Unnecessary Drug Research Articles

Evaluation of the prevalence and influencing factors on poly-pharmacy among elderly patients - A review

ABSTRACT The evaluation of adverse effects caused by poly-pharmacy (PHP) in patients, especially in the elderly group, is very important. The purpose of the present study was to evaluate the prevalence and factors affecting PHP in elderly patients. This study was conducted as a narrative review. Related articles were downloaded using reliable international databases and specialized mesh terms. Finally, the results of 29 articles were extracted based on the authors’ names, study location, sample size, and key results. The findings of the study showed that the prevalence of PHP in the elderly was higher after discharge from the hospital than during hospitalization. In addition, the prevalence of PHP in the elderly who lived in care centers was higher than in those who lived at home. Based on the findings, there was a relationship between the source of obtaining information about drugs and the pattern of PHP consumption. The findings of the present study showed that PHP leads to serious complications in the elderly. Based on the results of the study, it can be concluded that some variables such as age, sex, health level, financial status, place of residence, type of disease, number of simultaneous diseases, hospitalization, duration of hospitalization, level of awareness of the elderly and their caregivers, the care place of elderly, and the number of visits of the elderly to the physician can be effective in the prevalence of PHP. Strategies such as choosing treatment goals for each patient in preventing unnecessary drug use, identifying at-risk groups, and periodically monitoring the benefits and side effects of drugs can be effective in reducing drug complications caused by PHP in the elderly.

Polypharmacy and Deprescription: Role of Internists.

Polypharmacy is the concurrent use of five or more drugs per day. It is common in old age because of multimorbidity. The prevalence of polypharmacy is increasing as the number of old people is increasing worldwide. The proliferation of clinical guidelines and wider availability of preventive and curative medicines are important causes of polypharmacy. Appropriate polypharmacy is beneficial to the patients. However, polypharmacy may be inappropriate, causing adverse effects, drug interactions (DI), poor treatment efficacy, hospitalizations, and high healthcare costs. Prescribing cascade and legacy prescribing add to the burden of inappropriate polypharmacy. Inappropriate polypharmacy can be prevented or managed by medication optimization through medication review, deprescription, ensuring adherence, and patient education. Deprescription includes the removal of risky, unnecessary, and duplicate drugs, replacement with efficacious drugs, and relaxation of tight control as per life expectancy. Several deprescription tools (both explicit and implicit) exist for helping physicians to decide when to deprescribe or to add medicines, especially in old age. Care should be taken during deprescription to prevent unjustified omission, reduction to subtherapeutic dose, and onset of withdrawal features. Age and disease-related changes in pharmacokinetics and pharmacodynamics of drugs should be considered during the optimization of pharmacotherapy.

Basophil activation test is a complementary tool in the diagnosis of immediate reactions to platinum salts and taxanes.

Delabelling pathways offer confirmatory diagnosis and can prevent unnecessary second-line therapies or drug desensitization procedures after chemotherapeutic hypersensitivity reactions (CHT-HSRs). However, these pathways rely on risky invivo tests. Data on whether invitro tests could be helpful are scarce. We assessed the role of basophil activation test (BAT) in the diagnosis of HSRs to platin salts (PSs) and taxanes (TXs) in a well-defined population featuring varied endophenotypes and severities of HSRs. We conducted a 3-year-long multicentric, prospective study with 121 suspected-immediate CHT-HSR patients. The allergy workup included clinical history (initial reaction based on Type I, cytokine release syndrome, and mixed phenotype's symptoms and if unable to fit in any of these, as "indeterminate"), skin testing (ST), and drug provocation testing (DPT), provided risk assessment was favorable. Final diagnosis classified patients as "hypersensitive," "non-hypersensitive," or "inconclusive." We performed BAT using CD63 and CD203c as activation markers in patients and controls. Patients underwent DPT regardless of BAT results to prevent bias. ST positivity significantly correlated with skin involvement, Type I phenotype, cancer recurrence, and lifetime exposures before reactions. DPTs were negative in all indeterminate phenotype patients (p = .02) and those considered low-risk, whereas they were negative in 62% moderate-risk patients. 55% were confirmed as hypersensitive (mainly Type I reactions, p < .0001), 24% as non-hypersensitive (mainly TXs and indeterminate phenotypes), and 21% as inconclusive. BAT showed 79% sensitivity in Type I IgE-mediated reactions to PSs with a high correlation to ST. BAT is a promising tool for delabelling and endotyping CHT-HSRs, especially Type I reactions to PSs, possibly identifying patients at risk of positive DPT. ST seems useful in confirming CHT-HSRs, especially PS-induced reactions, and DPT remains the gold standard, being essential even in moderate-risk patients.

Enhancing Healthcare Through Early drug allergy Detection: A Systematic Review

Drug allergies are a significant cause of adverse drug reactions (ADRs), affecting patient safety and healthcare outcomes. Early detection of drug allergies is crucial for preventing these reactions and improving clinical care. This systematic review explores the current methods of early drug allergy detection, including patient history, skin testing, in vitro tests, and emerging genomic approaches. Findings indicate that accurate early identification of drug allergies, particularly with the use of skin testing and electronic health records (EHR)-based alerts, reduces the likelihood of adverse reactions and unnecessary drug avoidance. In vitro testing, including drug-specific IgE and basophil activation tests, provides non-invasive alternatives, while pharmacogenomic data show promise for predicting hypersensitivity in the future. The review emphasizes the importance of integrating detection methods into healthcare systems to enhance medication safety, lower healthcare costs, and improve patient outcomes. However, challenges remain, such as mislabeling allergies, limited access to testing in some settings, and the need for standardized protocols. Further research is recommended to develop more accessible testing methods and explore the long-term impact of early drug allergy detection on healthcare systems.

A Skin Testing Strategy for Non–IgE-Mediated Reactions Associated With Vancomycin

Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein-Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction. To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects. This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC50, IDT-related local symptoms, and BAT results were compared between groups. A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC50 was 328 μg/mL (95% CI, 296-367) in the VIR versus 1166 μg/mL (95% CI, 1029-1379) in the tolerant group (P < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (P= .0185). The %CD63+ basophils were consistently less than 2%, without significant differences between groups (P < .54). Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.

Residue-Free Orally Administered Drug Carrier Based on a Porous Aromatic Framework for Efficient Multisite Treatment.

Nowadays, oral medications are the primary method of treating disease due to their convenience, low cost, and safety, without the need for complex medical procedures. To maximize treatment effectiveness, almost all oral medications utilize drug carriers, such as capsules, liposomes, and sugar coatings. However, these carriers rely on dissolution or fragmentation to achieve drug release, which leads to drugs and carriers coabsorption in the body, causing unnecessary adverse drug reactions, such as nausea, vomiting, abdominal pain, and even death caused by allergy. Therefore, the ideal oral drug carrier should avoid degradation and absorption and be totally excreted after drug release at the desired location. Herein, a gastrointestinally stable oral drug carrier based on porous aromatic framework-1 (PAF-1) is constructed, and it is modified with famotidine (a well-known gastric drug) and mesalazine (a well-known ulcerative colitis drug) to verify the excellent potential of PAF-1. The results demonstrate that PAF-1 can accurately release famotidine in stomach, mesalazine in the intestine, and finally be completely excreted from the body without any residue after 12 h. The use of PAF materials for the construction of oral drug carriers with no residue in the gastrointestinal tract provides a new approach for efficient disease treatment.

Integrated management of multiple drugs for cardiovascular disease in older adults

Background: Older people have a high frequency of use of medical institutions due to their multiple comorbidities, which increases the frequency of drug-related problems or adverse drug reactions, such as duplicate prescriptions and inappropriate drug use. Polypharmacy in older people increases the risk of side effects and drug-drug interactions, thereby affecting health outcomes and quality of life. Because most elderly person with cardiovascular disease are already taking multiple drugs, the risk is inevitably high. Therefore, there is a need to develop strategies to mitigate the adverse effects of multidrug therapy in older adults with cardiovascular diseases.Current Concepts: We reviewed the latest relevant guidelines and literature in order to provide practical considerations for appropriate prescriptions for older people with cardiovascular disease, balancing unnecessary or harmful drugs with proven long-term benefits.Discussion and Conclusion: Continuous dialogue between healthcare providers and patients allows the close monitoring of drug efficacy and the prevention of adverse events. Drug therapy requires individualization as treatment goals vary with advancing age.

Exposure-Response Modeling in Adults and Adolescents With Schizophrenia to Support the Extrapolation of Brexpiprazole Efficacy to Adolescents.

In order to accelerate drug development and avoid unnecessary drug trials in vulnerable pediatric populations, the US Food and Drug Administration (FDA) released a general advice letter to sponsors permitting the effectiveness of atypical antipsychotics for the treatment of schizophrenia in adults to be extrapolated to adolescents. Extrapolation is based on the evidence-based assumptions that (1) disease characteristics and (2) response to therapy, are similar in adults and adolescents. Whereas the FDA validated the extrapolation approach using data from multiple drug development programs, aripiprazole data are the most relevant to confirm the validity of the extrapolation approach for brexpiprazole, since aripiprazole and brexpiprazole both modulate dopaminergic and serotonergic signaling in the brain. The aims of this analysis were (1) to quantitatively assess the aripiprazole exposure (average steady-state concentration)-response (Positive and Negative Syndrome Scale total score change from baseline) similarity between adults and adolescents with schizophrenia, (2) to extend the aripiprazole exposure-response modeling to brexpiprazole using adult data, and (3) to use the brexpiprazole model to predict schizophrenia symptom response in adolescents. Disease-drug-dropout models were developed using patient-level data from clinical studies of aripiprazole (1007 adults, 294 adolescents) and brexpiprazole (1235 adults) in schizophrenia. The aripiprazole model demonstrated similar exposure-response between adults and adolescents with schizophrenia, validating the extrapolation approach. Extrapolation of the brexpiprazole adult exposure-response model to adolescents predicted the efficacy of brexpiprazole in adolescents aged 13-17 years with schizophrenia.

Acute COPD exacerbations and in-hospital treatment-related problems: An observational study.

Treatment-related problems (TRPs) interfere with the ability to attain the desired goals of treatment, adding cost to healthcare systems. Patients hospitalized with acute conditions are at particular risk to experience TRPs. Data investigating such burden in patients with acute exacerbation of COPD (AECOPD) is generally scarce with no studies ever conducted in Jordan. This study aimed to investigate and categorize TRPs among patients hospitalized with AECOPD in Jordan, and to estimate their cost savings and cost avoidance. This was a retrospective population-based cohort study. Patients' cases of AECOPD admitted to the study site from Jan 2017 to Jul 2021 were identified from the electronic clinical database and screened for eligibility. TRPs were identified/categorized using AbuRuz tool and assessed for their severity. Cost saving was estimated by calculating all the extra costs. Cost avoidance was estimated according to Nesbit method. A total of 1243 (mean±SD 3.1±1.5) and 503 (mean±SD 1.3±1.2) TRPs were identified during hospitalization and at discharge respectively, of which 49.4% and 66.7% were classified as "unnecessary drug therapy". In 54.5% of the cases, systemic corticosteroid was administered for a period longer than recommended. Most of the TRPs were of moderate severity. The total direct cost saving, and cost avoidance were estimated to be 15,745.7 USD and 340,455.5 USD respectively. The prevalence and cost of TRPs among AECOPD patients is a concern requiring attention. The study results implicate integrating interventions such as embracing clinical pharmacists' role in the respiratory care units to optimize patients' management.

Antimicrobial Stewardship: A Correct Management to Reduce Sepsis in NICU Settings.

The discovery of antimicrobial drugs has led to a significant increase in survival from infections; however, they are very often prescribed and administered, even when their use is not necessary and appropriate. Newborns are particularly exposed to infections due to the poor effectiveness and the immaturity of their immune systems. For this reason, in Neonatal Intensive Care Units (NICUs), the use of antimicrobial drugs is often decisive and life-saving, and it must be started promptly to ensure its effectiveness in consideration of the possible rapid evolution of the infection towards sepsis. Nevertheless, the misuse of antibiotics in the neonatal period leads not only to an increase in the development and wide spreading of antimicrobial resistance (AMR) but it is also associated with various short-term (e.g., alterations of the microbiota) and long-term (e.g., increased risk of allergic disease and obesity) effects. It appears fundamental to use antibiotics only when strictly necessary; specific decision-making algorithms and electronic calculators can help limit the use of unnecessary antibiotic drugs. The aim of this narrative review is to summarize the right balance between the risks and benefits of antimicrobial therapy in NICUs; for this purpose, specific Antimicrobial Stewardship Programs (ASPs) in neonatal care and the creation of a specific antimicrobial stewardship team are requested.

Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities.

Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients' quality of life, and reducing the economic burden.

Integrating Clinical Variability into PBPK Models for Virtual Bioequivalence of Single and Multiple Doses of Tofacitinib Modified-Release Dosage Form.

Tofacitinib is a potent, selective inhibitor of the Janus kinase (JAK) family of kinases with a high degree of selectivity within the human genome's set of protein kinases. Currently approved formulations for tofacitinib citrate are immediate-release (IR) tablets, modified-release (MR) tablets, and IR solution. A once daily MR microsphere formulation was developed for use in pediatric patients. Demonstration of bioequivalence (BE) between the 10 mg once daily (q.d.) MR microsphere formulation and 5 mg twice daily (b.i.d.) IR solution is needed to enable the exposure-response analyses-based bridging to support regulatory approval. To assess BE between MR microsphere and IR solution, an innovative approach was utilized with physiologically-based pharmacokinetic (PBPK) virtual BE trials (VBE) in lieu of a clinical BE trial. A PBPK model was developed to characterize the absorption of different formulations of tofacitinib using Simcyp ADAM module. VBE trials were conducted by simulating PK profiles using the verified PBPK model and integrating the clinically observed intrasubject coefficient of variation (ICV) where BE was assessed with a predetermined sample size and prespecified criteria. The VBE trials demonstrated BE between IR solution 5 mg b.i.d. and MR microsphere 10 mg q.d. after a single dose on day 1 and after multiple doses on day 5. This research presents an innovative approach that incorporates clinically observed ICV in PBPK model-based VBE trials, which could reduce unnecessary drug exposure to healthy volunteers and streamline new formulation development strategies.

Drug-Related Problems Prior to Hospitalization on Internal Medicine Wards

Drug-related hospitalisations pose a significant burden to the health-care system. The aim was to investigate the prevalence of drug-related problems (DRPs) and their association with hospital admissions in five internal medicine wards. The study included patients admitted to the nephrology, cardiology, gastroenterology, endocrinology and geriatric ward. Pharmaceutical Care Network Europe classification V9.1 was used for identifying DRPs. In total 535 patients participated in the study. We identified 954 DRPs (range 1-7) in 80.7% of patients. Most DRPs were identified on the endocrinology, cardiology and geriatric ward, and they were associated with the efficacy of treatment (71.4%), adverse drug events (10.2%) and unnecessary drug treatment (18.4%). DRPs were associated with the cause of hospitalisation in 74.4% of patients on the nephrology ward, 60.1% and 60.6% of patients in the cardiology and endocrinology ward, respectively, whereas this number was lower in the geriatric and gastroenterology wards (26.9% and 8.9%, respectively). Suboptimal drug treatment due to medication omissions, was often associated with the potential cause of hospital admission. Focusing on patients with specific diseases and DRPs, rather than reducing the number of medications in primary care, may be potentially rational in the attempt to reduce drug-related hospitalisations.

Transient Hyperthyroidism of Hyperemesis Gravidarum: A Case Report from Rural Kenya

Purpose: The aim of the study was to assess the transient hyperthyroidism of hyperemesis gravidarum: A case report from rural Kenya.&#x0D; Materials and Methods: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.&#x0D; Findings: Hyperthyroidism complicates 0.2-0.4% of pregnancies. It may be diagnosed in the setting of hyperemesis gravidarum and can be pathological or transient. Untreated pathological hyperthyroidism has adverse maternal and fetal outcomes. Transient hyperthyroidism of hyperemesis gravidarum (THHG) affects up to 60% of women with hyperemesis, is self-limiting, and needs no antithyroid drug treatment. A diagnosis of THHG (rather than overt pathological hyperthyroidism) should be made when hyperthyroidism occurs in the setting of hyperemesis gravidarum and in the absence of pre-pregnancy hyperthyroidism, clinical findings compatible with maternal hyperthyroidism, and a negative antithyroid autoimmune profile. THHG resolves by the end of the first trimester without adverse pregnancy outcomes. We present a case from a rural Kenyan hospital to highlight the clinical profile and management of THHG for the primary care physician.&#x0D; Implications to Theory, Practice and Policy: Assessment of thyroid functions is indicated in hyperemesis gravidarum, where there are clinical features of hyperthyroidism. THHG is a self-limiting benign condition that may inappropriately lead to unnecessary drug treatment for pathological hyperthyroidism in pregnancy. A diagnosis of THHG should be made when a laboratory picture of hyperthyroidism occurs in the setting of hyperemesis gravidarum in the absence of pre-pregnancy hyperthyroidism, compatible physical findings, and a negative antithyroid autoantibody profile.

Drug therapy problems among hospitalized patients with cardiovascular disease

BackgroundOptimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases.MethodA prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients’ medical records. We employed Cipolle’s method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05.ResultsThe study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68–9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47–5.11).ConclusionMore than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.

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.

Evaluation of Drug Use in Three Secondary Health Facilities in Liberia Using the World Health Organization Indicators

Background: Effective and quality healthcare is achieved through rational drug use. The consequences of irrational drug use manifest as drug related problems like unnecessary drug prescription, ineffective therapy, inappropriate dose and adverse drug reactions. Objectives: To evaluate drug use and drug related problems in three secondary health facilities in Liberia. Methods: A retrospective analysis of 1200 prescriptions was conducted in the outpatient section of Liberia Government Hospital (LGH), Redemption Hospital (RH) and James Davis Junior Hospital (JDJH) to assess drug use with the WHO drug use indicators followed by assessment of drug-related problems (DRP) using the DRP-Registration Form 8.0. A prospective cross-sectional study was then conducted to evaluate consultation and dispensing time, and the availability of essential drugs list. Data were analysed by one-way analysis of variance using Statistical Package for Social Sciences (SPSS) version 20.0. Results were expressed as mean ± SD and values were considered significant at P &lt; 0.05. Results: The average numbers of medicines per prescription were 4.5 ±1.3, 3.6 ±1.1, and 3.7 ± 1.2 in LGH, RH and JDJH hospitals respectively (WHO value-1.6-1.8). The percentages of encounters with antibiotics were 77.5%, 74.3% and 82.5% respectively (WHO value - 20.0% - 26.8%). Observed DRPs were more in LGH for ‘no indication for drug use’ (6.50%) and ‘prescription of more drugs than clinically indicated’ (4.75%) while JDJH recorded more ‘inappropriate medication per established guidelines’ (4.00%) and ‘preventive/synergic drug not given for clinical indication’ (5.50%). Conclusion: Irrational use of drugs existed in all the three hospitals studied.

Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan.

Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP's frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan. This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle's classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classesprimarily associated with DTPs were specified. During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were "needs additional therapy" 46 (23.96%), "unnecessary drug therapy" 45 (23.44%), and "dosage too low" 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients' length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs. DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.

Pharmaceutical Challenges for Drug-Related Problems in Neonatal Intensive Care Unit: An Observational Study

Introduction: Neonates are very sensitive and vulnerable individuals. They require multiple medications during their stay in the Neonatal Intensive Care Unit (NICU), which can lead to pharmacological errors and Drug-related Problems (DRPs), like drug-drug interactions and adverse drug effects. Aim: To assess DRPs in the NICU to improve the quality of pharmaceutical care. Materials and Methods: This prospective observational study was conducted from June 2023 to August 2023 in a tertiary-level, well-equipped NICU at JNU Hospital, Jaipur, Rajasthan, India. All 61 neonates admitted to the NICU were included, except for those who were admitted for less than 24 hours and had not been prescribed any medications. All DRPs were documented using the Pharmaceutical Care Network Europe (PCNE V9.1). The problems related to DRPs, their causes, planned interventions, acceptance of interventions, and outcomes were assessed. The final analysis was conducted with the Statistical Package for Social Sciences (SPSS) software version 25.0. A p-value &lt;0.05 was considered statistically significant. Results: A total of 61 newborns were enrolled, of which 34 (55.74%) were males. DRPs were present in 47 (77.05%) of the total 61 patients. The total number of DRPs identified was 98. The most common problems were ‘unnecessary drug treatment’ 63 (64.29%) cases and ‘effect of drug treatment not optimal’ 28 (28.57%) cases. The most common cause of DRPs was ‘dose selection’ 105 (62.87%) cases. The intervention was accepted in 96 (97.96%) of the DRPs, and the problem was totally resolved in 70.41% of the cases. However, the problem remained unsolved in 17.35% of DRPs, primarily due to the ‘lack of cooperation from the prescriber’ in 9.18% of cases. Conclusion: Unnecessary and ineffective treatments, along with inappropriate doses, are the major problems and causes of DRPs. The need for clinical pharmacologists in NICUs, along with planned interventions and their acceptance, could help address these issues and ultimately lead to improved quality of care.

An observational study to determine the category and causes of the drug-related problems among geriatric inpatients

Background: Geriatric patients are at a higher risk of drug-related problems (DRPs) because of age-related chronic diseases leading to the use of numerous therapeutic regimens, and pharmacokinetic and pharmacodynamic changes. DRPs are associated with reduced quality of life, increased hospital admissions, prolonged hospital stays, and increased health-care costs. Aims and Objectives: This study aimed at identifying the category and causes of DRPs so that better strategies can be framed, thereby improving the quality of health care. Materials and Methods: The observational study was conducted among geriatric inpatients in a tertiary care hospital. The DRPs were identified using national and international standard guidelines. The Pharmaceutical Care Network of Europe (PCNE) classification version 9.01 was used to determine the category and causes of DRPs in the patients. Results: Seventy patients were enrolled in the study. A total of 102 DRPs were detected among these patients. The mean number of DRPs per patient was 1.45. According to the PCNE classification, 36 DRPs were related to treatment effectiveness, 27 were related to treatment safety, 25 were unnecessary drug treatments and 14 were related to cost effectiveness of the treatment. One hundred and fifty-one causes of DRPs were identified. The most commonly involved class of drugs in DRPs was antimicrobials. Conclusion: The number of DRPs noted in the present study was lower than those in the other studies. Majority of DRPs were treatment effectiveness-associated and caused due to errors in drug selection and use.