Multidisciplinary Health Care Team Research Articles

Pharmacist administered parenteral medications: A descriptive report of an inpatient training program

AbstractIntroductionParenteral medication administration is a crucial aspect of in‐hospital patient care and has been historically managed by nurses and physicians. Despite pharmacists' extensive training in the medication use process, their underutilization in medication administration stems from various factors, including the lack of formalized training, limited awareness by other healthcare professionals, and unclear legal guidance. This report discusses the implementation and outcomes of a pharmacist medication administration program at a large academic medical center.MethodsThe initiative began by revising hospital policies, enabling pharmacists to administer medications during emergencies. Documentation and communication protocols were established. Training included an online module and hands‐on sessions covering various topics with a focus on parenteral medication administration and medication safety. Following completion of the program, competency of pharmacists was assessed by pharmacists experienced in intravenous administration using simulated patient case scenarios. Following implementation, the frequency and characteristics of pharmacist administered medications were captured and described.ResultsThirty pharmacists, including 11 residents, participated. Seven pharmacists administered 349 doses of medications to 284 patients in emergency situations. Administrations by pharmacists included 227 titratable infusions, 72 intermittent or continuous infusions, 49 intravenous pushes, and 1 intranasal naloxone. Classes of medications included high risk products such as vasopressors, sedatives, antiarrhythmics, and thrombolytics. No extravasations or infiltrations were reported.ConclusionImplementation of the pharmacist medication administration program signifies significant progress in strengthening the pharmacists' role in patient care at the bedside specifically highlighting the competency of pharmacists to administer parenteral products during emergency situations. The absence of adverse events highlights the feasibility and safety of integrating pharmacists into the bedside team. As the landscape of health‐system pharmacy evolves, embracing standardized training programs like ours reemphasize pharmacists' essential contributions to the multidisciplinary healthcare teams, ultimately enhancing patient care and safety.

Pharmacist-led medication management services: a qualitative exploration of transition-of-care cardiovascular disease patient experiences

ObjectiveHospitalisation due to medication-related problems is a major health concern, particularly for those with pre-existing, or those at high risk of developing cardiovascular disease (CVD). Postdischarge medication reviews (PDMRs) may...

Abstract PO1-02-12: Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer

Abstract Background Young women with breast cancer (YWBC) debut with more aggressive and advanced diseases; it may be related to chronic inflammation caused by the tumor. However, in Latin America, breast cancer is also related to malnutrition conditions such as obesity. Malnutrition is commonly associated with physiological adaptations to stress and inflammation resulting in muscle catabolism and loss of functionality, which may affect oncology outcomes. Our research group had previously reported that YWBCs in Mexico are overweight or obese at diagnosis. Although they received educational support, this malnutrition prevalence continues or increases during the follow-up. A limitation of this previous study is that we only have data such as weight and height and miss other anthropometric parameters to measure the metabolic impact of weight gain. Body composition assessment is valuable for measuring malnutrition, obesity, and sarcopenia. The body composition assessment with Bioimpedance analysis (BIA) provides valuable parameters such as phase angle (PhA), which correlates with nutritional status, disease prognosis, inflammation, cell health, and metabolic activity. BC patients with a PhA >5.6 show a better survival rate. Another accessible tool to evaluate systemic inflammation is the neutrophil-lymphocyte ratio (NLR). Higher NLR (>2.12) is associated with worse disease-free and overall survival. This pilot study aims to measure the importance of PhA and NLR in YWBC with early breast cancer at diagnosis and at 12 months to evaluate the effects of personal nutritional guidance on these parameters. Methods Patients included in the “Joven & Fuerte (J&F) navigator program” of the National Institute of Cancerology (INCan) from 2021 to 2022 were invited to participate in this observational study. To evaluate the efficacy of personal nutritional guidance in anthropometric and NLR parameters, basal and 12-month BIA and anthropometric measures such as the Waist-Hip index were assessed, and NLR was obtained from the patient's records. Results Eleven early breast patients agreed to participate in the pilot intervention. The median age of the participants was 37 years. The majority had local advanced disease (54.5%), regarding molecular subtype luminal was the more frequent subtype (45.5%), followed by HER2 (36.4%), triple-negative (18.2%). According to BMI at diagnosis, 18.2% had normal-weight, 63.6% were overweight, and 18.2% had obesity. At follow-up, 9.1% had normal-weight, 63.6% were overweight, and 27.3% had obesity. A significant change in body composition parameters was observed, the percentage of patients with excess adipose tissue increased from 54.5% at baseline to 81.1%. All patients exhibited cardiovascular risk, as indicated by a Waist-Hip ratio greater than 0.80, and maintained a PhA (5.2 at baseline, 5.5 final) associated with overall survival risk. No significant changes were observed in the NLR ratio (2.14 baseline, 2.34 final), maintaining the related risk for this parameter. Conclusions This pilot analysis suggests that a nutritional intervention based only in nutritional guidance and support seems inefficient in impacting nutritional or inflammatory parameters. A multidisciplinary intervention involving multidisciplinary healthcare teams, including rehabilitation, and psychology, may be required to achieve therapeutic effectiveness in this population. Further studies with larger sample sizes are necessary to confirm these findings and determine the most effective strategies to improve the nutritional status, cardiovascular health, and clinical outcomes of YWBC. Anthropometric and inflammatory parameters a The values presented as median and interquartile range, Wilcoxon. b The values presented as mean and standard deviation, paired t-test. Citation Format: Aline Barranco-Cortés, Fernanda Sarahi Fajardo-Espinoza, Ana Lorena Espadas-Vargas, Dana Aline Pérez-Camargo, Sara Aileen Cabrera-Nieto, Marlid Cruz-Ramos, Alejandro Mohar, Lucero Itzel Labra Alvarado, Cynthia Mayté Villarreal Garza. Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-12.

Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes.

Serious health-related suffering is predicted to double in low- and middle-income countries by 2060. Primary care offers the best opportunity to meet Universal Health Coverage in an equitable way. Primary palliative care growth should be evidence-based to ensure provision is feasible, acceptable and culturally congruent. To identify the current evidence related to primary palliative care and to describe how primary palliative is defined in this setting, dominant typologies of care and meaningful outcome measures in LMICs. A systematic review and thematic synthesis was conducted. We described the nature, extent and distribution of published literature on primary palliative care in low- and middle-income countries, use thematic synthesis to characterize typologies of primary palliative care and design a process model for care delivery in low- and middle-income countries. Medline, Psychinfo, Global Health, Embase and CINAHL. Thirty-five publications were included. Nearly half took place in Asia (n = 16, 45.7%). We identified five dominant typologies of primary palliative care, including delivery in primary care clinics by multidisciplinary healthcare teams and palliative care specialists, in people's homes by healthcare professionals and volunteers and in tertiary healthcare facilities by generalists. We designed a process model for how these models operate within larger health systems and identified barriers and facilitators to implementing primary palliative care in this context. Evidence supporting primary palliative care in low- and middle-income countries is limited, and much of the published literature comes from Asia and southern Africa. Health systems in low- and middle-income countries have unique strengths and needs that affect primary palliative care services that should guide how services evolve to meet future need.

Improving Maternal Health Care Quality and Outcomes: Evaluation of a Pregnancy Medical Home.

Current maternal care recommendations in the United States focus on monitoring fetal development, management of pregnancy complications, and screening for behavioral health concerns. Often missing from these recommendations is support for patients experiencing socioeconomic or behavioral health challenges during pregnancy. A Pregnancy Medical Home (PMH) is a multidisciplinary maternal health care team with nurse navigators serving as patient advocates to improve the quality of care a patient receives and health outcomes for both mother and infant. Using bivariate comparisons between PMH patients and reference groups, as well as interviews with project team members and PMH graduates, this evaluation assessed the impact of a PMH at an academic medical university on patient care and birth outcomes. This PMH increased depression screenings during pregnancy and increased referrals to behavioral health care. This evaluation did not find improvements in maternal or infant birth outcomes. Interviews found notable successes and areas for program enhancement.

An Assessment of Different Decision Support Software from the Perspective of Potential Drug-Drug Interactions in Patients with Chronic Kidney Diseases.

Chronic kidney disease (CKD) is a multifaceted disorder influenced by various factors. Drug-drug interactions (DDIs) present a notable risk factor for hospitalization among patients with CKD. This study aimed to assess the frequency and attributes of potential DDIs (pDDIs) in patients with CKD and to ascertain the concordance among different Clinical Decision Support Software (CDSS). A cross-sectional study was conducted in a nephrology outpatient clinic at a university hospital. The pDDIs were identified and evaluated using Lexicomp® and Medscape®. The patients' characteristics, comorbidities, and medicines used were recorded. The concordance of different CDSS were evaluated using the Kendall W coefficient. An evaluation of 1121 prescribed medications for 137 patients was carried out. The mean age of the patients was 64.80 ± 14.59 years, and 41.60% of them were male. The average year with CKD was 6.48 ± 5.66. The mean number of comorbidities was 2.28 ± 1.14. The most common comorbidities were hypertension, diabetes, and coronary artery disease. According to Medscape, 679 pDDIs were identified; 1 of them was contraindicated (0.14%), 28 (4.12%) were serious-use alternative, and 650 (9.72%) were interventions that required closely monitoring. According to Lexicomp, there were 604 drug-drug interactions. Of these interactions, 9 (1.49%) were in the X category, 60 (9.93%) were in the D category, and 535 (88.57%) were in the C category. Two different CDSS systems exhibited statistically significant concordance with poor agreement (W = 0.073, p < 0.001). Different CDSS systems are commonly used in clinical practice to detect pDDIs. However, various factors such as the operating principles of these programs and patient characteristics can lead to incorrect guidance in clinical decision making. Therefore, instead of solely relying on programs with lower reliability and consistency scores, multidisciplinary healthcare teams, including clinical pharmacists, should take an active role in identifying and preventing pDDIs.

Biomarkers in Systemic Lupus Erythematosus along with Metabolic Syndrome.

Metabolic syndrome (MetS) is a group of physiological abnormalities characterized by obesity, insulin resistance (IR), and hypertriglyceridemia, which carry the risk of developing cardiovascular disease (CVD) and type 2 diabetes (T2D). Immune and metabolic alterations have been observed in MetS and are associated with autoimmune development. Systemic lupus erythematosus (SLE) is an autoimmune disease caused by a complex interaction of environmental, hormonal, and genetic factors and hyperactivation of immune cells. Patients with SLE have a high prevalence of MetS, in which elevated CVD is observed. Among the efforts of multidisciplinary healthcare teams to make an early diagnosis, a wide variety of factors have been considered and associated with the generation of biomarkers. This review aimed to elucidate some primary biomarkers and propose a set of assessments to improve the projection of the diagnosis and evolution of patients. These biomarkers include metabolic profiles, cytokines, cardiovascular tests, and microRNAs (miRs), which have been observed to be dysregulated in these patients and associated with outcomes.

Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review.

The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units. Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve the families' outcomes and experiences. This review focused on effectiveness and experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. The type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched from January 2000 to April 2022. Findings of quantitative studies were statistically pooled through meta-analyses and those that could not pooled were reported in a narrative format. Qualitative studies were pooled through meta-synthesis. This review included 6 qualitative and 42 quantitative studies. There was mixed methodological quality and all studies were included regardless of methodological quality. Meta-analyses showed positive improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families" Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration. Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements seen in stress, anxiety, and satisfaction with family-centered care. PROSPERO CRD42019137834.

Determinants of the Health-Promoting Behaviors Among Community-Dwelling Older Adults with Non-communicable Diseases During the Post-Covid-19 Era

Background: While research has explored the health-promoting behaviors (HPBs) of older adults on a global scale during the first and second waves of COVID-19, there is limited knowledge about the factors that influence HPBs among older adults with non-communicable diseases (NCDs) in the "new normal" following the COVID-19 era. Objectives: The aim of this study was to identify the factors that affect HPBs among community-dwelling older adults with NCDs. Methods: This cross-sectional study involved surveying 250 older adults with NCDs in both urban and rural communities within Ubon Ratchathani province, northeast Thailand, between September 10 and November 10, 2022, during the COVID-19 pandemic. Data collection was conducted using a self-administered questionnaire, which included the Self-rated Abilities Scale for Health Practice, Health Literacy Scale, Access to COVID-19 Preventive Material, Lubben Social Network Scale, and Health-Promoting Behaviors Scale. The analysis utilized descriptive statistics and hierarchical regression analysis, setting the significance level at P &lt; 0.05 for all analyses. Results: Among the 250 older adults with NCDs surveyed, 65.60% had hypertension. These individuals demonstrated HPBs at a good level, along with a high level of perceived self-efficacy, good health literacy, adequate access to COVID-19 preventive materials, and greater social engagement. The analysis indicated that perceived self-efficacy (β = 0.343, P &lt; 0.001), attitudes towards smoking (β = 0.226, P &lt; 0.001), age (β = 0.204, P &lt; 0.001), health literacy (β = 0.199, P = 0.016), and access to COVID-19 preventive materials (β = 0.123, P = 0.026) were significant predictors of HPBs in older adults with NCDs. Conclusions: The results suggest that improved access to COVID-19 preventive materials, enhanced health literacy, and increased self-efficacy contribute to better health-promoting behaviors among older adults with NCDs. Multidisciplinary healthcare teams should consider these factors in their intervention strategies to achieve a deeper understanding and better health outcomes. Future research should investigate the causal relationships among these variables and examine older adults’ perceptions of HPBs in long-term care settings, particularly in the "new normal" era.

A study to assess the knowledge regarding antenatal care among pregnant women at District Hospital of Bareilly (U.P.) with a view to develop an information booklet

The objective of the study are to assess knowledge regarding antenatal care among pregnant women. To associate knowledge of pregnant women with their selected demographic variable that is age, area, qualification, occupation, religion, type of family, living of area, dietary pattern. To develop a information booklet on knowledge of antenatal care for pregnant women. Nurses being one of the members in multidisciplinary health care team must have adequate knowledge of the Antenatal Care. The researcher felt the need of a structured interview schedule for pregnant women and intended to assess the knowledge regarding antenatal care . The descriptive research design was used to assess the knowledge regarding Antenatal care among pregnant women of District Hospital Bareilly, (U.P). In view of the nature of problem and to accomplish the objectives of the study, a structured interview schedule to assess the knowledge regarding Antenatal care among pregnant women was prepared and used. Validity of the tool was ensured by consulting the guides and experts in the fields of statistics, medicines and Nursing and reliability (0.78) of the tool was tested. The study was carried out in District Hospital Bareilly (U.P) pregnant women were selected by Non probability purposive sampling technique. Structured interview schedule was used to collect the needed data. Data was analyzed by using descriptive and inferential statistics. Pregnant women knowledge regarding antenatal care is very good .Divided into 4 parts. Excellent 11(36.66%), V.Good15(50%) , Good 4(13.33%) Poor 0 (0%). Hence the total mean average is 706 and mean percentage is 78.43%. Thus by conducting this study we conclude that pregnant women having very good knowledge regarding antenatal care. Keywords: Assess; Knowledge; Antenatal care; pregnant women

Giving voice to the voiceless: Understanding the perceived needs of dementia family carers in Soweto, a South African township.

This qualitative study aimed to provide family caregivers with an independent platform to reflect on and identify their needs in the role of dementia caregiver. Thirty caregivers were interviewed using a semi-structured approach, and data analysis followed a reflective thematic analysis method. The study revealed that Black African caregivers in townships require sufficient information and orientation to dementia-specific services, psychoeducation on dementia as a disease and its behavioural manifestations, as well as practical skills to manage the disease process. Caregivers expressed the need for in-depth, accessible education to boost their confidence and resilience in handling the challenges of dementia caregiving. They also proposed community initiatives to raise awareness, promote knowledge, and facilitate early detection and diagnosis of dementia. Additional needs included informational and educational workshops, resources like transportation services and helplines, day care facilities, media campaigns, and collaboration with the government for funding and policy change. New caregivers were advised to seek comprehensive education, support, and services while preserving the dignity of their family members with dementia. Remarkably, the identified needs and community initiatives aligned with the priority areas outlined by ADI for a National Dementia Plan, which South Africa currently lacks. The study highlights the importance of developing a National Dementia Plan in South Africa through collaboration among stakeholders, including communities, policy-makers, and multidisciplinary healthcare teams, while ensuring that individuals and families affected by dementia have a voice.

The community nurse’s role on the promotion of papillomavirus vaccination among young students: A study protocol

ABSTRACT Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents’ HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents’ vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth’s health promotion.

Abstract WP53: Bringing Comprehensive Stroke Care Home: Supporting Early Supported Discharge

Background and Issues: Despite holding the highest certification as a Comprehensive Stroke Center, the project site's 'Discharge-to-Home' performance for ischemic stroke survivors ranked below the median compared to similar academic medical centers. Although an innovative Early Supported Discharge (ESD) program was available for patients who met geographical criteria, the utilization of these services was not optimal. Purpose: This Quality Improvement initiative aimed to investigate the impact of an early collaborative discharge planning process led by a multidisciplinary healthcare team on 'Discharge-to-Home' rates of ischemic stroke patients eligible for the site's ESD program, Homeward Stroke Recovery. Methods: Meleis' Transition Theory was used to shape the development of streamlined workflows, simplifying the identification of eligible patients and reducing the time taken to refer them to Homeward Stroke Recovery through enhancements to the electronic medical record system. Additionally, robust team education was provided to improve discharge coordination and improve the utilization of available ESD services. Existing system data was leveraged, and new data flows were created to monitor program-specific metrics. Descriptive statistics were used to examine the effect of an early collaborative discharge planning process on ‘Homeward Stroke Recovery Discharge Rates’ for ischemic stroke survivors. Results: There was a notable increase of 5.6% in the 'Homeward Stroke Recovery Discharge Rate' from Fiscal Year 2022 to Fiscal Year 2023 (rising from 43.9% to 49.5%). Conclusions: In conclusion, this Quality Improvement project successfully addressed the challenge of suboptimal 'Discharge-to-Home' rates for ischemic stroke patients eligible for the site’s ESD program. The observed 5.6% increase in the 'Homeward Stroke Recovery Discharge Rate' between Fiscal Year 2022 and Fiscal Year 2023 reflects the positive impact of the interventions performed, highlighting the importance of multidisciplinary teamwork and systematic improvements in healthcare delivery.

Roles of Pharmacists in the Management of Sickle Cell Disease in Adults: A Narrative Review.

Background: Sickle cell disease (SCD) is an autosomal, recessive, genetic condition of the sickle cell genes. It affects about 100 000 people in the United States where an estimated 1 out of every 365 black children and 1 out of every 13 black children will be born with SCD and sickle cell trait, respectively. Severe and unpredictable pain crisis are the leading cause of emergency department visit for adult patients with SCD and account for 90% of inpatient hospitalizations and 85% of all acute medical care, as well as high usage of medical resources. The care of patients with SCD is complex and requires a multidisciplinary approach. With a few pharmacotherapeutic options to reduce SCD complications and pain episodes, the role of pharmacists in the medication management is unclear. This article aims to outline the potential role of pharmacists in SCD management. Data sources: The authors searched Medline, PubMed, EMBASE, and Scopus from January 1, 1990 to August 31, 2022, for primary literature that assessed the role of pharmacists in managing patients with SCD. Results: The authors identified relevant studies and summarized the role of pharmacists in SCD management. Conclusions: Access to comprehensive health care is essential to ensure that patients with SCD have decreased hospitalizations and good health-related quality of life. Pharmacists are an integral part of the multidisciplinary health-care team and can help patients with SCD navigate the complexities of health care. Pharmacists are medication experts who are positioned to ensure comprehensive care in the acute and chronic SCD management.

The Relationship Between Perceived Stress and Coping Styles in Women Following Breast Cancer Surgery: A Cross-sectional Descriptive Study

Purpose: The present study aimed to examine therelationship between perceived stress levels andcoping styles of women with breast cancer.Materials and Methods: This descriptive and crosssectional study was carried out with 132 women whounderwent breast cancer surgery at a training andresearch hospital in Turkey between March andOctober 2021. Data were collected face-to-facemethod before the discharge from the hospital via thePersonal Information Form, the Perceived StressScale, and the Brief Cope Inventory. Data wereanalyzed with descriptive statistics, independentsample t-test, One-Way ANOVA and Pearsoncorrelation analysis.Results: It was found that women who hadsecondary or above education, were housewives, had comorbidities, had undergone a total radicalmastectomy, and were supported by their childrenduring the disease had higher perceived stress levels(p&lt;0.05). Women without social security had lowercoping styles (p&lt;0.05). On the other hand, there wasa significant negative relationship between women'sperceived stress levels and their coping styles(p&lt;0.05).Conclusions: The results emphasize the importanceof evaluating the perceived stress levels and copingstyles of women undergoing breast cancer surgeryby the multidisciplinary healthcare team andproviding counseling on this issue.

Physical therapy care to community-dwelling individuals with stroke in primary care setting in Brazil: a cross-sectional study

Physical therapy care to community-dwelling individuals with stroke in primary care setting in Brazil: a cross-sectional study

Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team.

Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.

Cardiovascular Consequences of Sickle Cell Disease.

Sickle cell disease is an inherited blood disorder which can lead to severe complications, particularly in the cardiovascular and respiratory systems, potentially resulting in arrhythmias, pulmonary hypertension (PH), and cardiomegaly. This study aims to investigate the risk of PH and arrhythmias in adult SCD patients. Retrospective analysis of medical records from King Abdulaziz University Hospital (KAUH) for patients with SCD aged 15 and above between 2009 and 2021. The study included 517 patients, with echocardiograms and electrocardiograms assessed according to the European Society of Cardiology/the European Respiratory Society (ESC/ERS) guidelines for categorizing PH risk (low, moderate, high) and detecting arrhythmias. Data analysis employed the Statistical Package for the Social Sciences (SPSS), utilizing quantitative and qualitative data representation. Multivariate logistic regression identified independent risk factors with odds ratios at a 95% confidence interval (CI). Among participants, 50.3% were male, with a total sample average age of 34.45 ± 9.28 years. Results indicated that 1.4% of patients experienced arrhythmias, 3.7% had a moderate PH risk, and 3.3% were classified as high PH risk. Logistic regression revealed significant independent risk factors for PH and arrhythmia in patients with SCD, with chronic kidney disease (CKD) carrying the highest odds (26.4 times higher odds of PH and 15.36 times higher odds of arrhythmias). Patients with SCD are at risk for developing PH and various arrhythmias but are often underdiagnosed. Key risk factors for PH included CKD, liver cirrhosis, and pre-existing cardiac conditions. Arrhythmias were significantly associated with CKD and pre-existing cardiac conditions. To mitigate these risks, we recommend involving a multidisciplinary healthcare team in the care of adult patients with SCD. Future prospective studies are advised for early detection of PH and arrhythmias in hemoglobinopathy patients, potentially reducing mortality.

Identifikacija terapijskih problema tokom uvođenja usluga farmaceuta na Odeljenju gerijatrije Kliničko-bolnickog centra

Introduction: Patients with multiple comorbidities and undergoing polypharmacy are at a high risk of experiencing drug-related problems (DRPs). These DRPs can lead to increased morbidity, mortality, and healthcare costs. Objective: This study aims to identify the prevalence and causes of DRPs in geriatric inpatients, as well as the factors that contribute to them. Additionally, the study intends to evaluate the implementation of ward-based pharmacy services in the geriatric department. Method: The pharmacist analyzed inpatient therapy, identified DRPs, and formulated recommendations. DRPs were categorized according to the PCNE-DRP classification, version 9. A total of 100 patients, of which 52% were men, average age of 79.7±7.88 years, were included in the study. Results: Our study found that on average, each patient had 2.36 drug-related problems (DRPs). The most common DRP was related to treatment safety, accounting for 44.9% of cases, followed by treatment effectiveness (33.1%) and unnecessary drug treatment (22%). The main cause of DRPs was inadequate drug selection (61%) and inadequate dose selection (38.1%). Patients with atrial fibrillation and chronic renal failure had more DRPs than those without these conditions. In total, we identified 229 interventions to address these DRPs. However, the acceptance rate of these recommended interventions was low at 25.9%. Conclusion: The rate of drug-related issues in elderly hospital patients was found to be high, but the rate of acceptance of interventions to address these issues was low. In order to enhance the implementation of pharmaceutical services and improve healthcare for elderly patients, it is crucial to improve the collaboration between healthcare providers and pharmacists. Recognizing the unique skills and expertise that pharmacists bring to the table can facilitate their integration as a valuable member of a multidisciplinary healthcare team.

Sotatercept for Pulmonary Arterial Hypertension in the Inpatient Setting.

Patients with pulmonary arterial hypertension (PAH) who are admitted to the hospital pose a challenge to the multidisciplinary healthcare team due to the complexity of the pathophysiology of their disease state and PAH-specific medication considerations. Pulmonary arterial hypertension is a progressive disease that may lead to death as a result of right ventricular (RV) failure. During acute on chronic RV failure it is critical to decrease the pulmonary vascular resistance with the goal of improving RV function and prognosis; therefore, aggressive PAH-treatment based on disease risk stratification is essential. Pulmonary arterial hypertension treatment for acute on chronic RV failure can be impacted by end-organ damage, hemodynamic instability, drug interactions, and PAH medications dosage and delivery. Sotatercept, a first in class activin signaling inhibitor that works on the bone morphogenetic protein/activin pathway is on track for Food and Drug Administration approval for the treatment of PAH based on results of recent trials in where the medication led to clinical and hemodynamic improvements, even when added to traditional PAH-specific therapies. The purpose of this review is to highlight important considerations when starting or continuing sotatercept in patients admitted to the hospital with PAH.