International Pharmaceutical Research Articles

Adherence to treatment for polycystic ovarian syndrome: A systematic review.

BackgroundPolycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders of women of reproductive age. Treatment plans for this chronic condition frequently include long-term use of a combination of medication and lifestyle interventions. However, treatment outcomes are dependent on adherence to treatment regimens. This study aimed to systematically review the literature for reported adherence to treatments for PCOS.MethodsA systematic search of Embase, Cochrane, PubMed, CINAHL, PsychINFO, SCOPUS, and International Pharmaceutical s from inception until January 2019 utilizing the terms PCOS, adherence, and patient compliance was conducted. A total of 179 possible articles were identified.ResultsFourteen articles reporting adherence data were included in the review. Self-report was the most commonly reported method of measuring adherence. Adherence to lifestyle interventions, such as prescribed diets and physical activity, was reported in ten studies and adherence to medications was reported in seven studies, with some reporting both.ConclusionsMinimal data are available regarding factors associated with adherence in patients with PCOS. Diverse methods of adherence assessment are utilized. Future studies of PCOS treatments should effectively assess and report adherence data as it is essential to evaluating the effectiveness of PCOS treatments and is critically needed to guide clinician efforts to facilitate optimal outcomes for patients.

Penicillin Skin Testing, Challenge, and Desensitization in Pregnancy: A Systematic Review

This study sought to evaluate available evidence of the safety of penicillin skin testing (PST), challenge, and desensitization in pregnancy, with efforts to improve perinatal care for patients with a penicillin allergy history and mitigate the negative sequelae of unverified penicillin allergy labels. A systematic review of studies was conducted using Cochrane Library, Medline, EMBASE, and International Pharmaceutical Abstracts. Included were peer-reviewed studies without date restrictions, published in English or French, relating to PST, challenge, or desensitization in pregnancy. Editorials, opinion pieces, and letters were excluded. Review authors independently screened citations and full-text articles, extracted data, and conducted quality assessment. Given the heterogeneity of study designs, a narrative synthesis was conducted. The search identified 1195 references, of which 18 studies met inclusion criteria. In total there were 231 patients with varying histories of penicillin allergy, the majority requiring treatment for syphilis or group B streptococcal (GBS) disease during pregnancy. Of the 203 participants who underwent PST, 83.7% had negative test results. Allergy-related reactions were rare in PST (1.5%) and challenge (0%), and although these reactions were more common in desensitization (19.7%), most were benign. Among the 231 cases, only one adverse pregnancy outcome was reported (0.4%). This review demonstrates that the known prevalence of true penicillin allergy extends to pregnant women. PST and desensitization can be safely applied during pregnancy and are tools that should be used more frequently. Further data on the safety of challenge during pregnancy are recommended.

Efficacy and Safety of Tapentadol Immediate Release for Acute Pain: A Systematic Review and Meta-Analysis.

Tapentadol (TAP) immediate release (IR) is a newer opioid option for acute pain. The aim of this systematic review was to examine the efficacy and safety of TAP IR compared with other opioids for acute pain. A systematic literature search as conducted using the Cochrane Library, Embase, International Pharmaceutical Abstracts, MEDLINE, PubMed, and Web of Science. The search included all randomized controlled trials and observational studies examining TAP IR versus other orally administered IR opioids for acute pain. The protocol for this study was registered on PROSPERO (CRD42018110267). Thirteen studies and 1 abstract were included in the systematic review (n=12,814 patients). Of these, 5 studies and 1 abstract were included in the qualitative review (n=9108 patients). Eight randomized controlled trials (n=3706 patients) comparing 50 to 100 mg TAP IR versus 5 to 15 mg oxycodone IR were included in the meta-analysis. The lowest dose of TAP IR (ie, 50 mg) was associated with less pain control compared with oxycodone IR (standardized mean difference=0.25, 95% confidence interval: 0.06-0.44, P<0.01). However, there were no significant differences at higher doses (ie, 75, 100 mg, or when a titration strategy was used). In the qualitative analysis, pain control with TAP IR was also similar to morphine IR and tramadol IR. TAP IR was less likely to have gastrointestinal adverse effects such as nausea and constipation compared with other opioids. TAP IR is as effective as other opioids at higher doses for acute pain and is associated with fewer gastrointestinal adverse effects. On the basis of these findings, TAP IR can be considered as a first-line opioid for acute pain.

Resveratrol for adults with type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is a chronic disorder that is characterised by insulin resistance and hyperglycaemia, which over time may give rise to vascular complications. Resveratrol is a plant-derived nutritional supplement shown to have anti-diabetic properties in many animal models. Less evidence is available on its safety and efficacy in the management of T2DM in humans. To assess the efficacy and safety of resveratrol formulations for adults with type 2 diabetes mellitus. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts, as well as the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. The date of the last search was December 2018 for all databases. No language restrictions were applied. All randomised controlled trials (RCTs) comparing effects of oral resveratrol (any dose or formulation, duration, or frequency of administration) with placebo, no treatment, other anti-diabetic medications, or diet or exercise, in adults with a diagnosis of T2DM. Two review authors independently identified and included RCTs, assessed risk of bias, and extracted study-level data. Study authors were contacted for any missing information or for clarification of reported data. We assessed studies for certainty of the evidence using the GRADE instrument. We identified three RCTs with a total of 50 participants. Oral resveratrol not combined with other plant polyphenols was administered at 10 mg, 150 mg, or 1000 mg daily for a period ranging from four weeks to five weeks. The comparator intervention was placebo. Overall, all three included studies had low risk of bias. None of the three included studies reported long-term, patient-relevant outcomes such as all-cause mortality, diabetes-related complications, diabetes-related mortality, health-related quality of life, or socioeconomic effects. All three included studies reported that no adverse events were observed, indicating that no deaths occurred (very low-quality evidence for adverse events, all-cause mortality, and diabetes-related mortality). Resveratrol versus placebo showed neutral effects for glycosylated haemoglobin A1c (HbA1c) levels (mean difference (MD) 0.1%, 95% confidence interval (CI) -0.02 to 0.2; P = 0.09; 2 studies; 31 participants; very low-certainty evidence). Due to the short follow-up period, HbA1c results have to be interpreted cautiously. Similarly, resveratrol versus placebo showed neutral effects for fasting blood glucose levels (MD 2 mg/dL, 95% CI -2 to 7; P = 0.29; 2 studies; 31 participants), and resveratrol versus placebo showed neutral effects for insulin resistance (MD -0.35, 95% CI -0.99 to 0.28; P = 0.27; 2 studies; 36 participants). We found eight ongoing RCTs with approximately 800 participants and two studies awaiting assessment, which, when published, could contribute to the findings of this review. Currently, research is insufficient for review authors to evaluate the safety and efficacy of resveratrol supplementation for treatment of adults with T2DM. The limited available research does not provide sufficient evidence to support any effect, beneficial or adverse, of four to five weeks of 10 mg to 1000 mg of resveratrol in adults with T2DM. Adequately powered RCTs reporting patient-relevant outcomes with long-term follow-up periods are needed to further evaluate the efficacy and safety of resveratrol supplementation in the treatment of T2DM.

Healthcare-related factors affecting the management of HIV infected patients: a systematic review of qualitative evidence.

Human immunodeficiency virus (HIV) infection is a major health concern that is associated with high mortality and socioeconomic burden on both patients and healthcare authorities. This systematic review aimed to qualitatively explore the healthcare-related factors influencing the management of HIV in adult patients. Seven online databases (PubMed, Embase, Google Scholar, CINAHL, PsycInfo, PsycExtra, and International Pharmaceutical Abstract) were searched. Articles published in English language between September 2000 and September 2018 were eligible for inclusion. Quality assessment tool developed by the EPPI-Centre was used to assess the quality of the included studies. A cross-case thematic analysis was conducted using NVivo 10. A total of 30 studies were included in the review. The qualitative analysis identified four major themes influencing the management of HIV: awareness of healthcare professionals (HCPs), attitudes of HCPs, lack of healthcare infrastructure, and stigma associated with HIV. The findings of this review suggest that people living with HIV are at an increased risk of experiencing poor disease management due to various healthcare-related factors. HCPs and policy makers should acknowledge the presence of these factors with the aim of providing quality care to people living with HIV.

Utilising a content analysis approach to assess measurement tools used in the management of general feverish illness in children

Convention states that it is inappropriate to use tools that have not undergone validity and reliability testing in order to form conclusions on the topic they are assessing. The use of content analysis to aid in the profiling and retrieval of measurement tools may be useful to inform tool design. These analysis methods can be applied effectively to any topic area to streamline questionnaire development. The aim of this review was to demonstrate that the utilisation of a content analysis of instruments found in literature may be helpful to aid in the profiling and development of a measurement tool in fever. MEDLINE, EMBASE, CINAHL, PubMED, PsycINFO and International Pharmaceutical Abstracts were searched in accordance with PRISMA guidelines. Studies were included if they contained a structured or semi-structured measurement tool and a focus on fever management, knowledge or participant attitudes, beliefs or behaviours of fever. All items extracted were imputed into NVivo11 and a thematic content analyses based on themes and style of question were undertaken. A total of 99 manuscripts were reviewed containing 82 unique measurement tools. A total of 1525 items were content analysed in 3 separate content analyses including the fever 'theme', the style of question and whether the question was based on knowledge, attitudes, beliefs or behaviours. A large proportion of manuscripts (41/99) had no reported form of validity or reliability testing undertaken on the tool utilised in the study. The majority of items (n = 778) were attitude/belief questions, and the most common question types were Likert-Type Scale(n = 380) items. Through the methodology of undertaking content analyses of literature, it is possible to streamline the tool development process by incorporating previously established data and circumventing the creation of items from the ground up. This was apparent in this content analysis of fever management tools.

Systematic Review of l-glutamine for Prevention of Vaso-occlusive Pain Crisis in Patients with Sickle Cell Disease.

l-glutamine was approved by the U.S. Food and Drug Administration (FDA) for sickle cell disease (SCD) in 2017. A vaso-occlusive crisis (VOC) occurs in persons with SCD and is associated with acute pain episodes. This systematic review summarizes the evidence for l-glutamine in the prevention of VOC and associated pain in patients with SCD. Medline, Embase, and International Pharmaceutical Abstracts were searched for records reporting on l-glutamine use in persons with SCD. Eligibility criteria identified primary reports of investigations conducted in humans who were administered l-glutamine, reported on outcomes related to VOC or associated pain, published in English, and were available as full text. All relevant efficacy, safety, participant demographic data, and study method characteristics were extracted and documented. Risk-of-bias assessments were conducted using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool and the revised Cochrane risk-of-bias tool for randomized studies. Three studies assessing the effect of exogenous l-glutamine administration in patients with SCD met eligibility criteria: one prospective nonrandomized controlled study and two prospective randomized controlled trials. Rate of VOC and related hospitalizations were reduced in patients receiving l-glutamine, although some conflicting results were noted between studies. l-glutamine was generally well tolerated. Limitations of one or more of the eligible studies included small sample size, nonblinding, and study groups that differed at baseline. l-glutamine has limited high-quality evidence supporting its use. Although l-glutamine is FDA approved for the prevention of frequent episodes of VOC pain, only one randomized controlled trial has strong evidence to support this indication. Based on the results of a systematic review, l-glutamine may be considered for patients unable to receive hydroxyurea or in addition to hydroxyurea for reduction in VOC and associated pain.

Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis.

Background: Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental and neurological disorders, but there has been no definitive meta-analysis of data from studies to determine the pooled estimate of central nervous system (CNS) medicines use in aged care homes. We conducted this systematic review to summarize the use of CNS drugs among aged care home residents. Methods: MEDLINE, EMBASE, CINAHL, Scopus, and International Pharmaceutical s (IPA) databases were searched (between 1 January 2000 and 31 December 2018) to identify population-based studies that reported the use of CNS medicines in aged care homes. Pooled proportions (with 95% confidence interval), according to study location were calculated. Results: A total of 89 studies reported the use of CNS medicines use in aged care. The pooled estimate of CNS drug use varied according to country (from 20.3% in Ireland to 49.0% in Belgium) and region (from 31.7% in North America to 42.5% in Scandinavia). The overall pooled estimate of psychotropic medicines use was highest in Europe (72.2%, 95% CI, 67.1–77.1%) and lowest in the ANZ region (56.9%, 95% CI, 52.2–61.4%). The pooled estimate of benzodiazepines use varied widely, from 18.9% in North America to 44.8% in Europe. The pooled estimate of antidepressant use from 47 studies was 38.3% (95% CI 35.1% to 41.6%), with the highest proportion in North America (44.9%, 95% CI, 35.3–54.5%). Conclusion: The overall use of CNS drugs varied among countries, with studies from Australia New Zealand reporting the lowest use of CNS drugs. The criteria for prescribing CNS drugs in clinical practice should be evidence-based. The criteria should be used not to prohibit the use of the listed medications but to support the clinical judgement as well as patient safety.

Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis

BackgroundComparative effectiveness of early rheumatoid arthritis (RA) treatments remains uncertain.PurposeCompare benefits and harms of biologic drug therapies for adults with early RA within 1 year of diagnosis.Data SourcesEnglish language articles from the 2012 review to October 2017 identified through MEDLINE, Cochrane Library and International Pharmaceutical s, gray literature, expert recommendations, reference lists of published literature, and supplemental evidence data requests.Study SelectionTwo persons independently selected studies based on predefined inclusion criteria.Data ExtractionOne reviewer extracted data; a second reviewer checked accuracy. Two independent reviewers assigned risk of bias ratings.Data SynthesisWe identified 22 eligible studies with 9934 participants. Combination therapy with tumor necrosis factor (TNF) or non-TNF biologics plus methotrexate (MTX) improved disease control, remission, and functional capacity compared with monotherapy of either MTX or a biologic. Network meta-analyses found higher ACR50 response (50% improvement) for combination therapy of biologic plus MTX than for MTX monotherapy (relative risk range 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). No significant differences emerged between treatment discontinuation rates because of adverse events or serious adverse events. Subgroup data (disease activity, prior therapy, demographics, serious conditions) were limited.LimitationsTrials enrolled almost exclusively selected populations with high disease activity. Network meta-analyses were derived from indirect comparisons relative to MTX due to the dearth of head-to-head studies comparing interventions. No eligible data on biosimilars were found.ConclusionsQualitative and network meta-analyses suggest that the combination of MTX with TNF or non-TNF biologics reduces disease activity and improves remission when compared with MTX monotherapy. Overall adverse event and discontinuation rates were similar between treatment groups.RegistrationPROSPERO (available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017079260).

Human Factors approaches to evaluating outpatient parenteral antimicrobial therapy services: A systematic review.

The expansion in terms of available treatment options and models of care has led to a growing global momentum for outpatient antimicrobial therapy (OPAT) services. A systematic review was undertaken to explore Human Factors aspects relating to OPAT service delivery and to evaluate whether OPAT is amenable to description using the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model. Following a preliminary search, a search string was applied to four databases, including Medline, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts and PsychINFO. Inclusion criteria ensured only articles published after the year 2000 and written in English were accepted. The methodological quality of studies was assessed by three reviewers. Narrative synthesis was performed to uncover the key interactions between work system entities which underpin OPAT processes and outcomes as described using the SEIPS 2.0 model. A total of twenty-seven studies were deemed eligible for the final review. Of these, most described sample populations representative of the population under study, while duration of the studies varied from a few months to years. Some studies evaluated a single model of care whilst others evaluated all three currently available models. The breadth and scope of the studies included enabled extraction of rich Human Factors data describing barriers and enablers to service provision. OPAT is a service which offers significant benefits to both patients and care providers. These benefits include patient satisfaction and wellbeing, as well as financial performance. OPAT is a complex sociotechnical system, and a systems approach may offer the opportunity to enhance system design, maximising system performance. This review demonstrates that the service can be better understood using the SEIPS 2.0 model to identify key work system interactions that support performance.

General practitioner and pharmacist collaboration: does this improve risk factors for cardiovascular disease and diabetes? A systematic review protocol

IntroductionCardiovascular disease (CVD) remains a major cause of morbidity and premature mortality globally. Despite the availability of low-cost evidence based medicines, there is a significant treatment gap in those with...

Community pharmacist patient care services: A systematic review of approaches used for implementation and evaluation

AbstractBackgroundStudies have identified the positive impact of community pharmacist patient care services. Identifying the most effective implementation strategies and performing robust research are critical to sustaining evidence‐based patient care in this setting. This systematic review aimed to describe: (1) implementation strategies, and (2) dissemination and implementation (D&amp;I) outcomes used to evaluate the implementation of patient care services in community pharmacies.MethodsPubMed/MEDLINE, EMBASE, and International Pharmaceutical Abstracts were searched for articles that were: (1) written in English and published in 1985 or later, (2) described a peer‐reviewed empirical study or practice experience implementing a patient care service in a community pharmacy, and (3) described the strategies used to implement and/or evaluate the implementation of the service. Two investigators reviewed the abstract, and full‐text when necessary, of each article to assess eligibility. Data were extracted from each article by two investigators using a standardized form. Implementation strategies were categorized using the Expert Recommendations for Implementation Change (ERIC) study terminology. The D&amp;I outcomes were classified using the Proctor and colleagues terminology. All data were summarized using descriptive statistics.ResultsTwo hundred and thirty‐seven articles were included, 223 of which described at least one implementation strategy and 224 described at least one D&amp;I outcome. “Train and educate stakeholders” and “engage consumer” were the most common and “provide interactive assistance” and “adapt and tailor to context” were the least commonly reported implementation strategies. Reach, acceptability, and adoption were the most common and fidelity and sustainability were the least commonly evaluated D&amp;I outcomes. Most studies used quasi‐experimental or observational designs.ConclusionsThis systematic review used published manuscripts to identify the breadth and depth of implementation and evaluation strategies being utilized in various community pharmacies. Findings suggest opportunities for further research and innovation via collaboration between pharmacists and implementation practitioners and researchers.

Safety of azithromycin in paediatrics: a systematic review protocol

IntroductionAzithromycin is widely used in children not only in the treatment of individual children with infectious diseases, but also as mass drug administration (MDA) within a community to eradicate or...

Does Adjuvant Treatment with Chinese Herbal Medicine to Antidiabetic Agents Have Additional Benefits in Patients with Type 2 Diabetes? A System Review and Meta-Analysis of Randomized Controlled Trials.

Introduction In the present meta-analysis, we aimed to determine the effects of adjuvant treatment with Chinese herbal medicine (CHM) on antidiabetic agents having additional benefits in patients with type 2 diabetes. Methods Randomized controlled trials were identified by searching the Cochrane Library, PUBMED, EMBASE, MEDLINE, the China National Knowledge Internet, Web of Science, Global Health, International Pharmaceutical s and the China biology medicine, Wanfang, and VIP databases. The intervention group received CHM as add-on treatment to antidiabetic agents therapy, and the control group received placebos in addition to antidiabetic agents or antidiabetic agents alone. We assessed pooled data, including weighted mean differences and 95% confidence intervals (CIs) using a random-effects model. ResultsA total of 125 randomized controlled trials were included. 10 articles were included based on literature screening. All trials contrasted Chinese herbal medicines or Chinese herbal medicines + antidiabetic agents with placebo or antidiabetic agents + placebo and included a total of 2004 individuals with T2DM. All selected trials displayed evidence of high methodological quality and possessed a low risk of bias. Meta-analysis of the trials demonstrated that Chinese herbal medicines resulted in a more favorable blood glucose profile in contrast to placebo (P<0.05). The total efficacy rate differed significantly between the two groups (P<0.001). All ten included studies reported the occurrence of tolerable adverse effects. Conclusions The results showed that in the intervention group, greater reductions were achieved for glucose control and body weight. The combined use of drugs improves the curative effect and has fewer adverse events and has additional benefits in patients with type 2 diabetes. This trial is registered with PROSPERO (CRD42018093867).

The impacts of medication shortages on patient outcomes: A scoping review.

BackgroundIn recent years, medication shortages have become a growing worldwide issue. This scoping review aimed to systematically synthesise the literature to report on the economic, clinical, and humanistic impacts of medication shortages on patient outcomes.MethodsMedline, Embase, Global Health, PsycINFO and International Pharmaceutical s were searched using the two key concepts of medicine shortage and patient outcomes. Articles were limited to the English language, human studies and there were no limits to the year of publication. Manuscripts included contained information regarding the shortage of a scheduled medication and had gathered data regarding the economic, clinical, and/or humanistic outcomes of drug shortages on human patients.FindingsWe found that drug shortages were predominantly reported to have adverse economic, clinical and humanistic outcomes to patients. Patients were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage. There were also reports of equivalent and improved patient outcomes in some cases.ConclusionsThe results of this review provide valuable insights into the impact drug shortages have on patient outcomes. The majority of studies reported medication shortages resulted in negative patient clinical, economic and humanistic outcomes.

The critical need for clinical decision support systems for identification and management of teratogenic medications

ObjectivesTo describe the critical need for clinical decision support systems to identify and manage use of potentially teratogenic medications in women of reproductive potential in the United States. Data sourcesMedline, CINAHL Plus, Academic Search Complete, International Pharmaceutical Abstracts, and the Cochrane Library databases were searched on November 1, 2018, with the key words (teratogen* OR birth defect OR Category D OR Category X OR (pregnancy or pregnant)) AND (clinical decision support OR decision support OR electronic record) to identify primary literature published in peer-reviewed journals describing clinical decision support systems implemented in outpatient settings in the United States to promote safe prescribing and clinician counseling for teratogenic medications. A hand search of the reference lists of relevant articles, including review articles, found through this search strategy was also performed. SummaryDespite the great potential for clinical decision support to assist clinicians in minimizing inadvertent fetal exposure to potentially teratogenic medications, there were only seven primary articles meeting the criteria. The results of these studies have shown some evidence of effectiveness yet had several notable limitations. No published clinical decision system showed great success. An eighth article, published in 2017, details the design of an intervention that had been implemented but not yet evaluated. ConclusionThere is a relative paucity of data regarding clinical decision support systems focused on teratogenic medications in the outpatient setting in the United States. Additional clinical decision support systems in this area need to be developed.

Remunerated patient care services and injections by pharmacists: An international update.

Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. Systematic searches for relevant articles published from January 2013 to February 2018 across PubMed (MEDLINE), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial or regional level, as applicable), payer, service description, patient eligibility criteria and fee structure. Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation. Can Pharm J (Ott) 2019;152:xx-xx.

Global scenario of counterfeit antimalarials: A potential threat.

Malaria, a parasitic infectious disease causes approximately >1 million deaths annually worldwide. Treatment with effective antimalarials is one of the major strategies to combat malaria-related mortalities. However, there is a continuous threat of counterfeit antimalarials in the community. Counterfeit antimalarial drugs not only result in an economic loss but also decrease the efficacy of treatment resulting in the loss of faith in the health system and increases the the chances of drug resistance in the parasites. Counterfeit drugs hamper the intellectual property-based innovation paradigms as well. Awareness about these counterfeit drugs not only helps in avoiding drug resistance but may also enhance the drug therapeutic value. This review discusses the prevalence of counterfeit drugs in different geographic areas across the globe, the methods deployed for its detection and possible anticounterfeiting strategies. Literature search was conducted through PubMed, Google and International Pharmaceutical Abstracts using the terms 'counterfeit antimalarials', 'substandard', 'falsified', and 'drug resistance'. Free searches in other search engines included the terms 'antimalarial counterfeit drugs' and 'drug resistance'. Analysis of the literature survey indicated that majority of such studies were conducted in Southeast Asia and Africa region. The prevalence of substandard antimalarials was reported as high as 88.4% in Africa region and 53 % in Southeast Asia region. There is a need to follow a multifaceted approach to prevent the entry of falsified drugs with pre- and post-marketing surveillance. The samples need to be examined by regulatory bodies and strict legislation should be envisaged in order to maintain the quality of medicines.

Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis

ObjectivesDeprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes. DesignSystematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028). Setting and ParticipantsRandomized controlled trials in a nursing home setting that included participants of at least 60 years of age. MeasuresFalls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis. ResultsA total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19–0.89). In subgroup analysis, medication review–directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65–0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62–0.93). ConclusionsCompared to other deprescribing interventions, medication review–directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review–directed deprescribing practice.

Remunerated patient care services and injections by pharmacists: An international update

ObjectivesRecognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services, and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. Data sourcesSystematic searches for relevant articles published from January 2013 to February 2018 across Pubmed (Medline), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus, and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. Study selectionPrograms were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. Data extractionDescriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial, or regional level, as applicable), payer, service description, patient eligibility criteria, and fee structure. ResultsOver the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations, and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. ConclusionAlthough funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility, and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation.