Suboptimal medication use may lead to morbidity, mortality and increased costs To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies Hence, there is a need for compiling the evidence within this area The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients Five databases (MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials The pharmacist interventions were well implemented with acceptance rates from 39% to 100% The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bcpt.12062

Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review.

Subject of Research. The paper presents the study of a graphite-epoxy composite plate strain detection possibility by the fiber-optic acoustic emission sensor mounted on its surface. Method. The proposed method consisted in additional lowfrequency phase-generated carrier implementation in the impulse Fabry-Perot interferometer and its amplitude evaluation. The phase-generated carrier amplitude depends on the interferometer optical path difference, therefore, its value change can be used for the studied composite strain estimation. VCSEL with a wavelength of 1550 nm was used as a light source. The phase carrier was generated by current modulation of the light source that caused center wavelength shift of the VCSEL. Main Results. The low-frequency phase-generated carrier signal amplitude dependence on the interferometer optical path difference and wavelength shift of the light source were obtained. According to simulation results the sensitivity of the proposed method is 1.6 urad×ppm, 5.3 urad×ppm and 13.3 urad×ppm at different values of the coefficient Kd 30, 100 and 250 pm, respectively. Experimental study of the proposed method and results analysis were performed. According to experimental results, the accuracy of the proposed method was about 110% that corresponds to the sensor relative stretch of 10 e, while the accuracy of the market available fiber optic systems based on fiber Bragg grating sensors equals to 4 ppm. Practical Relevance. The proposed method can be used for strain detection of the graphite-epoxy composite constructions along with its acoustic emission control by one fiber-optic sensor.

http://cyberleninka.ru/article/n/osobennosti-vremennyh-parametrov-transmitralnogo-diastolicheskogo-potoka-pri-serdechno-sosudistoy-patologii.pdf

Особенности временных параметров трансмитрального диастолического потока при сердечно-сосудистой патологии

AIM: To understand factors associated with quality of life (QOL), examine types of QOL instruments, and determine need for further improvements in QOL assessment.

METHODS: The method used databases (Pubmed, Google scholar) and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO definition of QOL.

RESULTS: For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 questionnaire manuals. Of the 34 studies, 82% were quantitative while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney disease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO definition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL.

CONCLUSION: Culture and disease specific QOL instruments that assess patients’ objective and subjective experiences covering most aspects of QOL are urgently needed.

Quality of life in end stage renal disease patients.

Purpose: To explore the quality of life in hemodialysis patients. Material and Methods: The sample studied consisted of 320 patients undergoing hemodialysis in one-day dialysis center. Data were collected by the completion of a specially designed questionnaire which apart from the sociodemographic and clinical variables, it also included the scale Missoula-VITAS Quality of Life Index (MVQOLI) for assessing quality of life. Results: Of the 320 hemodialysis patients, 57,2% were men while 28,1% of the participants were 71-80 years old. The average total score of quality of life was found to be 17.43 (in a range 0-30). The total score of quality of life was found to be higher in participants

/pdf/quality-of-life-in-hemodialysis-patients-48s72jlqxw.pdf

Quality of life in hemodialysis patients.

Introduction. Treatment modalities for end-stage renal disease affect quality of life (QOL) of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. Materials and Methods. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients’ caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Results. Eighty-nine patients (71.2%) were men, 99 (79.2%) were married, 75 (60.0%) were older than 45 years, and 77 (61.6%) were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 (environment). There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 (social relationship) of the patients at Mayo Hospital (a public hospital), which was significantly better. Nondiabetic patients had a better QOL in domain 1 (physical health) as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. Conclusions. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL.

/pdf/dialysis-related-factors-affecting-quality-of-life-in-11vpen1p86.pdf

Dialysis-related factors affecting quality of life in patients on hemodialysis.

A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis (n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired (P < 0.05) in comparison to healthy individuals of the general population, particularly with respect to the physical, psychological, and social relationship domains. In comparison to the quality of life of renal transplant patients, the quality of life of hemodialysis patients was significantly (P < 0.05) lower in all the four WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly (P < 0.05) lower quality of life than did male patients in the psychological and environmental dimensions of WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.

An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.

The primary aim of the study was to assess the medication knowledge of hemodialysis patients and to evaluate the impact of education on their medication knowledge. This was a prospective randomised study, conducted in two phases. Study population consisted of 90 hemodialysis patients, randomised into two groups. Baseline medication knowledge of these patients was assessed using medication knowledge assessment questionnaire developed for the study. During the first phase of the study, group I patients received the education provided by a trained clinical pharmacist regarding their medications for eight-weeks and group II patients were deprived of clinical pharmacist provided education but received services only by usual healthcare group. At the end of week eight, medication knowledge assessment questionnaire was applied to both the groups of patients. In the second phase, group I patients were deprived of clinical pharmacist education and group II patients were rendered with clinical pharmacist provided education for eight-weeks and medication knowledge assessment questionnaire was once again administered to both the groups at the end of week 16. At the end of week eight, there was a statistically significant ( P 0.05) improvement observed in scores of group II compared to baseline. At the end of week 16 of the study period, there was a statistically significant ( P< 0.05) improvement in the medication knowledge assessment questionnaire scores of the group II patients compared to their baseline and week eight scores. At the end of week 16 there was a significant ( P< 0.05) drop in the medication knowledge assessment questionnaire scores of group I patients compared to their week nine scores. The study confirms that medication knowledge of the hemodialysis patients was extremely poor regarding the name, indication and dosage regimen of their medications. Study emphasizes the need for the continued education to the hemodialysis patients for better understanding of the medications they use. A trained clinical pharmacist could play a vital role in educating hemodialysis patients, which has obvious benefits on therapeutic outcome.

/pdf/medication-knowledge-of-hemodialysis-patients-and-influence-ilhodedrh4.pdf

Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge

What is known and Objective: Patients suffering
from renal dysfunction often have multiple
medical conditions either as a cause or as a consequence
of their renal disease. These patients
receive an average of 10–12 medications daily
leading to complex dosing schedules and are
more likely to develop medication-related problems
(MRPs). The objectives of this study were to
determine the nature and extent of MRPs in
renally compromised patients and to explore the
potential clinical significance of the MRPs. The
potential for a clinical pharmacist to contribute
towards resolving or preventing some of these
MRPs was also explored.
Methods: A prospective study was conducted for
a period of 9 months in the renal unit of Jagadguru
Shri Shivaratheeshwara (JSS) Medical College
Hospital, Mysore, India. Patients undergoing
dialysis on outpatient basis and patients who
were admitted under the care of or referred to the
nephrologists for renal dysfunction from other
specialties were reviewed. Patterns of the MRPs
were identified using an adapted Hepler and
Strand criteria. The potential clinical significance
of the MRPs and the contribution of the clinical
pharmacist in resolving or minimizing some of
the MRPs were also explored.
Results and Discussion: Three hundred and
twenty-seven MRPs were identified with 308
patients reviewed. The incidence of MRPs was
found to be 1AE06 ± 0AE85 per patient reviewed. The
most common MRP identified in our study was
overdose (19AE3%) followed by adverse drug reactions
(19AE0%). Cardiovascular agents (33AE6%) followed
by anti-infective agents (26AE3%) were the
most common therapeutic classes of medication
implicated in causing MRPs. Twenty-six per cent
of the MRPs identified were explored to be
potentially moderate or major in clinical significance.
The clinical pharmacists’ recommendations
were accepted in 97% of the cases, which resulted
in a change in therapy in 83% of the cases.
What is new and Conclusion: Medication-related
problems are frequent in renally compromised
patients in our patient population. The high level
of acceptance of clinical pharmacist’s recommendations
by the nephrologists demonstrates that
clinical pharmacists may help improve overall
patient care in this setting.

Prevalence of medication-related problems among patients with renal compromise in an Indian hospital.

The aim of this research is to assess the impact of clinical pharmacist-provided education on medication adherence in haemodialysis patients. Ninety haemodialysis patients were randomized into two groups. Brief medication questionnaire (BMQ), a tool for screening adherence was administered to both groups at the baseline to assess adherence to antihypertensives, vitamin D analogues, phosphate binders and folic acid in haemodialysis patients. The intervention group received education regarding their medications by a clinical pharmacist over seven weeks. The control group received standard care. At the end of eight weeks, BMQ was once again administered to patients of both groups. At the baseline, there was no significant difference in the mean BMQ regimen, belief, recall and the medication access screen scores of the control and intervention groups. At the end of the eighth week, there was a significant drop (p<0.05) in the mean scores of regimen, belief and recall screens of BMQ in the intervention group, indicating an improved level of medication adherence. For the control group, there was no significant drop in the mean BMQ screen scores. The reported level of non-adherence was the highest for phosphate binders. We conclude that clinical pharmacist-provided education was effective in improving adherence behaviour of haemodialysis patients.

http://www.ijps.ir/article_2088_e7cc6977719142f04ad382d53fc5d6b5.pdf

MG Narahari

Papers

An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.

Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge

Prevalence of medication-related problems among patients with renal compromise in an Indian hospital.

Impact of Clinical Pharmacist-Provided Education on Medication Adherence Behaviour in ESRD Patients on Haemodialysis

Integrative medicine for global health program of morbidity management and disability prevention of lymphedema