The mainstay of management of patients presenting agitated and aggressive in the context acute mental disorder is with symptom triggered ‘as required’ (PRN) benzodiazepines and/or antipsychotics. The present clinical review and quality improvement project identified a culture based on a reliance on heavily sedating benzodiazepines for the management of such patients by way of audit, survey and clinical review. Through an intensive educational workshop series for nursing and medical staff, and the implementation of a ‘PRN Administered’ sticker, I was able to change a culture of utilising sedation for agitation and aggression to symptom triggered medication selection. Together with appropriate medication selection and adequate documentation of response to the selected medicine we were able to improve patient care and management, notably by way of drastic reduction in physical restraint and seclusion events.

Background: Pharmacists gaining increasing role in Type II Diabetes mellitus (T2DM) management services through collaborative practice with healthcare professionals.

Aim: To assess the Pharmacists’ interventions’ in management of T2DM and to address the effects of these interventions on different health outcomes

Method: Studies were identified by electronically searching the PUBMED/MEDLINE, NHS evidence, Science Direct, Pharmacy Abstracts, Web of Science, ClinicalTrials.gov, Trip Database, International Pharmacy Abstracts and Cochrane Library of Clinical Trials.

Randomized controlled trials, including participants whom received direct care from the pharmacists, reporting one or more of the following main outcomes: a) Clinical outcomes, b) Patients’ related outcomes, c) Healthcare Service Utilization

Results: 33 studies were included 4,952 T2DM patients, were conducted in different healthcare settings. Comparing to control groups, pharmacists groups showed significant reduction in mean change of HbA1c in twenty-four studies (-0.4% to – 2.5%) vs. (+0.43% to -1.6%), Systolic blood pressure in Fifteen studies (-20.09 mm/hg to +0.8 mm/hg) vs. (-4.4 mm/hg to +5.75 mm/hg), while Diastolic Blood pressure in twelve studies (-8.9mm/hg to +0.5mm/hg) vs. (-3.95mm/hg to +18mm/hg), Low-density lipoprotein in twelve studies (-23.20mg/dl to +1.16mg/dl) vs. (-21.65 to +5.02), high-density lipoprotein in seven studies (-5.8mg/dl to +10.44mg/dl) vs. (-2.8mg/dl to +3.48mg/dl), Total Cholesterol eleven studies (-30.54mg/dl to +8.5mg/dl) vs. (-20.10mg/dl to +3.86mg/dl) and Triglyceride in eight studies (-44.28mg/dl to +19.48mg/dl) vs. (-19.48mg/dl to +30.11mg/dl) respectively. Also it showed reduction in cardiovascular disease risk, improvement in medication adherence through decrease in self-reported non-adherence and improving in refill rate and overall health related quality of life. Improvement in patients’ knowledge and highly satisfaction rate (50-100%), high capability of identifying and resolving various drug therapy problems and considered as cost-effective.

Conclusion: These findings support the importance of pharmacists’ interventions as they have pivotal impact on improving different health outcomes in T2DM patients’.

Abstract:

Background: Diabetes is considered as a life long disorder by modern medical science. However, can be managed by changes in lifestyle and diet regulation and alternative system of medicine – Ayurveda, Homeopathy, Yoga, Naturopathy, Unani and Home remedies.

Objective: The present study aims to outline the number of patients opting for alternative system of medication of treatment for type-2 diabetes.

Methodology: 497 patients of Diabetes Mellitus with illness duration >3 months were taken and pre-structured questionnaires were filled. Details of patient viz age, sex, height, blood sugar level, HbA1C level, treatment prescribed, medication fee were recorded and later transcribed on Microscoft Office Excel for statistical analysis.

Results: Out of 497 patients, 51 patients (including male and female) opted for Ayurveda and 6 patients opted for Homeopathy; out of these patients only 4 had hypertension and only 1 had liver related problem. 100 patients changed their lifestyle and started doing yoga and exercise daily.

Conclusion: Present study concludes that the people are changing their lifestyles and switching from allopathy to other alternative treatments as less comorbidity is associated with them and are less harmful in the long run.

Objective: To revisit and assess the prevalence of clozapine induced cardiotoxicity incidence rates, summarize diagnostic features, and evaluate monitoring procedures for safe clozapine rechallenge.

Methodology: This review included all published reports of clozapine associated cardiotoxicity using keywords as “clozapine-cardiotoxicity”, “clozapine-myocarditis”, and “clozapine-cardiomyopathy” utilising  Discovery database till 2016. 5175 abstracts were reviewed preliminarily, to yield 110 reports that met criteria for inclusion.

Results of review: Clozapine-associated Myocarditis and rechallenge Incidence of early myocarditis (≤2 months) ranges from <0.1 to 1.0% and is about 10 times less 3–12 months later. Clinical diagnosis is confounded by variability in presentation and non-specificity of symptoms. Mortality involved 10–30% of affected cases. Rechallenge considerations include clozapine impact on symptomatic severity and associated disability and risk of suicidality. It’s recommended only after full clinical resolution of myocarditis and cardiac function impairment, under closely controlled conditions, with very low and slow retitration and frequently assays of lab and cardio biomarkers.

Clozapine associated cardiomyopathy and rechallenge Incidence ranges from 0.02% to 0.10% (UK) or more in Australia. Mortality has been reported at 12.5–24.0%. Rechallenge is generally not recommended. There are only three published case reports of which one experienced a re-exacerbation of cardiomyopathy.

Monitoring Cardiac Toxicity: Plausible steps include closer clinical monitoring, repeated assays of biomarkers, and echocardiographic studies, and cardiac MRI - in cases with unremarkable findings of cardiac dysfunction with echocardiography. 

Conclusion: The evidence suggests clozapine-induced myocarditis and cardiomyopathy may have been underreported worldwide. The true incidence may be as high as around 3%. Identification of subclinical cardiotoxic effects will improve outcomes by earlier recognition before clinical manifestations of cardiac impairments. Emerging consensus on a pragmatic closes clinical monitoring and repeated assays of cardiac biomarkers are aimed at timely detection of cardiac toxicity, in the initial phase of treatment will be proposed.

Inappropriateness of prescription: So far, there has been no scientific data on the prevalence of DRP regarding Clinical pharmacists’ intervention on hospitalized cancer patients in Vietnam reported. This study was conducted to investigate the DRPs with the intervention of clinical pharmacist in Oncology ward and was to Assess the identified DRP from physicians’ perspective.

Methods: Both quantitative and qualitative methods were implemented. The study was prospectively conducted from October to December 2016. Medication profiles of 149 inpatients were reviewed to identify DRPs in physicians’ prescription. Once a DRP was identified, intervention from clinical pharmacist was proposed and prescribers’ acceptance was analyzed. A questionnaire was designed to implement in – depth interview with seven oncologists about their perception and evaluation on identified DRPs.

Results: 182 DRPs were identified in 149 in-patients, giving an average of 1.2 DRPs per patient. The most common DRPs were categorized as “Dosing” (21.9%), “Selection” (24.7%) and “Administration” (20.3%). The common DRPs were related to preventative medications (57.7%). The majority of DRPs’ significance level was moderate (48.8 %) and minor (46.6%). 52% of the suggested intervention by clinical pharmacists was accepted by prescribers. Most of interventions in “Administration” and “Drug information provision” categories were implemented. 66.7% DRPs reached the 100% oncologists’ agreement. The factors affecting physician agreement were personal experience, medication cost and availability, the convenience for health care practitioners and patients.

Conclusion: The results of this study demonstrated that clinical pharmacists in oncology ward can probably improve the quality of pharmacotherapy. Greater understanding of DRPs from physicians’ perspective will enable the appropriate management of DRPs.

Background: Use of over-dosage of Non- Prescription Drugs (NPD) among university students is a serious public health issue. However, there are no extensive studies that measured the prevalence of taking more than the recommended dose of NPD and/or identified the risk associated with this behavior among university students.

Objectives: This study was undertaken to assess the prevalence and associated risks of self -over-dosage with NPDs in university students in United Arab Emirates (UAE).

Methods: A cross-sectional survey-based study was conducted from January to April 2014, among 2875 students in three randomly selected universities. A structured and validated questionnaire was used to collect the responses of the students. SPSS version 20 was used to analyze the data.

Results: Out of 2875 students, only 2,355 surveys were fully answered, returned back and included in the present study. Of 2,355, more than half (1,348; 57.2%) the participants reported using ONPD in the past 90 days before conducting the study and were asked to complete the survey.  Only 290 (22%) of a total 1348 participants reported taking more than the recommended dose of Oral NPD in the previous three months before conducting the study. Analgesic/antipyretic (223, 16.5%) and anti-allergic (67, 4.9%) drugs were more than other classes of the ONPD,  reported to be taken in a dose more than the recommended dosage The most common justifications for taking more than the recommended dose of ONPD among respondents were severe symptoms (6%), the belief that the recommended dose would not be sufficient to relieve the symptom (5%), the belief that a stronger dose would relieve the symptoms faster (11%), and previous experience (4%).Our results identified three risk factorsfor taking more than the recommended dose of NPD.  High frequently drug-users of daily use (OR = 3.494, 95% CI: 1.677-7.279) (p < 0.001),and students from non-medical colleges had higher odds of taking more than the recommended dosage as compared to students from medical colleges(OR = 1.486, 95% CI: 1.060-2.085, p value< 0.05).Furthermorere, participants with a polypharmacybehavior had higher odds of taking over-dosage of ONPD than single NPD users (OR =1.918, 95% CI: 1.440-2.555) (p < 0.001).

Conclusion: There are a sizable proportion of university students that use over-dosage ofNPD, but it is more serious issue when it comes to non- medical student.There is a need for educational programs designed to increase awareness among all university students and to motivate them not to use over dosage of NPD.  Further studies are also required to investigate additional explanatory variables that could influence the practice of over dosage with NPD.