Drug Information Center Research Articles

A comparison of drug information question responses by a drug information center and by ChatGPT.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. A study was conducted to assess the accuracy and ability of Chat Generative Pre-trained Transformer (ChatGPT) to systematically respond to drug information inquiries relative to responses of a drug information center (DIC). Ten drug information questions answered by the DIC in 2022 or 2023 were selected for analysis. Three pharmacists created new ChatGPT accounts and submitted each question to ChatGPT at the same time. Each question was submitted twice to identify consistency in responses. Two days later, the same process was conducted by a fourth pharmacist. Phase 1 of data analysis consisted of a drug information pharmacist assessing all 84 ChatGPT responses for accuracy relative to the DIC responses. In phase 2, 10 ChatGPT responses were selected to be assessed by 3 blinded reviewers. Reviewers utilized an 8-question predetermined rubric to evaluate the ChatGPT and DIC responses. When comparing the ChatGPT responses (n = 84) to the DIC responses, ChatGPT had an overall accuracy rate of 50%. Accuracy across the different question types varied. In regards to the overall blinded score, ChatGPT responses scored higher than the responses by the DIC according to the rubric (overall scores of 67.5% and 55.0%, respectively). The DIC responses scored higher in the categories of references mentioned and references identified. Responses generated by ChatGPT have been found to be better than those created by a DIC in clarity and readability; however, the accuracy of ChatGPT responses was lacking. ChatGPT responses to drug information questions would need to be carefully reviewed for accuracy and completeness.

The Züri Can study: Can regulated cannabis sales promote lower-risk cannabis use? Mini-review and study protocol

Background and AimsRecreational use of cannabis is illegal in most countries. Despite this, it is the third most commonly used psychoactive substance worldwide. As a result of this discrepancy, a growing number of countries have begun to reassess their legal approach to cannabis in recent years. While the health risks of cannabis and potential harm reduction measures are increasingly well understood, there are still significant gaps in knowledge about which regulatory and supply models are effective in promoting lower-risk cannabis use.In this paper, we outline the Züri Can study, which implements and evaluates a regulatory framework for cannabis sales in the city of Zurich, Switzerland, between 2023 and 2026. In addition, we illustrate how the study addresses current knowledge gaps to provide further insight into the potential future regulation of cannabis in Switzerland.To embed the study in the present scientific and political context, we first provide a brief overview of the state of knowledge on cannabis-related health risks and means of reducing them, along with lessons learned from other countries that have implemented varying regulatory systems. Design and Measurements2,100 participants will be able to legally purchase cannabis either at a pharmacy, a cannabis social club, or the municipal drug information center over a three-year period. As part of this observational study, participants will be evaluated regarding their cannabis use habits and motives, their knowledge of lower-risk use, and their mental and physical health, among other parameters.Established harm reduction strategies are implemented as an integral part of the study design. CommentsThe study will contribute to a better understanding of the impact of different cannabis distribution models on cannabis use patterns and related health outcomes. The results are expected to assist Swiss and international policy makers in developing evidence-based and public health-oriented regulatory frameworks for cannabis.

Characterization of patients with a snakebite presenting to healthcare facilities and reported to poison and drug information centers—Arizona, 2017–2021

Introduction Envenomation after a North American rattlesnake (Crotalus spp. and Sistrusus spp.) bite is associated with substantial morbidity. Arizona reports the highest number of rattlesnake envenomations annually in the United States. We evaluated the performance of poison and drug information centers for snakebite surveillance, compared with the hospital and emergency department discharge database. We used both datasets to improve the characterization of epidemiology, healthcare costs, and clinical effects of snakebite envenomations in Arizona. Methods We identified patients with a snakebite during 2017–2021 using Arizona hospital and emergency department discharge data and snakebite consults with two regional Arizona poison centers. Patients were matched using name and birthdate. The performance of poison center data for snakebite surveillance was evaluated using the percentage of snakebite patients in hospital and emergency department discharge data that consulted with poison centers. Patient demographics, healthcare characteristics, clinical effects, and context of snakebite events were described using both datasets. Results In total, 1,288 patients with a snakebite were identified using the Arizona hospital and emergency department discharge data, which resulted in 953 (74%) consultations with poison centers. The median age of patients was 48 years (IQR 28-62 years), and they were predominantly male (66%), White (90%), and non-Hispanic (84%). The median billed charges were US$ 84,880 (IQR US$ 13,286–US$ 168,043); the median duration of a healthcare stay was 34 h (IQR 13–48 h), and 29% of patients were transferred between healthcare facilities. Among 953 consulted poison center calls for a snakebite, a median of 14 vials of antivenom was administered per patient; 375 (60%) bites occurred near the home, and 345 (43%) patients were bitten on a lower extremity. One death was identified. Discussion Snakebites in Arizona can cause severe morbidity and require extensive healthcare resources for treatment. Poison centers are valuable for monitoring venomous snakebites in Arizona. Conclusions Using hospital and emergency department discharge data with poison center records can improve public health surveillance data regarding snakebite epidemiology and human-snake interaction information and be used to tailor interventions to increase awareness of snake encounters and prevent snakebites.

The Impact of Legalizing Recreational Cannabis on the Children of a Neighboring State.

In the United States, cannabis is legal for adult recreational use in 24 states and Washington, DC. Unintentional pediatric cannabis exposures have increased in many states following legalization.We evaluated the relationship between recreational cannabis legalization and the rates of unintentional pediatric exposures in a neighboring state that had not undergone legalization. We obtained cannabis exposure cases for children 0-12 years from the New Mexico Poison and Drug Information Center electronic database. Only deidentified patient data from closed-case exposure encounters were abstracted. Data were grouped as precommercial and postcommercial availability in neighboring Colorado, demarcated by January 2014. We coded cannabis products as edible, not edible, or unknown. For bivariable comparisons, we used odds ratios, risk ratio, χ2 test, and Wilcoxon rank sum test. We chose a type 1 error rate of 0.05 to determine significance. There were 269 exposures over 24 years of calls. Following neighboring legalization, the median number of exposures per year increased from 4 (interquartile range 2, 5) to 24.5 (16.5, 34), the median age increased from 1.9 to 3.0 (P = 0.007), and the relative risk of the exposure involving edible products was double (relative risk = 2.0, 95% confidence interval = 1.6, 2.6). The severity of the exposures' medical effects also increased (P = 0.008). The number, severity, and type of pediatric cannabis exposures in New Mexico changed after neighboring recreational cannabis legalization. States neighboring those undergoing cannabis legalization should be prepared to respond to increased acute exposures in children.

Infections following rattlesnake envenomation and use of antibiotics.

There are 7000-8000 venomous snake bites annually in the USA. Antibiotics are commonly administered to bite victims because infection is difficult to differentiate from local tissue injury following envenomation. The Arizona Poison and Drug Information Center (APDIC) in Tucson oversees antivenom administration for 14 Arizona counties. Records (1999-2021) were searched for antibiotic use and confirmed infections after a rattlesnake bite. There were 4160 calls to APDIC regarding rattlesnakes. After excluding bites to animals, 'dry bites', prisoners and records with missing data, 2059 records were evaluated. Systemic antibiotics were administered to 206 patients (10% of bite victims). Twenty patients (0.97%) had confirmed infections, including cellulitis (n=10), fasciitis (n=4), abscess (n=3) and osteomyelitis (n=3). Five of the victims had positive blood cultures. The presence of tissue necrosis, leukocytosis, fever and elevated fibrinogen levels did not discriminate between toxic effects of venom and infection. Confirmed infections following a rattlesnake bite are uncommon (0.97% of bites). Physicians should refrain from prescribing antibiotics, as they are not justified for most rattlesnake bite victims and the variety of pathogens encountered precludes use of any single effective antibiotic.

Factors Determining Quality of Drug Information by Hospital Pharmacies-Results from Five-Year Annual Quality Assessment.

Drug information (DI) provided by hospital pharmacies aims to promote rational and safe drug therapy. While quality assessment for this task is recommended, more knowledge on the factors determining the quality is needed. We aimed to evaluate the impacts of different factors on the quality of DI provided by hospital pharmacies to healthcare professionals. Retrospectively, answers on fictitious enquiries about annual DI tests for German hospital pharmacies over five years were evaluated for content-related and structural requirements. Multivariate analysis was performed for the impact of the enquiry complexity, DI organization (specialized DI center; pharmacist responsible per day; DI on top of other routine tasks), and quality measures (second look; experience of answering pharmacist in DI/on ward; use of documentation database). In 2017-2021, 45, 71, 79, 118, and 122 hospital pharmacies participated. The enquiry complexity had a statistically significant impact on the content-related quality, with poor results for a higher complexity (years 2018/2021, OR 0.25/0.04, p < 0.01). The DI centers achieved better results regarding content-related quality than for a pharmacist responsible per day (OR 0.76/p = 0.65) or DI on top of routine tasks (OR 0.35/p = 0.02). The DI centers scored better in structural quality. The second look showed an overall trend of a better content-related and structural quality. In conclusion, specialized DI centers and second looks are recommended as quality-improving measures. Training for answering complex enquiries should be intensified.

Evaluation of Adverse Drug Events of Remdesivir for the Treatment of COVID-19 in Patients Contacting the 13-Aban Pharmacy Drug and Poison Information Center

Background: One of the FDA-approved treatments for COVID-19 is remdesivir. In this study, we investigated adverse drug events (ADEs) of remdesivir in COVID-19 patients who contacted 13-Aban pharmacy’s drug and poison information center (DPIC). Methods: In this study, data of patients receiving remdesivir who contacted the 13-Aban pharmacy’s DPIC between April 2021 and May 2022 were extracted. For the evaluation of potential ADEs, we reviewed all contacts related to remdesivir recipients. Results: Out of 223 patients enrolled, 108 (48.40%) developed 120 ADEs. Elevated liver transaminase levels (26.67%) were the most common ADE, followed by weakness (7.5%), nausea, and vomiting (7.5%). The causality assessment of ADE using the Naranjo scale revealed that 41.67% were probable and 58.33% were possible. Conclusion: Based on the results of this study, hepatic dysfunction was the most prevalent ADE among remdesivir recipients; thus, in order to ensure safe use of remdesivir, patients should be closely monitored for this ADE.

A 19-year longitudinal assessment of gyromitrin-containing (Gyromitra spp.) mushroom poisonings in Michigan

Mushroom poisonings are common in the United States. Gyromitrin (acetaldehyde N-methyl-N-formylhydrazone) is a clinically significant mycotoxin primarily associated with the lorchel (i.e. the false morel) Gyromitra esculenta. Resemblance between ‘true and false morels’ has resulted in misidentification of Gyromitra spp. as edible and sought after Morchella spp., resulting in toxicity. Despite literature evidence outlining toxic sequalae, Gyromitra spp. mushrooms are commonly consumed and prepared for culinary purposes. Classic clinical teachings emphasize significant neurotoxicity, including seizures, associated with ingestion of gyromitrin-containing mushrooms, stemming from gyromitrin's terminal metabolite monomethylhydrazine. We performed a longitudinal descriptive review of the clinical toxicity associated with ingestion of mushroom species known or suspected to contain gyromitrin in cases reported to the Michigan Poison & Drug Information Center between January 1, 2002, to December 31, 2020. Our 19-year descriptive case series of gyromitrin-containing mushroom ingestions reported to our Center demonstrated a preponderance of gastrointestinal signs and symptoms, including hepatotoxicity. Of 118 identified cases, 108 (91.5%) of the reported ingestions involved Gyromitra esculenta. The most frequent clinical findings associated with symptomatic ingestions (n = 83) were the aforementioned gastrointestinal symptoms (n = 62; 74.7%). Neurological symptoms were less frequent (n = 22, 26.5%) while hepatotoxicity occurred in fewer patients (n = 14; 16.9%). Of symptomatic patients, most were treated with symptomatic and supportive care (n = 58; 70%). Pyridoxine was used in a total of seven patients (n = 7; 8.4%) with either hepatotoxicity or neurotoxicity. Medical outcomes ranged from minor to major, with no reported deaths. Patient presentations (i.e. GI vs. neurotoxic symptoms) following ingestion of gyromitrin-containing mushrooms may be highly variable and multifactorial, owing to differences in dose ingested, geographical distribution, genetic variability of both patient and mushroom species, and species-specific differences in toxin composition. Future research warrants species-level identification of ingested gyromitrin-containing mushrooms and investigating the contribution of genetic polymorphisms to differences in clinical toxidromes.

Snake eyes: Characterization of topical ocular exposures from rattlesnakes in Arizona

Patients occasionally present with reports of ocular exposure to fluids from rattlesnakes, claiming or suspecting the substance to be venom. This study set out to evaluate and characterize reported cases of suspected venom-induced ophthalmia in humans. A retrospective review of rattlesnake exposures reported to the Arizona Poison and Drug Information Center over a 24-year period was conducted for ocular exposures. Recorded information included patient demographics, clinical course, laboratory results, and treatments. Documentation regarding interactions between patients and snakes was reviewed by Arizona Poison and Drug Information Center herpetologists to evaluate what substance was expelled from the snake resulting in ocular exposure. Our review of rattlesnake encounters found a total of 26 ocular exposure cases. Patient demographics were largely intentional interactions and involved the male sex. Symptoms ranged from asymptomatic to minor effects with 46.2% managed from home and treated with fluid irrigation. A review of cases by herpetologists concluded the exposure patients commonly experienced was to snake musk. Kinematics of venom expulsion by rattlesnakes conclude the venom gland must be compressed, fangs erected to ≥60o, and fang sheath compressed against the roof of the mouth for venom expulsion. Evidence suggests the chance of venom “spitting” by rattlesnakes is close to zero. Rattlesnakes are documented to forcefully expel airborne malodorous “musk” defensively. An important distinction to remember is musk has a foul odor and is usually colorless, while venom is comparatively odorless and yellow. Rattlesnake venom-induced ophthalmia is a rare event as venom expulsion requires the kinematics of feeding or defensive bites. If the rattlesnake is not in the process of biting or otherwise contacting some other object with its mouth, it is more biologically plausible patients are being exposed to snake musk as a deterrent. Whether it's venom or musk, topical exposure to the eyes should prompt immediate irrigation.

Assessment of the hospital pharmacy quality assurance system in selected hospitals in the Amhara Regional State, Ethiopia.

Pharmacy services in hospitals are designed to meet the needs of all patients. This is undoubtedly one of the most complex services provided by hospitals. In government hospitals, including those in Ethiopia, pharmacies mainly serve as drug stores and dispensaries. To the best of our knowledge, this study is the first to assess and ensure better quality assurance for hospital pharmacy services in Ethiopia. Therefore, the objective of this article was to assess the current status of the quality assurance of pharmacy services in hospitals. A cross-sectional survey was conducted. The data were collected from hospital pharmacy heads using the Kobo Collect mobile application and then exported to the Statistical Package for Social Science (SPSS) version 25 for analysis. Descriptive statistics for categorical variables are presented as percentages and frequencies. All (100%) of the studied hospital pharmacies had a qualified pharmacy director and worked in the pharmacy full-time. Only 40% had a drug information center and a functional drug formulary committee. All pharmacies had their own disposal facilities but did not regularly dispose of expired or unfit medications. The results revealed that all hospital pharmacies did not have a responsible body delegated for quality evaluation. The findings of this study clearly show that quality assurance services in hospital pharmacies are compromised. The findings can be used to identify areas of improvement and develop strategies to enhance the quality of hospital pharmacy services.

Descriptive Study of the Performance of the Drug and Poison Information Center at a Tertiary Hospital in Riyadh, Saudi Arabia, 2008–2018

Descriptive Study of the Performance of the Drug and Poison Information Center at a Tertiary Hospital in Riyadh, Saudi Arabia, 2008–2018

Evaluation of recorded phone calls to Iran’s Drug and Poison Information Centers: a 4 years’ study

Evaluation of recorded phone calls to Iran’s Drug and Poison Information Centers: a 4 years’ study

Brazilian Drug Information Centre: descriptive study on the quality of information 2010-2015

ObjectiveTo define the activities of the Drug Information Centre of the Federal Council of Pharmacy (Cebrim/FCP), to describe the passive information and the satisfaction of its users. MethodThe centre has a computerized system for recording and storing the received questions and their answers: the Sistema de Informação Farmacoterapêutica SIFAR (Pharmacotherapeutical Information System) that generates management reports; out of these, the reports from the period 2010 to 2015 were analyzed. ResultsThe main activity carried out by the centre was the passive information provided to pharmacists and undergraduate Pharmacy students. The most frequent subjects were: administration and way of use of medicines and indication and drug interactions, which were answered in less than 24 hours in most cases. Approximately 80% of those users who completed the satisfaction survey rated the service provided as good and optimal. ConclusionsCebrim/FCP provides objective, updated and timely information (passive information) on medicines for pharmacists, with administration and way of use as the most recurrent subjects, and the majority of applicants were satisfied with the service.

Development of a carbocysteine 10% + urea 5% cream for the topical treatment of congenital ichthyosis

ObjectiveOptimization of a topical formula of N-acetylcystelne and urea for the topical treatment of ichthyosis. MethodWe reviewed the chemical structure of the N-acetylcysteine molecule and its metabolic processes. A search was conducted of possible alternative molecules with a chemical structure similar to that of N-acetyl- cysteine that could have improved organoleptic properties. The following databases were used: PubChem®, Botplus®, the Drug Information Centre of the Spanish Agency of Medicines and Medical Devices. The molecule selection criteria were as follows: structural similarity, same therapeutic group, same mechanism of action, same authorized indication, absence of unpleasant smell, and being marketed as raw material in Spain. To complete the pharmaceutical development and validation of the compound, several tests and controls were conducted following the emulsion production procedure of the National Formulary. In order to establish the validity period, we followed the recommendations of the “Guide to Good Drug Preparation Practices in Hospital Pharmacy Services”. ResultsN-acetylcysteine has a free sulfhydryl group, which is responsible for its smell, and undergoes deacetylation. Its main metabolites are cystine and cysteamine. The following molecules were assessed: cystine, cyst eamine, carbocisteine, cysteine and methionine. Carbocisteine was selected because it met all the selection criteria. Carbocisteine is practically insoluble in water and soluble in mineral acids and alkaline hydroxides solutions. Unlike N-acetylcysteine, it does not have a fetid smell. It reaches its maximum stability at pH 5.5 to 7.5. The composition of the compound (100 g) was as follows: carbocisteine (10 g), urea (5 g), glycerine (15 g), water (44 mL), sodium hydroxide (1 g), and Neo PCL® Oil/Water (O/W) (25 g). It has an expiration period of 30 days. The organoleptic characteristics, emulsion type, and pH remained stable within the established expiration period. The carbocisteine compound has been incorporated into the group of topical treatments available for the treatment of patients with ichthyosis in our hospital. ConclusionsThe carbocisteine molecule is a good therapeutic alternative that lacks the unpleasant smell of N-acetylcysteine. The carbocisteine compound developed has been included as topical treatment for ichthyosis due to its tolerability, acceptability, and effectiveness in the treatment of patients affected by this genodermatosis.

Assessment on the Pattern of Drug Information Queries in a Tertiary Care Hospital, Chennai

The drug information services help to assist healthcare workers to address patient-specific drug-related needs and promote rational drug use. The objective of the study is to assess the pattern of drug information queries in a tertiary care hospital from the Physician, Nurses, Pharmacists, Students, and other healthcare professionals. In one year, the drug information queries have been received, documented and retrospectively analyzed for various parameters including the professional status of the requestor, mode of receipt and reply, type and purpose of query, and reference details. Out of 588 queries received, the majority were answered by Physicians (n=468; 79.59%), followed by Pharmacists (n=55; 9.35%), Nurses (n=15; 2.55%), also Technicians (n=9; 1.53%), Students (n=21; 3.58%), Patients (n=3; 0.5%) and other health care professionals (n=17; 2.90%). The secondary resources (Micromedex/Medscape) were used majorly, followed by Textbooks (n=117; 19.89%), Internet (n=103; 17.51%), Journals (n=23; 3.9%) and others (n=5; 0.85%). The most common drug-related query was Pharmacological drug profile (n=149; 25.34%) and including Product identification (n=132; 22.44%), Product Information (n=84; 14.28%), Adverse Drug Reactions (n=74; 12.58%), Therapeutic uses (n=55; 9.35%) and others (n=94; 15.98%). Drug Information Services has been developed to promote rational prescribing patterns among prescribers, reduce medication errors and provide better clinical outcomes.&#x0D; Keywords: Drug Information Centre (DIC), Query, Drug Information Services, Patient care, Tertiary Care Hospital, Clinical Pharmacist.

Training on Procedures for Using Good and Correct Medicine for Health Cadres at the Surobayan Sedayu Mosque

During the pandemic and post-pandemic times, public awareness of health has increased. This condition, of course, must be accompanied by increased health knowledge, including knowledge about medicine. The Al-Hikmah Surobayan Mosque Foundation and LAZISMU Sedayu are starting a health center for residents, so this community service is aimed at training health cadres regarding drug problems. The community service, which took place at the Al-Hikmah Mosque Health Center on March 5, 2023, was attended by 22 health cadres aged 50.78 years. In this activity, the speakers were pharmacists from the pharmacist profession study program FKIK UMY and pharmacists from the UAD pharmacy faculty, assisted by students who were members of PIO activities.The training was carried out in stages, starting with a brief introduction to the types of drugs, then how to use drugs, store drugs, and recognize signs of drug side effects. This service collaborated with the Faculty of Pharmacy Ahmad Dahlan University collaborators. The results of the community service that has been carried out show increased knowledge of cadres and the community regarding drugs, as indicated by an increase in the average post-test score (from 69.1 to 81). This activity was continued by sending students who are members of the Drug Information Center (PIO) during the opening hours of the health center on Saturday and Sunday. The pharmacist must assist cadres on an ongoing basis to escort the health center to the Pratama clinic

Identifying safety concerns related to antiseizure medication use in breastfeeding women with epilepsy by reviewing questions to the Norwegian drug information and pharmacovigilance centres

Identifying safety concerns related to antiseizure medication use in breastfeeding women with epilepsy by reviewing questions to the Norwegian drug information and pharmacovigilance centres

Epic Fail? Try Again

We read with interest the manuscript titled “Failure of Crotalidae Immune F(ab’)2 Equine Antivenom to Achieve Control in a Southern Pacific Rattlesnake Envenomation” by Levine et al. The authors indicate that their patient “failed to respond adequately to F(ab’)2AV” because his initially unmeasurable platelet count reached a maximum of 102,000/μL at 56 hours after envenomation. We have several concerns with this conclusion. Adequate platelet response in the setting of venom-induced hemotoxicity is not universally defined. Although some patients may have complete reversal of thrombocytopenia after a single antivenom dose, others may have increasing platelet numbers but never achieve a platelet count of >150,000/μL. A 2011 study by Yin et al1Yin S. Kokko J. Lavonas E. et al.Factors associated with difficulty achieving initial control with crotalidae polyvalent immune fab antivenom in snakebite patients.Acad Emerg Med. 2011; 18: 46-52Crossref PubMed Scopus (21) Google Scholar suggested that it “may not be reasonable to attempt to completely control” thrombocytopenia. Antivenom may have been underdosed initially. F(ab’)2AV is dosed at 10 vials over 1 hour and repeated hourly until initial control is obtained, as evidenced by the halt of proximal swelling and improvement in laboratory markers. However, as above, there is no consensus on specific numeric goals.2Anavip [Package Insert]. Franklin, TN: Rare Disease Therapeutics, Inc.Google Scholar Although the patient received 10 vials initially, his next dose approximately 1 to 2 hours later was only 4 vials. He received the remaining 6 vials after approximately 9 hours. His platelet count continued to increase. The trend suggests that earlier administration may have prevented persistent thrombocytopenia. After viper envenomation, platelets may be sequestered, pro- and anti-aggregated, and destroyed through multiple mechanisms, leading to recurrent or refractory thrombocytopenia, which is difficult to predict in the absence of routine venomic studies on individual patients. This inability to reliably predict the mechanism of thrombocytopenia results in the inability to predict platelet response to antivenom.3Shen C. Liu M. Mackeigan D.T. et al.Viper venoms drive the macrophages and hepatocytes to sequester and clear platelets: novel mechanism and therapeutic strategy for venom-induced thrombocytopenia.Arch Toxicol. 2021; 95: 3589-3599Crossref PubMed Scopus (4) Google Scholar,4De Queiroz M.R. de Sousa B.B. da Cunha Pereira D.F. et al.The role of platelets in hemostasis and the effects of snake venom toxins on platelet function.Toxicon. 2017; 133: 33-47Crossref PubMed Scopus (45) Google Scholar Owing to platelet sequestration and aggregation, antivenom should quickly reverse thrombocytopenia. However, with platelet destruction or consumption, levels would not increase until the patient could synthesize more platelets de novo. This patient may have had ongoing platelet consumption to repair venom-induced tissue damage, yet the authors did not describe the progression of cytotoxicity. The lack of fibrinogen trend also makes the inference of ongoing venom effect problematic. Rattlesnake antivenom is best suited not to resolve thrombocytopenia but to reverse defibrination, so the significance of persistent thrombocytopenia in the absence of fibrinogen levels is unclear.5Dudley S. Smelski G. Massey D.J. et al.Fashionably late: A characterization of late coagulopathies in rattlesnake envenomations between Fab and F (ab’) 2 antivenoms.Toxicon. 2022; 212: 49-54Crossref Scopus (0) Google Scholar Twenty-three years of unpublished data from the Arizona Poison and Drug Information Center shows that persistent thrombocytopenia after antivenom is common regardless of which of the two commercially available antivenoms is used (FabAV or F[ab’]2AV). Considering cases with thrombocytopenia during initial hospital stay, 197 of 556 (35.43%) FabAV patients and 39 of 107 (36.45%) F(ab’)2AV patients were discharged with a platelet count of < 150,000/μL. Some patients did not develop thrombocytopenia until after discharge. Among FabAV patients, 106 of 472 (22.46%) developed delayed thrombocytopenia compared with only 7 of 130 (5.38%) F(ab’)2AV patients. Similar rates of persistent thrombocytopenia in the inpatient setting suggest that destruction of platelets occurs in some patients regardless of antivenom manufacturer. The difference in delayed thrombocytopenia suggests that the longer half-life of F(ab’)2AV continues to protect against thrombocytopenia compared with FabAV. Finally, the authors did not provide an illustration of the patient’s overall clinical picture throughout his hospital stay, including progression of edema, pain, and coagulation factors. Isolated thrombocytopenia is not an indication to provide more antivenom as bleeding due to thrombocytopenia is unlikely if there is no defibrination. A patient with stabilization of other indicators, despite persistent thrombocytopenia, has had an adequate response to antivenom. As always in medicine, treat the patient, not the number.

Role of drug information centre in detecting medication errors in a tertiary care hospital, central region, Saudi Arabia.

To identify the incidence of medication error in a tertiary care hospital and to document the role of drug information centre to prevent such errors. The retrospective cross-sectional study was conducted at the Security Forces Hospital, Riyadh, Saudi Arabia, and comprised review of secondary data collected from the Drug Information Centre from March 2013 to February 2016. The errors were categorised as under-prescribing, dispensing, administrating and transcription, while the received inquiries were classified according to the inquirer; physicians, pharmacists and nurses. The score was given according to the Grade of Severity scale. Data was analysed using IBM SPSS Statistics for Windows, version 20. Armonk, NY: IBM Corp. Categorical variables were presented as frequency and percentage. Among the 2800 drug-related inquiries received, 238(8.5%) medication errors were detected. The inquirers of these queries included 108(45.4%) nurses. Administration errors were the highest 113(47.5%), while the least were transcription errors 31(13%). Majority of errors were committed by nurses 113(47.5%). Grade 2 errors were the most common 86(36.10%), while grade 4 life-threatening errors were minimal 2(0.8%). There were significant differences in the number of received questions based on the specialty (p˂0.05), staff having committed the error (p˂0.01) and the type of errors detected (p˂0.01). The prevalence of medication errors committed by healthcare providers was high.

Effectiveness and Process Evaluation of Using Digital Health Technologies in Pharmaceutical Care in Low- and Middle-Income Countries: A Systematic Review of Quantitative and Qualitative Studies.

Introduction: Digital health technology (DHT) has the potential to enhance remote health care delivery. However, little is known about the effectiveness of DHTs and factors that contribute to the limited uptake of DHTs in low- and middle-income countries (LMICs). Therefore, the objective of this study was to systematically review the effectiveness and evaluation process concerning the use of DHTs in pharmaceutical care in LMICs. Methods: A literature search on PubMed and Embase was conducted to identify experimental, descriptive, qualitative, and mixed-method studies that focused on the use of DHTs in pharmaceutical care as the main intervention, reported on the effects and/or the process of the DHT intervention, were performed by pharmacists, were conducted in LMICs, and had been published in English. Two reviewers independently conducted the study selection process. A qualitative narrative review of the effectiveness of using DHTs was conducted evaluating the population, intervention, comparators, and outcomes. We summarized the content and identified themes of the evaluation process under two categories-challenges and opportunities. Results: The search produced 589 studies, of which 16 met the eligibility criteria. The most common type of DHT was mobile health application (mHealth app; n = 8), followed by mobile phone call (n = 6) and mobile video call (n = 2). Eight studies assessed the effectiveness of using DHTs in pharmaceutical care. mHealth app, mobile phone call, mobile video call, text messages, home telemonitoring, and internet-based drug information centers improved some health-related outcomes. Two of these eight studies, however, did not find significant effects of a phone call or an mHealth app on certain health-related outcomes. Of the seven quantitative studies conducting a process evaluation, all showed that patients were satisfied with the use of DHTs in pharmaceutical care provided by pharmacists. Of the two mixed-methods and one qualitative study assessing the process evaluation concerning DHT usage, three distinct themes of challenges (patient-, DHT-, and health care system-related challenges) and opportunities (patient-, DHT-, and pharmacist-related opportunities) were identified. Conclusions: DHT is a promising approach in pharmaceutical care toward improving health-related outcomes in LMICs, despite the variable intervention effects. The challenges and opportunities identified are important considerations when developing and implementing DHTs in pharmaceutical care in LMICs.