Patient Care Practice Research Articles

Review of the Efficacy and Safety of Lemborexant, a Dual Receptor Orexin Antagonist (DORA), in the Treatment of Adults With Insomnia Disorder.

To provide an overview of the efficacy and safety of lemborexant in the treatment of insomnia disorder by assessing the currently available literature. A literature search of PubMed was performed (2010 to March 2021) using the following search terms: lemborexant, sleep, orexin. All relevant English-language studies were reviewed and considered, with a focus on phase 3 trials. The efficacy and safety of lemborexant in the treatment of insomnia disorder in adults was demonstrated in 2 phase 3 trials. Lemborexant significantly reduced latency to persistent sleep compared with placebo. The first study also demonstrated a significant reduction compared with the active control zolpidem ER. Somnolence and headache were relatively common, but the marked adverse effects associated with other medications commonly used to treat insomnia, such as cognitive and psychomotor impairment and complex sleep-related behaviors, were not observed. Although nonpharmacological therapy is considered first-line treatment for insomnia disorder, pharmacological treatment is most commonly utilized. Lemborexant is a viable pharmacological treatment option for patients who are unable to tolerate the adverse effects associated with the most commonly prescribed medications for insomnia, such as benzodiazepines and sedative-hypnotics (Z drugs). This is especially true for geriatric patients, who may be more sensitive to these adverse effects. Lemborexant can be recommended to treat insomnia disorder when pharmacological treatment is warranted. It has demonstrated efficacy in clinical trials and is likely better tolerated than most currently available treatment options.

Hospital Adoption of Electronic Decision Support Tools for Preeclampsia Management.

Background:Electronic health record (EHR)–based clinical decision support tools can improve the use of evidence-based clinical guidelines for preeclampsia management that can reduce maternal mortality and morbidity. No study has investigated the organizational capabilities that enable hospitals to use EHR-based decision support tools to manage preeclampsia.Objective:To examine the association of organizational capabilities and hospital adoption of EHR-based decision support tools for preeclampsia management.Methods:Cross-sectional analyses of hospitals providing obstetric care in 2017. In total, 739 hospitals responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) and were linked to the 2017 American Hospital Association (AHA) Annual Survey Database and the Area Health Resources File (AHRF). A total of 425 hospitals providing obstetric care across 49 states were included in the analysis. The main outcome was whether a hospital adopted EHR-based clinical decision support tools for preeclampsia management. Hospital organizational capabilities assessed as predictors include EHR functions, adoption of evidence-based clinical treatments, use of quality improvement methods, and dissemination processes to share best patient care practices. Logistic regression estimated the association of hospital organizational capabilities and hospital adoption of EHR-based decision support tools to manage preeclampsia, controlling for hospital structural and patient sociodemographic characteristics.Results:Two-thirds of the hospitals (68%) adopted EHR-based decision support tools for preeclampsia, and slightly more than half (56%) of hospitals had a single EHR system. Multivariable regression results indicate that hospitals with a single EHR system were more likely to adopt EHR-based decision support tools for preeclampsia (17.4 percentage points; 95% CI, 1.9 to 33.0; P < .05) than hospitals with a mixture of EHR and paper-based systems. Compared with hospitals having multiple EHRs, on average, hospitals having a single EHR were also more likely to adopt the tools by 9.3 percentage points, but the difference was not statistically significant (95% CI, −1.3 to 19.9). Hospitals with more processes to aid dissemination of best patient care practices were also more likely to adopt EHR-based decision-support tools for preeclampsia (0.4 percentage points; 95% CI, 0.1 to 0.6, for every 1-unit increase in dissemination processes; P < .01).Conclusion:Standardized EHRs and policies to disseminate evidence are foundational hospital capabilities that can help advance the use of EHR-based decision support tools for preeclampsia management in the approximately one-third of US hospitals that still do not use them.

Nurse Managers’ perceptions of mentoring in the multigenerational workplace: a qualitative descriptive study

Objective: To examine how nurse managers in metropolitan healthcare organisations in Western Australia perceive intergenerational mentoring and its place in the contemporary workforce. Background: Mentoring in nursing has benefits for professional career success, new role transition and as a strategy to mitigate negative workplace influences. Study design and methods: A qualitative descriptive study with 20 nurse managers from public and private health services. Face to face semi-structured interviews were held at a neutral location. The interview schedule included 10 questions which were audio-recorded and transcribed verbatim. Thematic analysis was applied to data to generate themes and present the results. Results: Four main themes were identified: conceptualising mentoring, adding value, influences and support mechanisms, and workforce investment. The nurse managers described the positive and negative aspects of their understanding of intergenerational mentoring practice in the contemporary clinical setting. Discussion: The nurse managers highlighted the importance of life experience in mentoring relationships and how mentoring was generationally bi-directional. As part of everyday nursing practice mentoring was evident despite clinical and organisational challenges. Clear benefits identified were the creation of a positive workforce, promotion of quality patient-centred care, and retention of staff. Mentoring has traditionally occurred face to face however, the recent coronavirus pandemic has provided a catalyst for increasing the use of online mentoring across all generations. Conclusion: The nurse managers were willing to be involved in intergenerational mentoring in either a mentor or mentee role or both. This view of practice occurred throughout the professional work life of nurses with benefits for all generations and the continuity of organisational values. Implications for practice: Mentoring is a practice necessary for promoting best practice in patient care and effective relationships in teams of staff. Consideration of accessibility through e-mentoring could increase involvement and take mentoring forward in the digital age. What is already known about the topic? Nursing shortages are predicted There are multiple generations in the nursing workplace which can contribute to issues in communication and workplace harmony The term mentoring is applied to numerous programs and practices in the contemporary workplace What this paper adds: Current Western Australian clinical nursing managers perspective on the value of intergenerational mentoring in their workplace Exploration of intergenerational mentoring as astrategy for retention and succession planning in nursing Mentoring in action supports the promotion of quality patient-centred care and positive workplace relationships

The impact of clinical decision making in a molecular tumor board at a tertiary care center.

3128 Background: Multidisciplinary molecular tumor boards were first established with the onset of precision oncology (PO), as many clinicians were unfamiliar with the interpretation and incorporation of the information into clinical practice. PO has since rapidly evolved and integrated itself into standard of care practices for most cancer patients, yet molecular tumor boards have not grown accordingly and in fact some have been discontinued. There remains a paucity of data in regards to the value and impact of molecular tumor board discussions themselves. We previously reported on our longitudinal experiences in PO ( Sadaps et al, 2018), focusing on the therapeutic impact of matched therapy. Here, we report on the utility of our molecular tumor board in clinical decision making. Methods: We conducted a retrospective review of patients seen at Cleveland Clinic with a solid tumor malignancy who had large panel, next-generation-sequencing (NGS) performed via any commercial platform from November 2019-January 2021. Cases were filtered through a local therapeutic algorithm and then reviewed individually. Initial review was performed by a core genomics committee comprised of 2 oncologists and 2 genetic counselors. Interesting and/or complex cases were flagged for discussion at our bimonthly molecular tumor board, which is regularly attended by medical oncologists, pathologists, genetic counselors, bioinformaticians, and patient care coordinators. Data analyzed included categorization of treatment recommendations and the percentage of cases for which initial recommendations were changed based on tumor board discussion. Results: Of 782 total cases, 575 (73.5%) had a clinically relevant genomics tumor board (GTB) recommendation as compared to 51.7% from our previously reported study. 16.7% of patients had on label recommendation(s) and 86.4% had off label/ clinical trial recommendation(s). 179 (22.9%) patients were recommended for genetic counseling (GC). During our bimonthly GTB, we discussed 173 (22.1%) of these cases. Of the discussed cases, the most common tumor types were hepatobiliary (18.5%), lower gastrointestinal (17.3%), and breast (16.2%). Topics of discussion at GTB included such things as pathologic/histologic/molecular testing, prioritization of available trials, appropriateness of an off label therapy, and need for a genetics consult. Discussion at GTB resulted in a change in treatment recommendation in 63 (36.4%) cases. Conclusions: Discussions from multidisciplinary molecular tumor board impacted treatment decisions for our patients. Referral to GC was also common and should be considered an integral part of somatic sequencing review. Molecular tumor boards remain a crucial platform for treatment guidance and clinical management, especially given the increase in “actionability” over the years due to newly discovered targets and targeted therapies in this rapidly evolving field.

Patient-Centered Care and Associated Factors at Public and Private Hospitals of Addis Ababa: Patients' Perspective.

BackgroundPatient-centered care is a practice of caring for patients in ways that are valuable to the individual patient and families. Implementation of the practice is a common problem worldwide. In Ethiopia, the available information is limited and is largely skewed to certain dimensions of the practice.ObjectiveTo assess the patient-centered health care practice and associated factors among public and private general hospitals of Addis Ababa 2020.MethodsAn institution-based comparative cross-sectional study was conducted in two public, and seven private general hospitals located in Addis Ababa from April 08 to May 20, 2020. A multistage sampling technique was employed to select the study participants. Data were collected using an interviewer-administered structured questioner, then entered into Epi-data version 3.1, and finally analyzed using SPSS version 25. Multivariable logistic regression was used to identify independent predictors of clients’ perceived patient-centered care. Statistical significance was declared at p-value <0.05 and adjusted odds ratio with 95% confidence interval.ResultsA total of 570 patients were involved with 99.8% response rate. About 49% (95% CI: 45.0–53.1) of patients rated the practice as good. It was 27.8% (95% CI: 22.5–33.1), and 70.2% (95% CI: 64.6–75.4) for public, and private hospitals, respectively Hospital type (AOR:0.21; 95% CI: 0.13–0.35), service easiness (AOR:3.3; 95% CI: 2.0–5.8), hospital attractiveness (AOR:2.3; 95% CI: 1.2,4.5), privacy to access care (AOR:2.0; 95% CI: 1.1,4.1), information on plan of care (AOR:2.3; 95% CI; 1.1,4.6), information on medication (AOR:3.1; 95% CI; 1.5,6.3), and perceived intimacy with the provider (AOR: 0.4; 95% CI;0.2,0.8) were the factors associated with the practice.ConclusionEven though providing patient-centered care has been the focus of quality improvement in Ethiopia, this study showed it is mostly being implemented from the traditional provider-centered approach and public hospitals were lower in practice than private hospitals.

From the (skin) doctor's office to the lecture hall: An innovative, practice-oriented, media-supported teaching project with supra-regional interdisciplinary usage options.

The transfer of practical knowledge and skills is the focus of modern medical teaching (master plan medical studies 2020). The aim of the teaching project is to provide medical students with important dermatological learning goals and contents by using innovative methods. As part of a teaching project funded by the Federal Ministry of Education and Research (BMBF) at the Department of Dermatology, University Hospital Schleswig-Holstein in Kiel, various new, partly media-supported teaching modules were developed in addition to curricular teaching and optimized by regular acceptance evaluations during the development process. (1.) Professionally created instructional movies present essential techniques for diagnosis and therapy: standardized dermatological whole-body examination, wound smear sampling, performing of biopsies, curettages and excisions as well as skin suturing techniques on exercise material and on patients. (2.) Tutor-based courses offer students the ability to practice these techniques independently. (3.) Seminar lectures show different clinical pictures in university medicine and doctor's offices as well as the important interaction between clinic and doctor's practice in patient care. (4.) One-day internships in a teaching practice convey the activity in this setting. (5.) Seminars on psychodermatology provide insight into the stress caused by the skin disease using the "bio-psychosocial disease model". So far, 282 students have participated in the modules. In 88-100% of the evaluations, there was a desire for further expansion of the new courses and integration into curricular teaching. Our innovative teaching modules resulted in great acceptance by the students. The freely available instructional films were successfully used by other university locations due to networking in the Academic Teaching Forum. One perspective is the supra-regional and sustainable use of our teaching modules and the transfer of the concept to other departments and faculties.

Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient.

COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta2-agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.

Efficacy and Benefits of Augmented and Virtual Reality Based Learning during COVID‐19

PurposeThe COVID‐19 pandemic has created extensive disruptions for medical education, causing urgency to implement and develop solutions to combat this disturbance. For students to pursue learning opportunities, the education system must improve. Augmented (AR) and virtual reality (VR) provide a promising future for the enhancement of medical education. This review article aims to evaluate the benefits and efficacy of AR and VR, especially during the COVID‐19 pandemic.MethodsMultiple peer‐reviewed, randomized trials were synthesized into a review study investigating the efficacy, benefit, and use of VR and AR for medical education. The reviewed studies included medical and graduate‐level students as participants and aimed to support the use of AR and VR as an educational adjunct. The results of these trials support the use of additional technology in medical education.ResultsThe COVID‐19 pandemic propelled medical schools, educators, and students into a world of total computerized learning. This pandemic acted as a necessary push to implement novel, untested technologies into the educational sector. Previous research demonstrates that AR and VR can confront these unfamiliar challenges and allow for a safe and beneficial COVID‐19 education, consisting of socially‐distanced and low‐risk patient‐care practice.ConclusionsThe benefits of continuous, safe learning outweigh the potential technological challenges of implementing AR and VR into medical education. During the pandemic, the medical community is faced with teaching students many skills necessary to become adept medical practitioners. Although the COVID‐19 pandemic offers a unique opportunity for the implementation of new technologies, virtual instruction does not have to end beyond this crisis. Virtual technology can teach medical students interpersonal skills such as empathy, engaging in difficult conversations, and delivering bad news. Because students have traditionally been exposed to passive teaching styles, it is time to look toward expanding medical students’ repertoire and allow them to personalize their education.

Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

Objective: To summarize literature assessing the safety and efficacy of budesonide/formoterol, a low dose inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used as needed for the treatment of adult patients with mild persistent asthma requiring step 2 therapy compared to low dose inhaled corticosteroid (ICS) plus short-acting beta agonist (SABA) and SABA monotherapy. Data Sources: A literature search of PubMed (1966-October 2020), EMBASE (1973-October 2020) and clinicaltrials.gov was conducted using the following search terms: budesonide, formoterol, as needed, and mild asthma. Study selection and data extraction: Randomized, controlled trials with data describing as needed use of budesonide-formoterol in the treatment of mild, persistent asthma were included. Data synthesis: Current trials demonstrate a reduced risk of exacerbation and an improvement in symptom control in patients receiving budesonide/formoterol as needed when compared to as needed SABA alone. However, when compared to scheduled budesonide maintenance, patients receiving budesonide/formoterol as needed experienced worse symptom control and mixed exacerbation results. Relevance to patient care and clinical practice: This review evaluates the efficacy and safety of budesonide/formoterol as needed for patients with mild asthma. The Global Initiative for Asthma (GINA), a global strategy for asthma management and prevention adopted this change in 2019, and the most recent updated Expert Panel Report 4 of the National Asthma Education and Prevention Program (NAEPP) did not address this area. Conclusions: Based on this review of the literature, further study is needed to determine the place in therapy for budesonide/formoterol as needed in the treatment of mild persistent asthma. Low-dose ICS should remain the standard of therapy in patients with mild asthma requiring Step 2 therapy.

Patient-reported outcome measures (PROMs) use in post-stroke patient care and clinical practice: a realist synthesis protocol

BackgroundThere is growing interest in the use of routine patient-reported outcome measures (PROMs) to influence the care of individual patients with stroke. However, there are significant gaps in our understanding as to how PROMs influence post-stroke patient care and clinical practice. This is due to factors including the number of purported uses for PROMs and that PROMs are complex interventions, which attempt to stimulate varied actions or behaviours. Therefore, the objective of this realist synthesis is to offer theory-based explanations as to how PROMs influence post-stroke clinical practice and patient care.MethodsThis is a protocol for a realist synthesis, which involves three distinct phases: theory building (phase 1), theory testing and refinement (phase 2) and synthesis (phase 3). Phase 1 will develop initial rough programme theories (IRPTs), through literature searches (from January 2000 onwards) of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and the grey literature. Only secondary sources will be included that contribute to the development of IRPTs. Only two IRPTs, prioritised by the stakeholder group, will be taken forward to be tested and refined during phase 2. Further novel searches will be employed in phase 2, utilising the same criteria as phase 1; however, phase 2 searches will not utilise grey literature searches, and only primary research studies that contribute to the refinement of programme theories under investigation will be included. Two independent reviewers will screen and select all returned results. The reviewers will code and annotate relevant sources, resulting in ‘fragments’ to be extracted and graded based on the richness of their contribution to explanation and causal insight. Further, these fragments will be organised into ‘Context-Mechanism-Outcome’ configurations. Phase 3 of the review will involve the synthesis of context-mechanism-outcome configurations to form middle-range theory-based explanations and developed logic models for stakeholders to understand how PROMs in post-stroke clinical practice and patient care work for whom, how and under what circumstances.DiscussionThe resulting realist synthesis will provide guidance on the implementation of PROMs within routine post-stroke clinical practice and patient care and act as a touchstone for further testing and refinement of PROMs programmes.Systematic review registrationPROSPERO CRD42020138649.

Approach to Sedation and Analgesia in COVID-19 Patients on Venovenous Extracorporeal Membrane Oxygenation.

To describe clinically pertinent challenges of managing sedation in COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) and describe considerations for enhanced safety and efficacy of pharmacological agents used. A PubMed search was performed using the following search terms: ECMO, ARDS, sedation, COVID-19, coronavirus, opioids, analgesia, fentanyl, hydromorphone, morphine, oxycodone, methadone, ketamine, propofol, dexmedetomidine, clonidine, benzodiazepines, midazolam, lorazepam, and diazepam. Relevant clinical and pharmacokinetic studies were considered. All studies included were published between January 1988 and March 2021. Patients with acute respiratory distress syndrome secondary to COVID-19 may progress to requiring VV-ECMO support. Agents frequently used for sedation and analgesia in these patients have been shown to have significant adsorption to ECMO circuitry, leading to possible diminished clinical efficacy. Use of hydromorphone-based analgesia has been associated with improved clinical outcomes in patients on VV-ECMO. However, safety and efficacy regarding use of other agents in this patient population remains an area of further research. This review addresses clinical challenges associated with sedation management in COVID-19 patients requiring VV-ECMO support and provides potential strategies to overcome these challenges. Historically, sedation and analgesia management in patients requiring ECMO support have posed a challenge for bedside clinicians given the unique physiological and pharmacokinetic changes in this patient population. A multimodal strategy to managing analgesia and sedation should be used, and the use of enteral agents may play a role in reducing parenteral agent requirements.

Ethics education for contemporary clinical pharmacy practice in Africa.

The paradigm shift to a patient-centred pharmacy practice model has resulted in dramatic increases in the number and variety of ethical and other dilemmas that confront pharmacists in their routine practice. However, ethical problems may go undetected by many pharmacists in most developing countries. Hence, there is a huge need for sound educational preparation of future pharmacists before they are faced with an urgent decision. This paper highlights the urgent need for pharmacy ethics to be adequately taught in schools of pharmacy, especially at the undergraduate and professional levels, so that future pharmacists can begin their professional careers with adequate ethical knowledge, skills, competencies and experience to detect and resolve ethical dilemmas of the contemporary patient-centred pharmacy practice.

Crizanlizumab for the Prevention of Vaso-Occlusive Pain Crises in Sickle Cell Disease.

Objective: To review the efficacy and safety of crizanlizumab (Adakveo) in the prevention of vaso-occlusive pain crises in sickle cell disease. Data Sources: An English-language literature search of PubMed, MEDLINE, and Ovid (1946 to January 2021) was completed using the terms crizanlizumab, SEG101, SelG1, and sickle cell disease. Manufacturer prescribing information, article bibliographies, and data from clinicaltrials.gov were incorporated in the reviewed data. Study Selection/Data Extraction: All studies registered on clinicaltrials.gov were incorporated in the reviewed data. Data Synthesis: Crizanlizumab is the first monoclonal antibody approved for sickle cell disease to reduce the frequency of vaso-occlusive crises. One phase 2 clinical trial and a post hoc analysis of the trial have been published. Relevance to Patient Care and Clinical Practice: Crizanlizumab is a monthly intravenous infusion approved by the Food and Drug Administration for patients with sickle cell disease 16 years of age and older to reduce the frequency of vaso-occlusive crises. Conclusion: Crizanlizumab appears to be an efficacious therapy for patients with sickle cell disease to reduce the frequency of vaso-occlusive crises. Concerns include drug cost and administration. Long-term benefits and risks have not been determined.

Recent advances in understanding and managing Kallmann syndrome.

Many of the recent advances in our understanding of human reproductive biology and its genetic basis have arisen directly via the genetic investigation of patients with Kallmann syndrome and their families. The disease is characterised by the association of an isolated defect in the secretion (or, less commonly, action) of gonadotropin-releasing hormone (GnRH) and consequent infertility, with anosmia and potentially other associated non-reproductive features. GnRH-producing neurons are located in the hypothalamic brain region after a peculiar migration during embryonic life. To date, different genes affecting GnRH neuron development/migration have so far been implicated in Kallmann syndrome, but our knowledge of the genetic basis of the syndrome remains incomplete. From a clinical point of view, the disease has suffered from a lack of definitive diagnosis and treatment, and although progress has been made in terms of timely diagnosis and evidence-based treatment of patients, implementation remains inconsistent. These aspects will be discussed in this review, which examines new strategies for arriving at more evidence-based and patient-centred medical practice in Kallmann syndrome.

HOW TO CRITICALLY APPRAISE A RESEARCH PAPER?

Background: Critical appraisal of research paper is a fundamental skill in modern medical practice, which is skills-set and developed throughout the professional career. The professional experience facilitates this and through integration with clinical experience and patient preference, permits high quality evidence-based medicine practice in patient care. These skills to be mastered not only by academic medical professionals but also by the clinicians involved in clinical practice.&#x0D; Objective: To provide a simple and robust method for assessing the trustworthiness of a research paper and its value in clinical practice.&#x0D; Methodology: Through detailed literature search, All essential sections and subsection mandatory for a research paper were identified followed by the necessary steps or information required in each section or questions which may arise or needs to addressed were identified. The important questions or steps which are integral in assessing the reliability and validity of a research are gathered during critical review of a research paper. &#x0D; Results: Out of 128 full text articles, 49 full-text articles containing robust and pertinent information as per objective were short listed for review.&#x0D; Conclusion: Critical appraisal of a research paper or project is a fundamental skill in modern medical practice for assessing the worth of clinical research and in providing a guideline of its relevance to the profession.

Mind–Body Interventions for an Occupational Athlete Following Total Knee Arthroplasty: A Clinical CASE Report

A 58-year-old female had a total knee arthroplasty due to arthritic changes in her right knee, along with pain and loss of function. Mind and body intervention techniques were utilized to improve patient-centered outcomes. Protocols are in place for the rehabilitation of patients following a total knee arthroplasty. However, sometimes the mind–body connection can be disrupted, and plateaus in the rehabilitative process may benefit from innovative techniques. As patient-centered care, biopsychosocial models, and collaborative practice continue to push the athletic training profession, these types of cases that provide holistic approaches to expand health care will lead to future research.

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

Evolution of pharmacy practice and direct patient care roles for pharmacists in Bangladesh

AbstractThe increasing emphasis on the pharmacists' role as the medication expert has created a global movement towards the implementation of clinical pharmacy practice, defined as any pharmacist in any setting who provides patient care. Although the pharmacy profession in Bangladesh has traditionally been oriented towards the pharmaceutical industry sector, direct patient care roles of pharmacists in both community and hospital practice settings are slowly beginning to emerge. The MEDLINE, Cochrane, Web of Science, and Scopus databases were searched for relevant reference articles for this study. This article presents a narrative review on the current state of pharmacy education and practice in Bangladesh, including a case study highlighting the successful implementation of the country's first clinical pharmacy team‐based care model at a private, tertiary‐care hospital in Dhaka, Bangladesh. Challenges and lessons learned initiating advanced hospital pharmacy practice and a decentralized team‐based care model in Bangladesh may provide insight for institutions in similar settings seeking to expand the role of pharmacists.

Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations.

To provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder. A literature review was conducted using the search terms pain management, pharmacogenomics, pharmacogenetics, pharmacokinetics, pharmacodynamics, and opioids on PubMed (inception to February 1, 2021), CINAHL (2016 through February 1, 2021), and EMBASE (inception through February 1, 2021). All relevant clinical trials, review articles, package inserts, and guidelines evaluating applicable pharmacogenotypes were considered for inclusion. More than 300 Food and Drug Administration-approved medications contain pharmacogenomic information in their labeling. Genetic variability may alter the therapeutic effects of commonly prescribed pain medications. Pharmacogenomic-guided therapy continues to gain traction in clinical practice, but a multitude of barriers to widespread pharmacogenomic implementation exist. Pain is notoriously difficult to treat given the need to balance safety and efficacy when selecting pharmacotherapy. Pharmacogenomic data can help optimize outcomes for patients with pain. With improved technological advances, more affordable testing, and a better understanding of genomic variants resulting in treatment disparities, pharmacogenomics continues to gain popularity. Unfortunately, despite these and other advancements, pharmacogenomic testing and implementation remain underutilized and misunderstood in clinical care, in part because of a lack of health care professionals trained in assessing and implementing test results. A one-size-fits-all approach to pain management is inadequate and outdated. With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.

Nurse-perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey.

BackgroundThe palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision‐making. To deliver patient‐centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach.ObjectiveThis paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease.DesignAn e‐Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales.Participants and MeasurementsA list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries.ResultsSeven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items.ConclusionsSpecific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease.