Medication Regimen Adjustment Research Articles

Shared decision-making in the treatment of adolescents diagnosed with depression: A cross-sectional survey of mental health professionals in China.

INTRODUCTION: Shared decision-making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well-documented. This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. In this cross-sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. The mean SDM-Q-Doc was 80.47 (±16.31). Within the six specific decision-making situations, most MHPs selected non-SDM (52.7%-71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision-making, working in an outpatient clinic and receiving SDM training (F = 23.582; p = .000; R2 = .198; adjusted R2 = .189). Although the MHPs' self-rated score of SDM-Q-Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM-related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer-practitioner relationship. MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high-quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families.

Medication regimen adjustment and pharmaceutical care for gefitinibinduced drug toxicity

Medication regimen adjustment and pharmaceutical care for gefitinibinduced drug toxicity

Knowledge, attitude and practice of Sudanese pharmacist with regard to management of diabetes during Ramadan: A cross-sectional survey

BackgroundFasting during Ramadan for some individuals with diabetes may lead to complications. Pharmacists may assist in dose adjustment and compliance with medication during Ramadan. Therefore, the aim of this study was to assess the knowledge, attitude and practice of Sudanese community pharmacists in the management of diabetes during Ramadan. MethodA cross-sectional study from April to June 2017, included 330 pharmacies in Khartoum state. The sampling technique was done by two methods using stratified and systematic methods for seven localities of Khartoum State. The community pharmacists were assessed in their knowledge about Medication regimen adjustment (MRA), diabetes risk stratification and the condition in which the fasting diabetic patient have to stop their fast. ResultsThe total response rate was 311(94.2%), and the females were 203(65.3%). Pharmacists mean age was 27.6 (SD = 5.9), ranged between 21-62 years. Importantly, more than 75% of the Pharmacists have sufficient knowledge of both identifying high-risk individuals and whether they need to break their fasting. The practice questions answered correctly by more than 80% of pharmacists in relation to monitor blood glucose level, undergo meal planning to avoid hypoglycemia and dehydration during prolong fasting hours and to undergo meal choices to avoid postprandial hyperglycemia. Importantly, 56.9% community pharmacists advised individuals with diabetes about physical activity. The barriers that hindering the proper counseling was attributed to the Lack of knowledge (71.4%). MRA was reported as highly important by (56.6%) and extremely important by (39.2%). The confidence of knowledge about MRA was reported by 52.1%. ConclusionThis study showed that pharmacists had sufficient knowledge, positive attitude and good practice about diabetes management during Ramadan.

Pharmacist-patient communication about medication regimen adjustment during Ramadan.

During Ramadan, Muslims fast from dawn to sunset while abstaining from food and drink. Although Muslim patients may be aware of their religious exemption from fasting, many patients still choose not to take that exemption and fast. This study examines pharmacists' initiation and timing of communication about medication regimen adjustment (MRA) with patients related to Ramadan. Predictors for initiating this communication with patients were also explored. A probability sample of community pharmacists in Alexandria, Egypt was surveyed. The self-administered instrument covered timing and likelihood of initiating discussion about MRA. Using ordered logistic regression, a model was estimated to predict pharmacists' initiation of the conversation on MRA during Ramadan. Ninety-three percent of the 298 approached pharmacists completed surveys. Only 16% of the pharmacists reported that they themselves usually initiated the conversation on MRA. Pharmacists' initiation of these conversations was associated with pharmacists' perceived importance of MRA on pharmacy revenue odds ratio ((OR) = 1.24, CI = 1.03-1.48). Eighty percent of the responding pharmacists reported the MRA conversation for chronic conditions started either 1-3 days before, or during the first week of Ramadan. These results suggest considerable pharmacist patient communication gaps regarding medication use during Ramadan. It is especially important for pharmacists and other health professionals to initiate communication with Muslim patients early enough to identify how best to help patients transition safely into and out of Ramadan as they fast.

Pharmacist Role in Pharmaceutical Care during Ramadan

Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan; moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.

Community pharmacists' knowledge of diabetes management during Ramadan in Egypt.

Although Muslim diabetic patients may be aware of their religious exemption from fasting, many still fast and adjust their medication regimens accordingly. Pharmacists have a significant potential to identify and prevent harm from medication misuse in Ramadan. This study examines Egyptian pharmacists' knowledge regarding management of diabetes during Ramadan. It also explores pharmacists' willingness to attend a 1 day workshop on medication regimen adjustment during Ramadan. Community pharmacies throughout Alexandria, Egypt. A cross-sectional study using a pretested self-administered survey was conducted among a random sample of community pharmacists. The survey included three knowledge questions relevant to counseling diabetic patients during Ramadan. Questions covered the recommended timing and dosing for metformin and insulin as well as the safe blood glucose range required for diabetic patients to safely continue their fast. Using logistic regression, a model was estimated to predict pharmacists' willingness to attend a workshop on the adjustment of medication regimens during Ramadan. Content analysis was used to analyze pharmacists' answers to the question concerning what they would like the workshop to cover. Pharmacists' aggregate scores for all three diabetes management knowledge questions and pharmacists' willingness to attend a workshop on the adjustment of medication regimens during Ramadan. Ninety three percent of the 298 approached pharmacists agreed to participate. Forty three pharmacists (15.9%) did not know the correct answer to any question, 118(43.7%) 24 answered one correctly, 86 (31.9%) answered two correctly and only 23 (8.5%) answered all 25 three correctly. Confidence in therapeutic knowledge regarding medication regimen 26 adjustment during Ramadan was not associated with the pharmacists' knowledge of diabetes management during Ramadan. One hundred seventy five (63.6%) pharmacists wanted to attend a workshop on adjusting medication regimens during Ramadan. This was significantly associated with pharmacists being Muslim (OR 3.52, CI 1.70-7.27) and of younger age (OR 30 = 0.98, CI 0.96-0.99978). Pharmacists offered specific content and communication process 31 suggestions for the workshop content. This study identifies variability among community pharmacists' knowledge of diabetes management during Ramadan. It also shows willingness among the majority of pharmacists to learn more about the topic.

Pharmacist-Patient Communication about Medication Regimen Adjustment during Ramadan

Objectives During Ramadan, Muslims fast from dawn to sunset while abstaining from food and drink. Although Muslim patients may be aware of their religious exemption from fasting, many patients still choose not to take that exemption and fast. This study examines pharmacists' initiation and timing of communication about medication regimen adjustment (MRA) with patients related to Ramadan. Predictors for initiating this communication with patients were also explored. Methods A probability sample of community pharmacists in Alexandria, Egypt was surveyed. The self-administered instrument covered timing and likelihood of initiating discussion about MRA. Using ordered logistic regression, a model was estimated to predict pharmacists' initiation of the conversation on MRA during Ramadan. Results Ninety-three percent of the 298 approached pharmacists completed surveys. Only 16% of the pharmacists reported that they themselves usually initiated the conversation on MRA. Pharmacists' initiation of these conversations was associated with pharmacists' perceived importance of MRA on pharmacy revenue odds ratio ((OR) = 1.24, CI = 1.03–1.48). Eighty percent of the responding pharmacists reported the MRA conversation for chronic conditions started either 1–3 days before, or during the first week of Ramadan. Conclusion These results suggest considerable pharmacist patient communication gaps regarding medication use during Ramadan. It is especially important for pharmacists and other health professionals to initiate communication with Muslim patients early enough to identify how best to help patients transition safely into and out of Ramadan as they fast.

Predicting pharmacists' adjustment of medication regimens in Ramadan using the Theory of Planned Behavior.

During Ramadan, many Muslim patients may choose to abstain from food, drink and oral medications from dawn to sunset. This study explored the utility of the Theory of Planned Behavior (TPB) model in predicting community pharmacists' Medication Regimen Adjustment (MRA) behavior for patients during Ramadan. A sample of pharmacists was drawn from a recent list of community pharmacies in the Alexandria governorate. A cross-sectional, self-administered survey was completed by community pharmacists to determine their attitudes and behaviors regarding adjustment of medication regimens around Ramadan. Multiple linear regression was used to predict MRA as a function of the TPB constructs and four other factors - "pharmacist initiation of the conversation on MRA," "number of hours worked," "age," and "religion" of pharmacist. Two hundred seventy-seven (92.9%) of the 298 approached pharmacists participated. While 94.2% reported performing one or more kinds of MRA around Ramadan for at least one patient, the majority of these were for a small percentage of patients. The most common MRA was changing the frequency of taking the medication followed by the dose of the medication, the dosage form of the medication and the medication itself. Statistically significant predictors of MRA in the final model included patient social pressure (PSP) (β=0.274, P<0.001), pharmacist perceived behavioral capability (PBC) (β=0.217, P<0.001), pharmacist perceived patient benefit (PPB) (β=0.207, P=0.001), initiating communication (β=0.167, P=0.001) and the number of working hours (β=0.145, P=0.005). The TPB appears to have utility in predicting pharmacists' MRA behavior. Pharmacists may be open to a larger MRA role than they are currently performing. There is a need to prepare pharmacists who are frequently requested to adjust patients' medication regimens to make sure they provide a safe transition for fasting patients into and out of Ramadan.

A study on the relevance of eosinophil counts in induced sputum and fractional concentration of exhaled NO and lung functions in asthmatics

Objective To investigate the correlations between eosinophil counts in induced sputum and lung function (FENO) and evaluate these parameters in medication adjustment in patients with asthma.Methods Sixty-five outpatients with mild to moderate persistent asthma ( mild,32 ; moderate,33 ) from January to August 2008 were enrolled in the study.All were treated with combined medications comprising inhaled corticosteroids plus long-acting β2 agonists for 1 year.Lung function (FEV1％ and PEF％ ),eosinophil counts in induced sputum,FENO,and Asthma Control Test (ACT) scores were obtained at regular follow-up intervals.Twenty-one healthy volunteers served as controls,and lung function,eosinophil counts in induced sputum,and FENO were also obtained.Results Sixty-three subjects completed 1-year or longer follow-up.Lung function of 63 subjects recovered quickly in the early days and improved slowly during the following 6 months.FENO decreased from (61 ± 25 ) nmol/L at baseline to ( 32 ± 19 ) nmol/L by the third month (q =7.32,P＜0.05) and to (22 ± 12) nmol/L by the sixth month,which showed significant difference from normal controls [ ( 13 ± 8) nmol/L; q =6.63,P ＜ 0.05 ].Eosinophil counts in induced sputum of the asthma group at baseline were (0.093 ±0.023) × 109/L and decreased to (0.032 ±0.011)× 109/L by the third month,which was significantly different from baseline and normal controls [ (0.005 ±0.003) × 106/ml; q =5.49,P ＜0.05 and q =5.87,P ＜0.05,respectively].FENO showed a significantly positive correlation with eosinophil counts in induced sputum in the first 6 months (r1 =0.612,r2 =0.558,r3 =0.675; all P＜0.05) and a negative correlation with FEV1 (r1 =-0.537,r3 =-0.658,r6 ＝ -0.623,r9 =-0.537,r12 =-0.597 ; all P ＜0.05 ) at any time point of the study.The ACT score of 63 subjects at baseline was 14 ±3,and the scores after treatment for 1,3,6,9,and 12 months were 18 ±5,19 ±7,23 ±2,24 ± 1,and 24 ± 1,respectively; at the same time,significant difference was found ( F =5.72,P ＜ 0.05).Effectiveness was found according to the ACT score only 1 month after treatment.Conclusion The parameters of FENO and eosinophil counts in induced sputum were sensitive in the detection of airway inflammation and may be useful in evaluation of the efficacy of treatment and adjustment of medication regimens. Key words: Asthma; Sputum eosinophils; Exhaled nitricoxide

Takayasu's arteritis with associated aortic insufficiency and coronary ostial obliteration

To describe the presentation, assessment, and management of Takayasu's arteritis (TA), a rare vascular condition exhibited predominantly in females in their second and third decades of life. Thorough review of current scientific literature was obtained from electronic databases and medical journals (CINAHL and PubMed). A case study is presented to illustrate TA, which was reviewed and approved by the Human Subjects Committee for the release of protected health information. Clinical presentation of TA varies depending on the location of vessel involvement. Diagnosis is challenging because of the complex pathogenesis of TA. The chronic nature of TA requires ongoing evaluation and adjustment of medication regimens. The patient's quality of life is improved with maintenance of TA in a quiescent state. Presentation of a young woman with symptoms suggestive of vascular inflammatory changes should prompt consideration of TA within the differential diagnosis.