multiple linear regression analyses showed positive associations between the number of FRIDs and the total number of prescribed drugs and falls. Conclusion: Older age and medications were associated with increased incidence of falls. Fallers had a higher number of FRIDs. Numbers of FRIDs were associated with the total number of drugs dispensed and falls.
Efficacy and Safety of Original Versus Generic Erlotinib in Non-small Cell Lung Cancer with Epidermal Growth Factor Receptor Gene Mutations in Thailand: A Retrospective Cohort Study
Background: Non-small cell lung cancer (NSCLC) is a major cause of cancer-related mortality, for which mutations in the epidermal growth factor receptor (EGFR) gene are common in Asian populations. Erlotinib, an EGFR tyrosine kinase inhibitor, has been used as the first-line therapy for EGFR-mutated NSCLC. Generic erlotinib has been introduced in Thailand to increase accessibility, but efficacy and safety are major concerns. Objective: This study aimed to compare the efficacy and safety of generic versus originator erlotinib among Thai patients using real-world data from two quaternary hospitals. Methods: A retrospective cohort study collected data from medical record of advanced or metastatic EGFR-mutated NSCLC receiving either generic or originator erlotinib between September 2019 and September 2021 from Maharaj Nakorn Chiang Mai Hospital and Sunpasitthiprasong Hospital, Thailand. Primary outcomes were clinical benefit rate (CBR) at 12 months, progression-free survival (PFS) and treatment-related adverse events. Kaplan-Meier survival curve with log-rank test and the propensity score (PS)-adjusted models were employed to estimate the difference of response rate and safety between the generic vs. the originator erlotinib. Results: One hundred and seven patients were included. CBR at 12 months of the generic vs. originator erlotinib were 75.4 and 74.0% (adjusted HR 1.47 [95%CI 0.45-4.83, p= 0.519]). Median PFS of the generic vs. originator erlotinib were 15.2 months and 18.9 months (adjusted HR 1.98 [95%CI 0.99-3.94, p = 0.053]). The incidence of any adverse events for the generic vs. originator was 21.0 and 36.0% (adjusted OR 0.84 [95%CI 0.26-2.71, p = 0.770]). Most adverse events comprised mild skin toxicity, with no significant difference between the two groups (adjusted OR 1.03 [95%CI 0.31-3.43, p = 0.958]). Conclusions: No significant differences were noted regarding efficacy or safety between generic and originator erlotinib. These findings support the use of generic erlotinib as a cost-effective alternative in Thailand.
Epidermal Growth Factor Receptor Genes (EGFR)
Drug-related problems identified during pharmacy consultation in outpatient
Background: Drug-related problems (DRPs) might lead to adverse drug events, and medication errors have received extensive attention among the public and health care system worldwide. The purpose of this study was to identify common drug-related problems (DRPs) during pharmacy consultation in outpatient pharmacies by implementing a counseling model. Method: We conducted a prospective study in the outpatient pharmacy of a tertiary academic hospital for 16 months. A counseling model was implemented by a pharmacy team, and data were collected during pharmacy consultation. Data analysis was performed on identified DRPs, causes and their relationships. Problem-level descriptive analysis and network analysis were conducted using R 3.6.3. Result: Pharmacists identified 504 DRPs during pharmacy consultation with primarily adverse drug events (ADEs, 26.98%) and untreated symptoms or indications (16.67%). The most frequent drug classes correlated with DRPs were ‘cardiovascular system’ drugs (13.39%), followed by ‘traditional Chinese medicine’ (12.71%) and ‘alimentary tract and metabolism’ drugs (12.54%). Most DRPs were due to necessary information not provided in dispensing and drug selection. More than 98.25% of advice given by the pharmacist was accepted or taken into consideration, and 97% of patients reported that their medication problems were totally or partially solved. Conclusion: Implementation of the counseling model appears to be a means to improve drug use by serving as an important tool to increase the identification and resolution of DRPs, resulting in positive experiences in both pharmacy practitioners and patients.
Prescribing pattern of COX-2 inhibitors in patients with a history of allergy to conventional NSAIDs in hospital belong to Thai Redcross Society
Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are known to cause allergic reactions, particularly conventional NSAIDs [1,2]. COX-2 inhibitors may be a suitable alternative for patients with a history of conventional NSAID allergies [3]. This study aimed to explore the prescribing rate and pattern of COX-2 inhibitors in patients with a history of conventional NSAID allergies. Method: A retrospective descriptive study was conducted using the computerized drug allergy history database from Queen Savang Vadhana Memorial Hospital (QSMH) between January 1, 2013, and December 31, 2016. Percentage statistics were used for comparison. Results: Among 638 patients, the most common allergy was to ibuprofen (34.95%), and the most frequently prescribed COX-2 inhibitor was etoricoxib (34.48%). The most common type of allergy to conventional NSAIDs was angioedema (42.65%), primarily associated with ibuprofen. Non-serious adverse drug reactions (ADRs) occurred in 90.61% of cases, while serious ADRs (anaphylaxis, acute renal failure, and anaphylactic shock) accounted for 9.39%. Physician staff prescribed COX-2 inhibitors most frequently (63.75%), with the orthopedic surgery unit being the most common prescribing department (48.17%). Conclusion: This study provides insights into the prescribing pattern of COX-2 inhibitors in patients with a history of conventional NSAID allergies. This information is valuable for establishing monitoring plans to ensure optimal medication safety for this patient group.
Combinatorial Multiplicity of Cardiometabolic and Inflammatory Markers in Gum Arabica Modality of CKD CAM: Part 2
AIM: A combinatorial multiplicity of molecular blood markers were assessed using ELISA colorimetric determinations in this prospective cohort study of the impact of guar gum arabica (GA) use on kidney function parameters of chronic kidney disease (CKD) in consumers (cases) vs. non consumers (age- and CKD stage- matched controls). RESULTS: Mean age of study participants was 68.12 (±SD 10) years with homogenous sex distribution in both study arms and comparable levels of eGFR, sCr, ESR, CRP, HbA1c, FPG, UA and fasting lipid profiling parameters (P value >0.05). Consistently in study population of recruits; mean CKD duration was 6.94 years (±SD 7.8) and CKD stage IV (37.6% of total study population) was of predominant incidence, followed by stages IIIa and IIIb (20.4% and 19.4%, respectively). Despite the negative glucosuria in 75% of CKD patients; hypertension (92.5%), dyslipidemia (64.8%) and diabetes mellitus (54.8%) were prevalent in a descending order of predominance. GA consumption mean duration was 1.3±1.1 (range 0.25-6) years with a mean dose of 1.7±1.0 (range 0.5-6) spoons per day. Substantially plasma concentrations of resistin (P value =0.047), and nesfatin-1 in cases were substantially greater (P value =0.005) but obestatin (P value =0.018), kisspeptin (P value =0.006), and vascular endothelial growth factor (VEGF) (P value =0.003) were found of pronouncedly lower blood levels in cases in comparison to those of controls. Invariably, human asymmetric dimethylarginine (ADMA), zinc alpha 2-glycoprtein, alpha klotho, ghrelin, and C-reactive protein (CRP) lacked any significant discrepancies in plasma levels in cases vs. those of controls (P value >0.05). In CKD cases on GA modality, ghrelin had substantial inverse correlations with dialysis duration, FBS and uric acid in CKD cases. Pronounced proportional associations of sCr levels were found with ghrelin, hsCRP and resistin in the same pool of cases. eGFR disproportionally correlated with cases’ hsCRP and resistin. In GA-naïve-CKD controls; sCr related proportionally and significantly with asymmetric dimethylarginine (ADMA) and Zinc alpha 2-glycoprtein. CONCLUSIVELY: interventional studies are much justifiably needed.
1. ADMA (asymmetric dimethylarginine), alpha klotho, chronic kidney disease (CKD), C-reactive protein (CRP);
2. Ghrelin, gum Arabica, kisspeptin, nesfatin, obestatin, resistin;
3. zinc alpha 2-glycoprtein, Alpha klotho, Ghrelin, C-reactive protein (CRP), Obestatin, Vascular endothelial growth factor (VEGF)
Preliminary investigation of Haloxylon persicum and Heliotropium bacciferum plants from the United Arab Emirates for possible development of new drugs
Natural antioxidants from plants can counteract various free radicals that contribute to human diseases. In this study, we aimed to explore the phytochemicals, mineral composition, and antioxidant and free radical scavenging activities of methanolic extracts derived from Haloxylon and Heliotropium species, specifically Haloxylon persicum and Heliotropium bacciferum, which are prevalent in arid regions. We conducted phytochemical screening, analyzed the macro- and micro-elements in the leaf extracts, and performed four different in vitro antioxidant assays (ABTS, DPPH, superoxide anions, and hydroxyl radicals) to investigate the scavenging properties of these plant extracts. Both H. persicum and H. bacciferum extracts contained flavonoids, tannins, phenols, and cardiac glycosides, with H. persicum containing steroids and H. bacciferum containing alkaloids, saponins, and terpenoids. Mineral analysis revealed significant levels of macro- and micro-elements in the studied Haloxylon and Helitropium species. H. persicum exhibited high amounts of Mg (12.16 mg/kg) and H. bacciferum had elevated levels of Ca (38.45 mg/kg) and S (6.73 mg/kg). Micronutrient content was particularly high in H. persicum, with varied composition of Cr (8.46 mg/kg), Ni (8.06 mg/kg), Pb (3.55 mg/kg), and Zn (60.73 mg/kg). Antioxidant activity analysis demonstrated that the methanolic extract of H. bacciferum displayed efficient scavenging activity against ABTS, DPPH, and hydroxyl radicals at a concentration of 160 µg/ml, inhibiting them by 81.23%, 83%, and 83.46%, respectively, with IC50 values of 5.9 µg/ml, 26.16 µg/ml, and 25.82 µg/ml, respectively. Meanwhile, the methanolic extract of H. persicum exhibited the highest superoxide anion scavenging activity, at 160 µg/ml, with an inhibition of 80.06% and an IC50 value of 26.03 µg/ml. Methanolic extracts from the leaves of H. persicum and H. bacciferum are promising sources of natural antioxidants, offering the potential for effective free radical inhibitors in plant-based pharmaceutical products.
Long-Term Impact of Pillbox Use on Medication Adherence in Patients with Type 2 Diabetes Mellitus
Background: This follow-up study assessed the long-term impact of pillbox use on medication adherence in type 2 diabetes mellitus (T2DM) patients over two years. Method: A cross-sectional study consisting of 52 participants was divided into two groups: pillbox (intervention) and non-pillbox (control). Adherence was measured using the pill count method, and clinical outcomes such as blood glucose levels were recorded. Results: Results revealed that the pillbox group had significantly higher adherence rates over time, with adherence increasing from 94.01% initially to 96.67% after two years. In contrast, adherence in the non-pillbox group declined from 88.62% to 88.26%. Postprandial blood glucose control improved significantly in the pillbox group (141.38 mg/dl to 129.88 mg/dl), whereas the non-pillbox group experienced an increase (137.96 mg/dl to 145.69 mg/dl). Fasting and random blood glucose levels did not show statistically significant changes. The analysis identified education and occupation as important predictors of adherence, while factors such as age, gender, comorbidities, and medication changes showed marginal or non-significant effects. Conclusion: These findings suggest that pillbox interventions can effectively improve long-term medication adherence and postprandial blood glucose control in T2DM patients, particularly when considering sociodemographic factors like education and occupation. Further research should explore the broader implications of these findings for diabetes management and potential strategies to improve adherence in diverse patient populations.
Heat therapy in the treatment of musculoskeletal pain: current pharmacy practice and perspectives
Objectives Musculoskeletal pain is a complex condition affecting millions of people worldwide. Even though heat as a form of thermal therapy is often used by healthcare professionals as a treatment option, alone or as a complement to other treatments, there are no specific guidelines and recommendations in the literature on the correct use of this therapy. The aim of this research was to explore the pharmacists’ attitudes and level of knowledge on heat therapy among different EU countries and to identify eventual needs in guidance and training. Methods An international Board of experts from the participating countries was established to achieve consensus on the questions to be included in the questionnaire. The experts formulated the questions based on their professional experience and the published literature and reached consensus on 20 questions. Questionnaires were disseminated only to pharmacists currently dealing with patients. In order to exclude pharmacists and participants who did not meet this requirement, two questions were inserted at the beginning of the survey. If the respondents answered “no” to one or both of these questions, their answers were excluded from the analysis. Two hundred eighty-one questionnaires were included in our analysis. Results Heat therapy is a common therapeutical approach recommended by European pharmacists, who often do not find that a referral to other levels of care is necessary. This study identified a clear need for guidance on recommendation principles, such as correct timing and administration, highlighting the need for guidance and training opportunities. Conclusions Our findings indicate that there are significant opportunities to enhance pharmacists' education and training on the use of HT. The absence of clear recommendations and a robust scientific foundation for HT underscores the need for specific guidelines. Developing such guidelines is essential to bridging the existing gap in the literature, ensuring that pharmacists are better equipped to advise on the effective and safe use of heat therapy.
Evaluation of Pediatric Delirium in Saudi Arabian PICUs:A Comprehensive Assessment of Awareness and Management
Introduction: Pediatric delirium, a neuropsychiatric disorder, affects up to 66% of critically ill children, disrupting cerebral functioning. Often misdiagnosed or confused with other conditions, delirium remains a challenge in pediatric care. This study aims to evaluate the awareness, practices, and management strategies for pediatric delirium in Saudi Arabia among healthcare professionals working in pediatric intensive care units (PICUs). Method: A cross-sectional study was undertaken to assess pediatric delirium awareness and management among physicians practicing in PICUs across various healthcare facilities in Saudi Arabia. The study spanned from December 2023 to February 2024 and included physicians with expertise in pediatric delirium. Utilizing a validated tool, data analysis was performed using SPSS version 24®. Statistical analyses included chi-square and Fisher exact tests for categorical variables with two groups, and One-Way ANOVA for those with more than two groups. A p-value of less than 0.05 was deemed statistically significant. Results: Ninety-eight participants responded to the emailed questionnaire (response rate: 61.25%). Most were PICU consultants (53.1%) working in government hospitals (85.7%). Uncertainty prevailed regarding delirium prevalence in their units were (53.1%), with hyperactive delirium being the most reported type (31.6%). Preventive measures included maintaining a normal sleep-wake cycle (85.7%), modifying contributing factors (75.5%), and optimizing sedation goals (75.5%). The Cornell Assessment of Pediatric Delirium (CAP-D) was the primary assessment tool. Supportive treatment (60.2%), non-pharmacological interventions (58.2%), and benzodiazepines (41.8%) were common preventive measures. A statistically significant associations were found between professional qualification and recognizing delirium-mistaken conditions (p-value=0.001). PICUs with at least one consultant (p-value=0.023) and a nurse-to-patient ratio of 1:1 (p-value= <0.001) had significantly higher awareness, while single-patient rooms showed greater awareness compared to multiple-patient occupancy settings (p-value= 0.009) among healthcare professionals. Conclusion: The study identified inadequate knowledge for delirium and assessment in PICUs, it underscores the importance of enhancing the knowledge of consultants working in these units. Keeping in mind the side effects of pharmacological interventions, the modifiable factors and non-pharmacological management should be encouraged for achieving an optimal outcome of pediatric delirium.
Hepatocyte nuclear factor 4, alpha (HNF4A): A potential biomarker for chronic hypoxia in MCF7 breast cancer cell lines
Introduction: Hypoxia mediates cancer hallmarks and results from low oxygen levels due to irregularities in tumor vascularization or when the bulk of the tumor prevents oxygen diffusion and stimulates angiogenesis to compensate for low oxygen. Aims: This study aims to identify significant biomarkers associated with tumor hypoxia, focusing on prolonged exposure to hypoxic conditions. Methods: The breast cancer cells (MCF7) were exposed to 8-hour hypoxic episodes (1% oxygen) three times per week for 60 episodes and once weekly for 72 hours for a maximum of 12 episodes. After 60 and 12 episodes of hypoxia, changes in gene expression were profiled using a hypoxia RT- PCR array and compared to normoxic cells. An assay was performed after 60 and 12 episodes of hypoxia to determine the effect of hypoxia on angiogenesis migration. Results: The expression of the Hepatocyte Nuclear Factor 4 gene increased by 32.71-fold following exposure to 12 hypoxic injections and by an additional 14.95-fold following exposure to 60 hypoxic injections. After twelve episodes of hypoxia, the capacity for cell migration increased. Conclusions: This study provides empirical support for the notion that cellular exposure to prolonged durations of hypoxia, specifically three months, induces expression changes distinct from those induced by fleeting durations of hypoxia, which are less than weeks and hours. The study hypothesized that HNF4A could serve as a viable biomarker for tumor hypoxia and a major contributor to the response of MCF7 breast cancer cells to protracted hypoxic conditions.
An assessment of the Storage and Disposal of Unused Medications in Southern Jordan: Knowledge and Socio-Demographic Influences
Background: Improper storage and disposal of unused medications in households raise global concerns due to environmental, health, and animal welfare impacts. Objectives: This study aims to investigate medication storage and disposal practices in southern Jordan while identifying socio-demographic factors contributing to household medicines' storage and evaluating the level of knowledge regarding medicines disposal. Methods: Between January and July 2023, a cross-sectional study was conducted in southern Jordan. In the current study, an online questionnaire was designed based on a comprehensive review of relevant literature. Data analysis was performed using Statistical Package for Social Science (SPSS) software. The Chi-Square test and logistic regression were employed to assess the relationships between socio-demographic factors and the storage of medications. Results: All participants stored unused medications at home, with 43.4% expired. The primary reason for storage, cited by 49.8% of respondents, was the anticipation of future use. Analgesics were the most commonly stored type and kept in kitchens and bathrooms. Logistic regression analysis revealed significant links between storage practices and socio-demographic factors such as age group more than 61 (p-value <0.001 ), Illiterate (p-value = 0.006), large family size (p-value = 0.012), no health insurance (p-value <0.001), and high income (p-value = 0.027), with gender having no significant effect. Half of the participants throwing medications in the garbage The Pharmacists played a pivotal role as the primary source of information on medication disposal, yet there was a lack of knowledge concerning the consequences of improper disposal. Conclusion: The prevalence of storage of unused medications and improper disposal was high in southern Jordan. This study underscores the necessity for government policies regulating medicine dispensing to ensure appropriate quantities and reduce excess household storage. Furthermore, public awareness campaigns should educate individuals on safe disposal methods for unused medications at home and assist in mitigating associated risks.
Comparative analysis of pharmaceutical care, professional development, and policy compliance in chain vs. independent pharmacies: A Cross-sectional study
Background: The rapid proliferation of community chain pharmacies management models has garnered significant attention. Despite this surge, there is a notable scarcity of research that comprehensively evaluates this model in comparison to traditional independent pharmacies. Objective: This study aims to analyze pharmacists' insights into the status of community pharmacy management models, specifically comparing chain pharmacies to traditional independent pharmacies. We employed a framework assessing 40 aspects across five critical pillars: 1) Pharmaceutical care & Patient Services, (2) Professional development and Working environment, (3) Economic considerations, (4) Legal aspects, and 5) General concerns. Methods: This cross-sectional analytical study utilized a validated and reliable online survey (Lawshe's content validity ratio > 0.741, p < 0.05, Cronbach's alpha = 0.86) distributed among pharmacists. The analysis included measurements of associations and the strength of association to explore significant results. Results: A total of 835 pharmacists responded. Gender, workplace, and responder qualifications exhibited no significant association (P>0.05) with pharmacy model preferences. However, older participants and those with increased years of experience demonstrated a very strong statistically significant association toward preferring independent pharmacies (P<0.001, Cramer's V (ϕc) for age > 48 = 0.7) and experience (P<0.001, (ϕc) for > 6-year experience = 0.52). Overall, independent pharmacies were favoured over chain pharmacies (43.7% vs 29.5%, P<0.001). Quality of pharmaceutical care parameters indicated that independent pharmacies were perceived as superior to chains in patient consultation (p<0.001), reduced waiting time for patients (p<0.001), and better longer-term relationships (p<0.001). Regarding economic impact, chain pharmacies were perceived to yield higher profits and more sales for non-medical products (P<0.001). Independent pharmacies generally exhibited a superior profile in legislative parameters compared to chain pharmacies, including compliance with ownership regulations (P<0.001) and bequeathable practices (P<0.001). Chain pharmacies were perceived to provide better professional development to their staff compared to independent pharmacies (P<0.001). Conclusion: The significant expansion of chain pharmacies in the market highlights the imperative need for the establishment of new regulations and criteria. These measures are crucial to guarantee stability and equity for both chain and independent pharmacies operating within the market.
Illness Perception and Healthcare-Seeking Behaviour among People with Schizophrenia and Their Caregivers: A Qualitative Study
Objective: This study explored the perception of illness and health care-seeking behavior from the perspective of people with schizophrenia and their caregivers in the Indonesian cultural context. Methods: A qualitative study was employed, using in-depth interviews, in the southern areas of Kalimantan, Indonesia. The qualitative data were analyzed using inductive content analysis. Results: Participants perceived schizophrenia as a result of diverse factors, including drug abuse, depression, stress, spiritual possession, black magic, and neurological disorders. These perceptions were influenced by participants' beliefs, religions, social norms, local culture, and information provided by clinicians. The patterns of healthcare-seeking behavior were similar in the first psychosis episode and during relapse. The severity of symptoms, whether classified as mild or severe, affected their healthcare-seeking behavior. When symptoms were considered mild, they chose self-medication or alternative treatments. However, if symptoms were severe or life-threatening, patients were directed to seek assistance from healthcare centers. During relapses, the recurrent patterns of healthcare-seeking behavior persisted, with the caregivers' capacity to recognize symptoms significantly influencing this continuity. Conclusion: participants' unfamiliarity with the term "schizophrenia" is indicative of a knowledge gap. Moreover, to manage the symptoms and provide quality care, an intervention is necessary to improve the patient and caregiver's knowledge of schizophrenia.
Exploring the impact of pharmacist involvement in palliative care medication management
This study aimed to evaluate the impact of pharmacist involvement in palliative care medication management. By examining medication appropriateness, patient outcomes, and healthcare team collaboration, to identify opportunities for improvement. Data was collected from 50 palliative care patients at King Hussein Medical City in Jordan. Results revealed that pharmacist interventions positively influenced medication safety and efficacy, but their involvement was inconsistent. Barriers to effective collaboration included communication challenges, time constraints, and limited pharmacist availability. The study underscores the need for increased pharmacist training and expanded roles within palliative care teams to optimize medication management and improve patient outcomes. Therefore, the study recommended the necessity of improving communication within the healthcare team Enhancing pharmacist participation, strengthening medication reconciliation, and improving patient education.a
Current pattern of off-label drug use among hospitalized pediatric patients: a short-term longitudinal study
Background: Many hospitalized pediatrics receive off-label drugs that are not tested prior to being put on the market. Objective: To assess the prescribing pattern of off-label drug use among hospitalized pediatric patients in Punjab, Pakistan. Method: A longitudinal study was conducted from October 2023 to February 2024 from 3 governments and 3 private hospitals of 5 most populated cities (Faisalabad, Lahore, Gujranwala, Multan, Islamabad) of Punjab, Pakistan. Stratified random sampling was applied to select samples from pediatric wards of hospitals. All the drugs were classified as off-label or on-label on the basis of package insert and BNF. Off-label drug use was categorized on the basis of route of administration, indication, frequency, formulation, dose and age. Frequency distribution is used to explore the data. Chi-square test was used to explore the association between on-label and off-label categories against various variables. Finally, Multiple logistic regression models were used to find the determinants of off-label drugs. Results: Of 2100 prescriptions, a total of 472 (22%) patients received off-label drugs. Most off-label drugs were found in Faisalabad (55.2%). In all age groups, children were more prone to off-label use (30.60%). The presence of chronic illness was significantly associated with off-label drug use (p<0.05). Off-label drug use in children general ward was 2 times more than the other wards. A statistically significant correlation (p<0.001) was found between the on-label and off-label drug use within the diagnostic category. In all prescribed drug categories, anti-infective for systemic use accounts highest off-label use followed by systemic hormonal preparation (13.5%) and the most common off-label drug category was off-label by indication. Conclusion: High level of off-label drug prescriptions was found in children as compared to neonates. Off-label drugs showed poor results in patients with chronic illness. The number of drugs prescribed by an MBBS physician increases the chances of off-label prescriptions.
Effects of Adding Semaglutide to Basal-Bolus or Mixed Insulin Therapy: A Retrospective Chart Review
Objective: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has beneficial effects when incorporated into basal insulin therapy. Despite mounting evidence from diverse geographical regions supporting its efficacy in more intricate insulin regimens for patients with type 2 diabetes (T2DM), real-world data from our region remains scarce. This study aims to assess the impact of adding Semaglutide to the basal-bolus or mixed insulin therapy over a 12-month period on glycated hemoglobin (HbA1c), weight, and total daily dose (TDD) of insulin. Methods: A retrospective chart review was conducted at a military medical center in Riyadh from January 2021 to September 2022. The study included all adult patients with T2DM who experienced clinical benefit from the addition of Semaglutide to basal-bolus or mixed insulin therapy during this timeframe. Measurements of HbA1c, weight, and TDD were obtained at baseline, 3, 6, and 9 months. Descriptive statistics and one-way ANOVA tests were utilized for statistical analysis. Results: The study cohort comprised 152 patients, of whom 105 (69.1%) were female, with a mean age of 57.7+11.4 years. There was a significant reduction in mean HbA1c levels from 9.32 at baseline to 8.62, 8.28, and 8.36 at three, six, and nine months, respectively (p-value <0.001). Moreover, mean weight in kilograms (kg) decreased from 94.8 kg at baseline to 93.54, 92.46, and 91.94 kg at three, six, and nine months, respectively (p-value > 0.005). Conclusion: This study demonstrates that the addition of Semaglutide to the current treatment regimen of patients with T2DM leads to improvements in HbA1c levels, accompanied by observed reductions in weight over nine months in individuals utilizing basal-bolus or mixed insulin therapy. Further studies with extended follow-up periods are warranted to validate these findings.
First Middle Eastern-Based Gut Microbiota Study: Implications for Inflammatory Bowel Disease Microbiota-Based Therapies
Objective To investigate the differences in gut microbiota composition between healthy individuals and those with inflammatory bowel disease (IBD) in Jordan and to understand how these differences may contribute to the pathogenesis of IBD. Methods This study involved the comprehensive analysis of 20 gut microbiota samples from diverse populations in Jordan. Using 16S rRNA sequencing, the gut microbiome composition of healthy individuals was compared to that of individuals with IBD. The analysis focused on microbial diversity and the relative abundance of specific bacterial taxa. Results The study revealed significant disparities in the gut microbiota composition between healthy individuals and those with IBD. IBD patients exhibited reduced microbial diversity. There was a notable decrease in the abundance of beneficial taxa such as Firmicutes and Bacteroidetes, specifically the families Erysipelotrichaceae, Ruminococcaceae, and Lachnospiraceae. IBD patients showed elevated levels of potentially harmful bacteria, particularly the Proteobacteria phylum. Three bacterial classes, Pseudomonas, Clostridia, and Escherichia, were significantly increased in IBD patients. Beneficial genera such as Faecalibacterium prausnitzii, Bifidobacterium, Blautia, Coprococcus, and Bacteroides dorei were more prominent in healthy controls, highlighting their roles in maintaining gut health and anti-inflammatory properties. Conclusion The findings underscore a significant association between gut microbiota dysbiosis and IBD. IBD patients in Jordan exhibited lower microbial diversity and an imbalance favoring harmful bacterial taxa. These insights into the gut microbiota composition offer a valuable understanding of IBD pathogenesis and suggest that therapeutic strategies targeting the gut microbiome could be promising for managing the disease. Further research into the interplay between gut microbiota and the immune system is essential for developing novel IBD treatments.
Exploring Pharmacists Attitudes, Practices, and Barriers to Conducting Medication Reviews in Community Pharmacy Settings
Background: Medication review (MR) services are essential in optimizing therapy outcomes. In addition to the barriers hindering its adoption, understanding community pharmacists’ perception and practice of MR is crucial in formulating strategies to enhance MR services in pharmacy practice Objective: To evaluate pharmacists' attitudes, practices, and barriers to providing MR services in the community pharmacy setting. Methods: In this cross-sectional study, a validated self-administered questionnaire was distributed online to community pharmacists across the UAE using convenience-sampling technique. The questionnaire evaluated whether the pharmacists practiced MR, attitudes toward MR, the extent of its implementation, and the associated barriers. Stepwise regression was conducted to explore the variables associated with attitudes and MR practice. Results: The majority of the pharmacists (72.5%) reported providing MR, with a notable decline in engagement among older pharmacists (OR = 0.243, 95%Cl (0.113-0.522), employee pharmacists (OR = 0.909, 95% Cl (0.844-0.979) and those with no access to patient medication records (OR = 0.131, 95%Cl (0.052-0.327). The median attitude score was 27 out of 35, indicating favorable perceptions, particularly among pharmacists in chain pharmacies (OR = 2.974, 95%Cl (1.245-7.103). Employee pharmacists showed decreased odds of being in the high-attitude group (OR = 0.233, 95%Cl (0.076-0.714) and decreased odds to practice MR (OR = 0.192, 95%Cl (0.051-0.723) compared to pharmacists in charge or owner pharmacists. On the other hand, an increased number of working pharmacists (OR = 2.053, 95%Cl (1.381-3.052) and improved attitudes increased the odds to practice MR in the community pharmacy (OR = 2.617, 95%Cl (1.159-5.906). Conclusions: The study revealed a room for improvement in MR practice, especially among older and employee pharmacists. Enhancing the accessibility to specialized databases and authorized references, and enforcing pharmacists' attitudes towards MR practice via providing education and facilitating inter-professional collaboration are essential strategies to improve MR practice in the community pharmacy setting.
Vitamin D and bee propolis: A comparative study about their effect on tooth movement and resorption
Objective: The study aimed to evaluate and compare changes in some inflammatory markers involved in the inflammatory pathway associated with tooth movements, such as TRAP (tartrate-resistant acid phosphatase), RANKL (receptor activator of nuclear factor kappa beta ligand), ALP (alkaline phosphatase), and TNF-α (tumor necrosis factor alpha) in gingival tissues of the maxilla for second premolar in a dog's model. Method: The experimental sample consisted of 20 male dogs divided into 4 groups. The study involved dental arch division. Groups included control, injection bee propolis, oral propolis, and Vitamin D3 groups. Control groups received DMSO (Dimethyl sulfoxide) injections, while bee propolis was divided into two sections during dental treatment 150 mg and 300 mg of propolis were injected every 3 days. Oral propolis was administered as 100 mg/kg/day daily, while Vitamin D3 was administered as 25 units weekly. Immunohistochemistry expressions with scores were achieved for the 4 markers. Results: recorded a significant decrease in the TRAP, RANKL and TNF-α levels in both tension and compression sides in the injected propolis groups especially at a dose of 300 mg, while orally and injected propolis recorded a significant increase in ALP in both teeth sides compared with control groups. The vitamin D3 group revealed a significant increase in the TRAP and RANKL compared with propolis and control groups, in addition to a significant increase in the ALP particularly in the tension side but not like the propolis group. Conclusion: vitamin D3 plays a higher role in tooth movement to the compression side than propolis, which is considered more beneficial in terms of time, but it causes resorption of both the alveolar bone and tooth root apex, whereas propolis has a very good influence in the new bone formation compared with vitamin D3 and well tooth movement to the compression side when comparing with ordinary orthodontic treatment. Both biomaterials, through complicated biological processes, promote bone health and effective orthodontic therapy.
Pharmacists’ Recommendations to Reduce Drug Therapy Problems in Nursing Home Residents
Objective: Comprehensive Medication Management Services (CMM) are clinical services based on pharmaceutical care, and represents a patient-centred approach in which the pharmacist takes the responsibility for the patient’s needs. This study aimed to describe drug therapy problems among nursing home residents, identified through pharmacists’ provision of CMM, and assess physicians’ acceptance of pharmacists’ recommendations. Methods: A cross-sectional observational study was conducted from February 2018 to January 2019 in a nursing home in Croatia. Utilizing the Pharmacotherapy Workup method by Cipolle et al., pharmacists assessed and classified DTPs related to indication, effectiveness, safety, and adherence. Recommendation included medication discontinuation, dose adjustments and patient education. Results: Sixty residents were included in the study. Median age was 79.9 (IQR 66.1 – 96.7) years. On average, residents used 7 (IQR 2–16) medications and had 5 (IQR 1–12) comorbidities. In total, 141 DTPs were identified (4.3 ± SD2.35 per resident). The most prevalent DTP was” additional drug therapy needed” (n =55; 39%), falling into the effectiveness category. The pharmacists suggested 133 modifications for the identified DTPs. Physicians accepted a total number of 112 recommendations (84.21%). Conclusion: The high prevalence of DTPs identified and substantial acceptance of pharmacists’ recommendations strongly suggests the need to incorporate CMM services within long-term care facilities with intent to improve quality of care. The results demonstrate that pharmacists are pivotal in optimizing therapeutic outcomes through effective medication management.
Probing biosimilar-related concerns and practices among community pharmacists
Background: The successful integration of biosimilars into routine clinical practice depends on their acceptance. Given the vital role of community pharmacists in medication management, it is essential to understand their concerns and practices related to biosimilars, which was the objective of the present study. Methods: In this cross-sectional study, a research pharmacist distributed in person a validated self-administered survey to community pharmacists across various geographical areas of the UAE. The survey included four sections that evaluated sociodemographic and work-related characteristics, pharmacists’ concerns and extent of biosimilar utilization, and the factors facilitating its adoption in the community pharmacy settings. Results: Out of 472 pharmacists, 415 (87.9%) were familiar with biosimilar efficacy and safety. Most of the study pharmacists were females (53%), and had a median [interquartile range (IQR)] age of 35 (30-41) years. The median (IQR) score for biosimilar-related concern was 21 (20-24) out of a possible score of 32, demonstrating a room for improvement. Most of the pharmacists expressed moderate-to-high concerns. The perceived acceptance of biosimilars by the patients and the prescribers represented the highest concern among the study pharmacists (30.6%). The median (IQR) of biosimilar-related practice score was 25 (23-27) out of 40, showing a window for practice improvement. More than half of the pharmacists did not often perform the essential biosimilar-related practices. The most frequently reported factors to facilitate biosimilar adoption in clinical practice were providing information on the clinical benefits of the biosimilars for prescribers and patients (48.30%), providing education on biosimilar use (44.70%), and establishing guidance on interchangeability or possibility of switching (43.60%). Conclusion: Pharmacists in the present study demonstrated concerns and inadequate adherence to practices concerning biosimilar therapy. Targeted educational interventions highlighting the benefits, effectiveness, safety and proper administration of biosimilar therapy are essential to address these concerns and facilitate the integration of biosimilars into routine clinical care.
Barriers to Implement Generic Medicine Prescribing and Dispensing Policies in Pakistan: Current Challenges and Future Implication
Background: Prescriptions comprising of generic names have made place as the norm in many countries owing to established drug regulatory regimes. Nevertheless, generics have greatly reduced worldwide pharmaceutical and healthcare spending. Objective: The current review comprehensively explores research studies focused on generic medicine in Pakistan, utilizing a variety of research methodologies. The prime objective of this review is to assess the barriers toward the implementation of generic medicine prescribing and dispensing policies in Pakistan in order to reduce the prescription cost. Methodology: The articles were filtered using databases: Google Scholar and PubMed. The research questions were developed and focused exclusively on all literature available regarding generic medicine in Pakistan. Results: Google Scholar and Pub-Med were searched for the period 2000-2023. 45 studies were included as per our criteria. The selected papers were grouped into different themes. Seven (7) papers were included regarding knowledge, attitude, perception & practice of healthcare givers regarding generic medicine in Pakistan. Seven (7) studies were related to Availability, Affordability, Pricing of Generic Medicine in Pakistan while 31 studies were included regarding percentage of generic prescribing as per WHO Core indicators. Both quantitative and qualitative research studies were eligible for inclusion. the selected papers were grouped into different themes. Conclusion: With the help of the evidence available through screening, it has been revealed that situation of generic medicine is quite alarming in Pakistan. Bioequivalence regulations as well as proper generic policy are need of the day. Educational interventions and uncompromising compliance to the drug policies of WHO may play a part in generic medication prescribing. Implementation of pricing policies is compulsory to promote rational use of drugs and to enhance availability. Presence of qualified pharmacists and electronic health system at every level of healthcare setups is need of an hour.