Essential Medications Research Articles

EMCREG-International Multidisciplinary Consensus Panel on Management of Hyperkalemia in Chronic Kidney Disease (CKD) and Heart Failure.

Hyperkalemia, generally defined as serum potassium levels greater than 5.0 mEq/L, poses significant clinical risks, including cardiac toxicity and muscle weakness. Its prevalence and severity increase in patients with chronic kidney disease (CKD), diabetes mellitus, and heart failure (HF), particularly when compounded by medications like Angiotensin converting inhibitors, Angiotensin receptor blockers, and potassium sparing diuretics. Hyperkalemia arises from disruptions in potassium regulation involving intake, excretion, and intracellular-extracellular distribution. In CKD and acute kidney injury, these regulatory mechanisms are impaired, leading to heightened risk. The management of chronic hyperkalemia presents a challenge due to the necessity of balancing effective cardiovascular and renal therapies against the risk of elevated potassium levels. The emergency department management of acute hyperkalemia focuses on preventing cardiac complications through strategies that stabilize cellular membranes and shift potassium intracellularly. Chronic management often involves dietary interventions and pharmacological treatments. Pharmacological management of acute hyperkalemia includes diuretics, which enhance kaliuresis, and potassium binders such as patiromer and sodium zirconium cyclosilicate (SZC), which facilitate fecal excretion of potassium. While diuretics are commonly used, they carry risks of volume contraction and renal function deterioration. The newer potassium binders have shown efficacy in lowering chronically elevated potassium levels in CKD and HF patients, offering an alternative to diuretics and other older agents such as sodium polystyrene sulfonate , which has significant adverse effects and limited evidence for chronic use. We convened a consensus panel to describe the optimal management across multiple clinical settings when caring for patients with hyperkalemia. This consensus emphasizes a multidisciplinary approach to managing hyperkalemia, particularly in patients with cardiovascular kidney metabolic (CKM) syndrome, to avoid fragmentation of care and ensure comprehensive treatment strategies. The primary goal of this manuscript is to describe strategies to maintain cardiovascular benefits of essential medications while effectively managing potassium levels.

ESMO Global Consortium Study on the availability, out-of-pocket costs, and accessibility of cancer medicines: 2023 update.

The availability and affordability of safe, effective cancer therapies are core requirements for effective cancer control. Global disparities exist in access, however, yielding unequal cancer outcomes. The goal of this study was to provide updated data regarding the formulary availability, out-of-pocket costs, and accessibility of cancer medicines in countries across the full spectrum of economic development areas. This study was conducted through an online survey based on a previously validated methodology. It evaluated the formulary availability, out of pocket costs, and actual accessibility of essential generic cancer medication commonly used for a wide range of cancers, including those on the 22nd WHO Model List of Essential Medicines (EML), and cancer medications used in eight high-incidence cancers. A total of 853 field reporters from 170 countries were invited to participate. The collected data were collated and peer-reviewed on the ESMO website, with final adjustments made accordingly. Data were collected by 317 reporters and 231 peer reviewers across 126 countries. The study revealed that patients in most high-income countries can access cancer medications without significant out-of-pocket expenditure, including novel treatments with high ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores. Conversely, in lower-middle and low-income countries, 40% of traditional chemotherapy agents deemed essential in the WHO EML are only available at full cost to patients. This dataset provides a new and updated 'Global Reference' to enhance accountability for inequalities in access and availability of cancer medicines and to identify challenges and shortcomings to drive public health policies and positively impact national cancer control planning.

Process evaluation of quality of precancerous cervical lesion screening program in selected public health centers in Addis Ababa, Ethiopia.

Cervical cancer is the second most prevalent disease among Ethiopian women of reproductive age and a serious gynecological malignancy affecting women regionally. About, 3235 deaths and 4648 new cases are reported nationwide each year. Precancerous cervical screening programs face many difficulties in settings with limited resources, despite their severity, such as a lack of medical supplies and equipment, poorly trained healthcare workers, a heavy workload for current staff, low professional compliance, and insufficient support from medical facilities. Furthermore, the quality of screening services is not well-supported by data in many places, which makes efforts to enhance these programs even more difficult. Improving service quality and customer satisfaction requires an understanding of the accessibility of critical screening tools and the skill of healthcare providers. Hence, this study aims to evaluate the process quality of the pre-cancerous cervical lesion screening program at selected public health centers in Gulele sub-city, Addis Ababa, Ethiopia. A case study design involving both quantitative and qualitative methods was conducted from April 09 to May 10, 2022. The study was conducted based on clinical guidelines and previously published evidence in peer-reviewed journals. A total of nine (n = 9) public health centers were involved in the study. A total of 223 study participants for service program evaluation. For the qualitative study, 12 key informants were interviewed at exit consecutively. Additionally, resource inventory and record review were conducted. Data were analyzed using SPSS for Windows version 25. Multi-variate logistic regression was used to check the association between the outcome and independent variables. Multivariate logistic regression was analyzed when the p-value was less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical significance at p-value < 0.05. Qualitative data were analyzed manually by summarizing into a key thematic area. The evaluation findings were interpreted based on a predetermined judgment matrix with stakeholders during the evaluability assessment. From quality perspectives, study found that, pre-cancerous cervical lesion screening service concerning program resource availability was measured to be 80 %, which was good. In terms of satisfaction, the study found that 88 % of clients were satisfied with the precancerous cervical lesion screening service provided by health centers. Occupational status of a government employee (AOR: 0.04; 95 % CI: 0.003,0.63), educational status with no formal education (AOR: 0.04; 95 %CI: 0.006, 0.23), long-term use of contraceptives (AOR: 3.70; 95 %CI: 1.34, 10.21), and having multiple children up to three (AOR: 3.27; 95 %CI: 1.3, 9.44) were significantly associated factors with client satisfaction on screening services for precancerous cervical. However, while the overall program implementation scored 78.67 %, categorized as good, certain areas require improvement. Compliance with national guidelines among healthcare professionals were rated at 74 %, indicating a need for enhanced adherence to established standards. Qualitative findings revealed that trained providers often handle multiple responsibilities, leading to service quality challenges due to overburdening. Additionally, financial constraints hinder the availability of essential equipment and medications, posing significant barriers to effective service delivery. In conclusion, although the level of satisfaction with service provision was good and the overall quality of service was acceptable. However, the availability of necessary resources and compliance of health care providers to national guidelines need improvement. We recommend more efforts be exerted on improving providers' compliance and availing of necessary resources to enhance the status of pre-cancerous cervical cancer screening services.

Sacubitril/Valsartan and Dapagliflozin in Patients with a Failing Systemic Right Ventricle: Effects on the Arrhythmic Burden.

Background/Objectives: Angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are essential medications in heart failure (HF) therapy, and their potential antiarrhythmic effects have been reported. Recently, ARNI and SGLT2i use for HF in adult congenital heart disease (ACHD) has been studied. However, whether any beneficial effects may be achieved on the arrhythmic burden in the complex population of ACHD with a systemic right ventricle (sRV) is still to be determined. Methods: We retrospectively collected all significant arrhythmic events from a cohort of patients with a failing sRV attending our tertiary care center on optimal guideline-directed medical therapy (GDMT) with ARNI and/or SGLT2i. Results: A total of 46 patients (mean age 38.2 ± 10.7 years, 58% male) on sacubitril/valsartan were included. Twenty-three (50%) patients were also started on dapagliflozin. After a median follow-up of 36 [Q1-Q3: 34-38] months, arrhythmic events occurred globally in 13 (28%) patients. Survival analysis showed significant reduction of clinically relevant atrial and ventricular arrhythmia at follow-up (p = 0.027). Conclusions: Our findings suggest that GDMT including sacubitril/valsartan and dapagliflozin may also offer an antiarrhythmic effect in ACHD patients with a failing sRV, by reducing the incidence of arrhythmic events at follow-up.

Pharmaceutical Resilience

Supply chain resilience involves creating diverse and redundant sources for raw materials, optimizing logistics, and employing advanced forecasting techniques to anticipate and mitigate potential shortages. Manufacturing resilience focuses on adopting scalable and adaptable production technologies, enhancing quality control measures, and establishing contingency plans for production disruptions. Regulatory resilience entails the capacity to navigate and comply with evolving regulatory landscapes swiftly, fostering collaborations with regulatory agencies to expedite approval processes during emergencies. Innovation and research resilience are crucial for sustaining drug development and responding to emerging health threats. This involves investing in cutting-edge technologies, fostering partnerships for collaborative research, and maintaining a pipeline of new therapies and treatments. Pharmaceutical resilience also requires effective communication and coordination among stakeholders, including pharmaceutical companies, healthcare providers, governments, and international organizations. By enhancing these components, the pharmaceutical sector can better withstand and recover from disruptions, ensuring continuous access to essential medications and safeguarding public health. This abstract emphasizes the multifaceted approach needed to build and sustain resilience within the pharmaceutical industry, ensuring its capacity to meet both current and future challenges effectively. Keywords: Supply Chain Management, Regulatory Framework, Research and Development (R&amp;D), Manufacturing Capabilities, Healthcare System Integration, Innovation

Drone-based medical delivery in the extreme conditions of Himalayan region: a feasibility study

IntroductionUnmanned aerial vehicles, or drones, have emerged as versatile tools across various sectors, including defence, agriculture, surveillance, mining, infrastructure, emergency response, transportation, geospatial mapping and notably medical supply delivery to...

Integration of Palliative Care into Primary Care: A Collaborative Effort Between the Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine

India staggers at the 59th position (out of 81 countries globally) in the quality of death and dying index. A chronic life-threatening illness is often complicated by marginalized living, out-of-pocket health expenditure, illiteracy, and poor social support, and pushes the population further into the vicious spiral of suffering. The Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine joined hands in April 2023 to address the gap in the demand and availability of palliative care and proposed to empower Community Medicine physicians to provide primary palliative care. They put forth recommendations for education, service, and research developments in primary palliative care. In April 2023, the Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine joined hands to disseminate palliative care services to the community. Subsequently, a task force comprising faculties from Palliative Medicine and Community Medicine was formed. The position paper on primary palliative care jointly published by the Indian Association of Palliative Care and the Association of Family Physicians of India provided the framework for this position paper. The paper focused on education, service development, and research. The task force recommended the following: 1. Empower faculties and residents of the Department of Community Medicine, undergraduate students from medical and allied specialties posted to the department to provide primary palliative care. 2. Integrate palliative care into outpatient clinics (general OPDs in the hospital), community health centers, and home care as a part of the family adoption program. 3. Improve access to essential medications, including opioids, in urban and rural areas 4. Follow the recommendations of the National Health Policy 2017 to develop blended training programs for faculties and students. 5. Engage the community to identify patients with chronic life-threatening illnesses and allocate resources to support patients at home. 6. Collaborate to develop a protocol for regular audits and research for service improvisation.

Using Vesicular Stomatitis Virus as a Platform for Directed Protease Evolution.

Antiviral drugs are essential medications to save the lives of infected people. However, they are under constant threat to become ineffective as viruses evolve quickly. Studying the development of resistance is therefore paramount to understand the impact of mutations on pharmacological treatment and to make informed decisions. Yet, such studies are open to scrutiny, as they are considered gain-of-function research, which is especially problematic with viruses of pandemic potential. In this article, we present a protocol that allows for the selection of antiviral resistance mutations safely, without using the actual virus (e.g., SARS-CoV-2, MERS-CoV). Instead, we use vesicular stomatitis virus (VSV) that serves as a surrogate virus; like other RNA viruses, it is prone to mutations due to its polymerase lacking proofreading. By replacing parts of the VSV genome with transgenes from other viruses, VSV becomes dependent on their function. Thus, we can mount a selection pressure with antivirals targeting the transgenes to subsequently sequence selected resistance mutations. This article provides a protocol for this process as well as a sequencing pipeline that we used to collect mutations. © 2024 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol: Using VSV as a platform for directed protease evolution Alternate Protocol: Dose response assay with TCID50 readout Support Protocol 1: A pipeline for high-throughput VSV sequencing Support Protocol 2: Rescue of VSV.

Barriers to and Facilitators of Buprenorphine Dispensing for Opioid Use Disorder: Evidence from Focus Groups in Appalachian Kentucky

As efforts to increase buprenorphine prescribing continue to intensify, pharmacy dispensing plays an important role in access to essential medications for opioid use disorder. Existing survey research suggests stigma and regulatory concerns are barriers to pharmacists dispensing buprenorphine, but facilitators are less clear, as are in-depth perceptions of pharmacists regarding buprenorphine. To assess barriers and facilitators to buprenorphine dispensing in Appalachian Kentucky using a series of focus groups with pharmacy employees. Between September and October 2023, five structured focus groups were conducted with a total of 19 pharmacists and pharmacy technicians across a mixture of high- and low-buprenorphine-dispensing counties. Investigators independently coded focus group transcriptions using a grounded theory approach to describe current dispensing practices as well as barriers to and facilitators of buprenorphine dispensing. Most participants described dispensing buprenorphine, but there was substantial variation in dispensing practices. Participants identified patient-, provider-, pharmacy-, regulatory-and medication-related barriers to and patient-, provider-, pharmacy-, and regulatory-related facilitators of pharmacy dispensing. Patient- and provider-related barriers accounted for over half of barriers identified. The most common facilitators were also patient- and provider-related. In a series of 5 focus groups with pharmacy staff in Appalachian Kentucky, the most common barriers to buprenorphine dispensing were patient and provider behaviors. Patient stories were the most common facilitators. Interventions to increase pharmacy buprenorphine dispensing should focus on addressing misperceptions regarding behavior, preferably driven by positive patient testimony.

Update in Asthma Management in Low-Middle Income Countries.

Asthma represents a significant global health burden, particularly in low and middle income countries (LMICs), where its impact is disproportionately severe. In these regions, asthma management is characterized by poorer control and greater mortality rates compared to wealthier nations. The prevalence of asthma is on the rise and demographic trends indicate that there would be a greater burden on children given that they represent a larger proportion of the population pyramid in LMICs. Challenges in addressing asthma in LMICs are various, amongst them: health care systems in these countries predominantly focus on acute and infectious diseases, leading to inadequate attention to chronic illnesses. Access to essential controller medications (inhaled corticosteroids) is often limited and availability tends to fluctuate. Infraestructural deficiencies and difficult health care access are also identified barriers. Furthermore, many LMICs struggle to meet the World Health Organization's (WHO) guidelines that are set for a minimum standard of care for asthma treatment. Suggested approaches should be aimed at: foment commitment from local health care providers and governmental involvement on policies to meet minimum standards of care (emphasis on continuous access to controller medications) Equally significant is the implementation of policies designed to augment educational strategies (health care professionals and general population), reduce smoking rates and air pollution.

Prevalence and Epidemiology of Diabetes in West Africa: Trends and Challenges

Diabetes mellitus (DM) has emerged as a major public health concern in West Africa, marked by a notable rise in prevalence due to rapid urbanization, lifestyle changes, and socioeconomic factors. This review examines the current epidemiology of diabetes in the region, discussing key trends, risk factors, and the socioeconomic determinants contributing to its rising prevalence. Urbanization has led to sedentary lifestyles and increased consumption of energy-dense diets, significantly raising Type 2 diabetes cases. Epidemiological analysis shows that factors such as genetic predispositions, obesity, and socioeconomic disparities impact diabetes risk and management. Diabetes management faces numerous challenges, including limited healthcare infrastructure, low public awareness, and financial barriers that hinder access to essential care, diagnostics, and medications. Addressing this growing crisis requires a multifaceted approach, involving improved healthcare systems, targeted awareness campaigns, and socioeconomic support to foster early detection and promote healthier lifestyle choices. This review emphasizes the urgency for collaborative efforts to mitigate the diabetes burden and improve outcomes for affected populations in West Africa. Keywords: Diabetes mellitus, West Africa, prevalence, epidemiology, Type 2 diabetes, public health, urbanization.

Qualitative discrimination of low-dose oral contraceptives and identification of environmentally stressed tablets: Comparing a handheld near infrared spectrometer to a benchtop spectrometer

Levonorgestrel – ethinyl estradiol tablets (Levo-EE) are an essential medication provided through global health supply chains for family planning purposes. Ensuring the quality of Levo-EE and other essential medications in a global supply chain is a primary concern. Portable and handheld diffuse reflectance spectrometers have become more approachable from a cost and usability perspective in recent years. A discriminatory screening method with a handheld near infrared (NIR) spectrometer (900 – 1700 nm) differentiating between brands of Levo-EE and placebos has been constructed. Additionally, the handheld spectrometer was used to determine if environmentally stressed tablets could be identified and differentiated in a qualitative screening method. The same samples were scanned on a benchtop diffuse reflectance NIR spectrometer as well (350 – 2500 nm) for comparison. Brands of oral contraceptives were able to be discriminated by applying a Mahalanobis distance-based classification approach to the handheld spectrometer, though be it at a slightly lower level of discernability due to the reduced spectral range collected. Environmentally stressed samples were applied to the classification model, which were flagged as unlike the reference dataset. Spectra from the environmentally stressed tablets saw an increase in absorbance for water associated peaks with the benchtop spectrometer at approximately 1450 nm and 1949 nm for tablets stored at 30, 40, and 50°C–54°C. Data collected by the handheld showed that the spectrometer offers a low-cost screening approach to oral contraceptive tablets containing two low-dose active ingredients. The handheld spectrometer was also able to flag environmentally stressed samples. The total model accuracy for the target product (brand “A”; N = 560) was above 98% for both benchtop and handheld spectrometers. While these results focus on oral contraceptives, a similar approach could be conducted for other solid dosage tablets for more approachable quality compliance screening.

“They are trying their best”: incarcerated individuals’ assessment of general healthcare services in selected Ghanaian prisons

BackgroundThe World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals’ perspectives and opinions on the general healthcare services in Ghanaian prisons.MethodsUtilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework – service delivery, health workforce, access to essential medicines, and leadership and guidance – were applied deductively to organise the data into themes and subthemes.ResultsFour themes were generated from the analysis: “Health service delivery”, “Health workforce in prisons”, “Access to essential medicines” and “Leadership; regulating healthcare services”. Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners’ perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals’ perceptions of the quality of health care.ConclusionsIncarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.

From affordable to accessible: How the pharmaceutical industry transformed patient consumers into charity recipients

Recent changes in healthcare pricing and financing have resulted in patients paying more out of pocket for their healthcare. As a result, more patients with insurance are being priced out of essential or desired medications. Pharmaceutical companies have responded by offering financial assistance programs for patients. Medical sociologists have productively used the concept of consumerism to describe the effects of markets on the provision of healthcare. But in this current context where financial assistance programs are increasingly important for patients seeking prescription drugs, what are the implications for medical sociological theories of patient consumerism? I use medical and economic sociology theories to analyze pharmaceutical executive testimonies in 34 federal US Congressional hearing transcripts prices from 1959 to 2020. Congressional testimony offers an ideal window into how these executives justify their prices and describe the implications for patients downstream in the healthcare system. I find that executives initially justified prices as fair and drugs as cost-effective because medications were an affordable form of healthcare. However, as drug prices rose, executives abandoned affordability arguments and instead argued drugs were accessible to patients though pharmaceutical company run financial assistance programs. Findings contribute to medical sociology by theorizing a system of corporate charity as the next phase of the capitalist US healthcare system and demonstrates how elite market actors (re)define downstream categories of consumers.

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

A model for integrating palliative care into Eastern Mediterranean health systems with a primary care approach

Background and aimsPalliative care in the Eastern Mediterranean Region (EMR) faces challenges despite the high number of patients in need. To provide accessible, affordable, and timely services, it is crucial to adopt a suitable care model. World health organization (WHO) recommends integrating palliative care with primary health care (PHC). Given the unique conditions of EMR countries, there is a need to design a model tailored to these contexts.MethodsThis study is a multi-method research project conducted through several sub-studies, including a literature review, policy analysis, expert opinion (Delphi Method), dimension-specific analysis, model development, and its validation and refinement (Delphi Method). Drawing from the WHO model, six dimensions: policy, drug availability, education, community integration, service delivery, and research were considered to developing the model and implementation requirements. Within each dimension, evidence-based solutions tailored to the region’s context were explored.ResultsA successful palliative care model requires, in the policy dimension, oversight by the Ministry of Health (MOH). Having a focal-person or working group within the MOH is crucial for policy-making, formulation, and approval of clinical guidelines, as well as addressing care challenges. It is essential to provide access to morphine and other essential medications, along with facilitating the administration and consumption of morphine at home. Conducting empowerment courses for care providers, can address various challenges. Community involvement through volunteers, charities, and non-governmental organizations (NGOs) is also important. To ensure service provision, monitoring and evaluating systems are crucial, along with striving for service continuity through an appropriate payment system. Lastly, research is necessary for needs assessment, evidence-based practice, and designing evaluation indicators. The proposed model relies on community health workers, especially nurses, as multitasking professionals available for community palliative care. In the presented model, special attention has been given to networking, collaboration, and the use of digital health technologies to support nurses.ConclusionThe model proposed for integrating palliative care into PHC should serve as a framework that enhances access to available and affordable services for countries in the region. While this model was developed based on the overall conditions of the region, each country can tailor it to its unique strengths and opportunities.

Patient privacy and the need for private consultation areas in Kuwait’s polyclinic pharmacies

Abstract Introduction In Kuwait, pharmacists provide essential medication counseling and education. However, the open layout of polyclinic pharmacies often compromises patient privacy, deterring individuals from seeking necessary consultations. Objective This study aims to assess how patients perceive the level of privacy in Kuwait’s polyclinic pharmacies and evaluate patients’ need for a private consultation area. Method A cross-sectional study was conducted among patients at polyclinic pharmacies in Kuwait. Convenience sampling was used to select the polyclinics. Patients were approached after collecting their medications and invited to participate in the study. Those who consented completed a questionnaire that included sections on demographics, six items assessing the privacy construct, four items evaluating the need for a consultation area, and an open-ended question for additional comments. Ethical approval was obtained from the Human Ethical Committee, Health Sciences Center, Kuwait University. Results The study included 210 participants, with a majority residing in the Capital Governorate (55.2%), and being female (70%). The median age was 43 years old (IQR=29-55). Over two-thirds of the participants held a university degree (69%). Most participants were collecting medication for themselves (83.8%), and were exempt from fees (84.3%). When measuring patients’ privacy satisfaction, a score was calculated and a scale was divided into good to excellent (24 - 30), fair (18 - 23), and poor (6 -17). In addition, when measuring the need for a private consultation area score, a scale was divided into high need (16-20), fair need (12-15), and no need (4-11). Regarding perceived privacy, only 20% of participants had a good to excellent score, while 41.9% had a fair score and 38.1% had a poor score. When asked about the need for a private consultation room, 63.8% expressed a high need, while 15.2% believed it was unnecessary. Participants who had lower privacy scores reported a higher need for private consultation areas. Discussion The findings provide valuable insights into patient perspectives and highlight the necessity of improving pharmacy practices in Kuwait. Enhancing privacy in pharmacies could significantly improve the public’s perception of pharmacists as essential healthcare providers. However, several limitations should be noted. The sample is not representative of the population, as the proportion of non-Kuwaiti participants is less than the actual population ratio. Consequently, the results cannot be generalized to the entire population. Future studies should aim for a more representative sample and consider a longer data collection period to address these limitations. Conclusion The results of this study reveal that a significant number of patients perceive privacy in Kuwait's polyclinic pharmacies as fair, with many expressing a strong need for private consultation areas. These findings underscore the importance of enhancing privacy measures in these settings1. Implementing private consultation rooms in polyclinic pharmacies could greatly improve patient satisfaction and the overall quality of healthcare services provided by pharmacists. Reference 1. Waheedi S, Marshall V, Alharbia H, Farris KB. Patients’ perceptions of privacy and the need for a private consultation area in community pharmacy. Poster Abstracts. International Journal of Pharmacy Practice. 2016;24:33–60

Prostaglandin use in broodmares. Part 2: other applications in reproduction

Prostaglandins are essential medications used in equine reproduction, and the author has explored physiology, safety and some clinical applications in the first of this two-part article series. This second part focuses on reported applications of prostaglandins in other areas of reproduction related to the broodmare. These include termination of pregnancy and examining protocols to be used depending on the stage of gestation. Infertility and treatment related to presumed oviductal blockage, foal fostering and treatment of foal rejection are described. This article also examines the effects of prostaglandins on the uterus and cervix, and their possible uses in clinical practice relating to uterine fluid accumulation and infection. The uses of prostaglandins in broodmare reproduction are numerous, although the mechanism of effect is not always clear and, in some cases, scientific evidence can be inconclusive. However, they still represent one of the most frequently used drugs in this subspecialty.

Readiness of primary healthcare and community markets for joint delivery of cardiovascular disease prevention services in Kenya: an observational feasibility study of Health Kiosks in Markets (HEKIMA)

ObjectivesThe increasing burden of cardiovascular diseases (CVDs) in Kenya threatens its healthcare system. There is a need for innovative models that improve equitable access to CVD prevention services. Community markets...

Evidence That Regulatory And Market Forces Are Driving Adoption Of Biosimilars.

Biosimilars present a key opportunity to contain the growing cost of biologic drug spending and to make essential medications more affordable. However, the lackluster performance of the US biosimilar market in its first decade was met with disappointment and concern for its future viability. To evaluate the evolution of the biosimilar market, we reviewed key distinctions in medication classes and the financial stakeholders involved in each. Within this context, we examined recent evidence that suggests that the maturing postapproval biosimilar marketplace is flourishing. The entry of biosimilars for adalimumab offers a case study demonstrating these recent market and policy dynamics. Building on recent gains, policy makers could take additional steps to accelerate biosimilar adoption through both payment and regulatory policy levers.