Persistent pain affects 20% of adults and can impair one’s daily functioning and well-being. Psychoeducational group interventions can be effective in aiding pain management and coping strategies, however the time commitment for most evidence-based programs (10-20 hours) leads to access barriers and delivery challenges in primary care. A mixed-methods, program evaluation was conducted on a low intensity, three-session, manualized group pilot psychoeducational intervention in a primary care practice, emphasizing pain education, behavioral strategies, and pain-alleviating activities. Eighty-two percent of the clinic’s panel of individuals with persistent pain (N=128) and being prescribed opioid pain medication attended at least one class (N=105). Attendees experienced significant pre-post improvements in self-reported pain functioning and favorable satisfaction ratings by patients and medical staff. However only 51% attended all three groups, despite frequent class offerings and heavily encourage by the patient’s medical providers. This study reviews the potential promise and limitations of a low-intensity, limited session pain group to aid pain-related functioning. Additional investigation is warranted to optimize participant attendance, group format and frequency, and outcome assessment.

Rationale, aims and objectives: Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients. The aims of this study were to evaluate the management of POAF in a cardiac surgery department, characterise the extent of its variability and develop a standardised protocol. Methods: Data from patients who underwent cardiac surgeries with subsequent POAF between 1 January 2017 and 1 June 2018 were analysed in this single-centre observational retrospective study. The primary outcome was the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy and both among hospital units (intensive care unit [ICU], intermediate care unit [IMCU] and general ward [GW]). Secondary outcomes included the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation. Results: Data from 97 patients were included in this study. The POAF management strategy differed significantly among hospital units (ICU: RhC 75.0%, RhC and RaC 19.4%, RaC 0.0%; IMCU: RhC 40.4%, RhC and RaC 34.6%, RaC 13.5%; GW: RhC 22.2%, RhC and RaC 33.3%, RaC 44.4%; p = 0.001). Ninety-five (97.9%) patients converted to sinus rhythm after the first POAF episode; 51.2% of these conversions occurred within 8 h after onset. POAF recurred in 56.7% of patients. Considering all POAF episodes, 83 (85.6%) patients received amiodarone as part of the RhC strategy. Based on these results, a hospital working group developed a standardised protocol for POAF management. Conclusions: POAF management was heterogeneous at our institution. This paper highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices for all patients undergoing cardiac surgery.

Rationale, aims and objectives: Appropriate treatment of paediatric fever in rural areas remains a challenge and may be partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda. Methods: Data on pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age was abstracted from drug shop sick child registers over a 12-month period; six months before and six months after introduction of peer-supervision. Interrupted time series was applied to determine the effectiveness of the peer-supervision intervention on appropriate treatment of pneumonia, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age attending drug shops in East Central Uganda. Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P<0.05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = 0.79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhoea was 4.00% (p <0.05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively. Post-intervention trend results showed an increase of 1.21% (p =0.008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (p <0.06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for non-bloody diarrhoea, respectively. Conclusions: Peer-supervision increased the proportion of children less than five years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhoea. Implementation of community level interventions to improve paediatric fever management should consider including peer-supervision among drug sellers.

Rational, aims, and objectives: To probe into the status of medication adherence in patients after PCI and its correlation with health literacy. Methods: A total of 260 patients after PCI in cardiology department of three hospitals in Zhengzhou, were investigated by two questionnaire, which are 8-item Morisky Medication Adherence Scale and Chronic Disease Health Literacy Scale. Results: The score of medication adherence was 5.21±2.04, the score of health literacy was 80.8±24.43; Multivariate linear regression analysis results showed that degree of education, the number of hospitalization, monthly income, course of diseases were the influencing factors of medication adherence, which could explain 61.2% of the total variation; The medication adherence in patients after PCI was positively correlated with health literacy. Conclusion: The higher levels of health literacy positively influenced medication adherence scores in patients after PCI. Nursing staff should assist the patients after PCI to establish self-health management awareness, in order to improve their medication adherence.

Rationale, aims, and objectives An inefficient health system wastes scarce resources even if it makes considerable gains in accountability and equity. Such a system is expected to perform better. Therefore, it is vital to examine the current performance of health systems and their constituents as well as assess how to reach their full potential. The aim of this study was to evaluate the technical and economic efficiency of medical diagnostic laboratories in hospitals affiliated with Urmia Medical Sciences University (UMSU) in 2016. Methods In this descriptive-analytical study, the data of all diagnostic laboratories of the hospitals of UMSU were inputted into Frontier 4.1 software after taking the logarithm. Then, the technical and economic efficiency of the laboratories were obtained by estimating the production and cost function using the stochastic frontier analysis method, assuming input minimization for 2016. Results The average technical and economic efficiency of the diagnostic laboratories was obtained as 0.931±0.34 and 0.519±0.33, respectively. These laboratories must reduce their inputs and costs to achieve full efficiency without changing the amount of their output. Conclusion Although the average economic efficiency of the diagnostic laboratories of the studied hospitals was high, there is still an increase in the efficiency of these units given the cost of inputs at the time of allocating resources. In addition, it is possible to improve the technical efficiency of the clinical laboratories of hospitals affiliated with UMSU by 48.1% by applying the same level of inputs and without increasing the costs.

Atopic dermatitis (AD) is the chronic relapsing inflammatory skin disorder that affects both in childhood and adulthood. Mounting evidence indicates that gut dysbiosis contributes to AD via the gut-skin axis. Constipation could result in alteration of the gut microflora. The clinical impact of constipation on AD has not been researched. Therefore, we aim to assess the risk of AD in constipated patients by the longitudinal nationwide population-based cohort study. We collected 87015 people with constipation and 87015 patients without constipation between 1999 and 2013 from the Longitudinal Health Insurance Database, which is the subset of Taiwanese National Health Insurance Research Database. Propensity score analysis was administrated to match age, gender, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression analysis was utilized to evaluate the adjusted hazard ratio of AD. In addition, sensitivity tests and a stratified analysis were conducted. The incidence of AD was 4.7 per 1,000 person-years in the constipation group, which was higher than the rate of 2.2 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, corticosteroids, and antihistamine, people with constipation had a 2.11-fold greater risk of AD compared to those without constipation (adjusted hazard ratio [aHR]: 2.11 (95% C.I. 1.98-2.24). In subgroup analyses, people aged 12-19 years had a 2.34-fold higher risk of AD in the constipation cohort (aHR; 95% CI, 1.84-2.98). Moreover, people with constipation had a higher likelihood of AD, regardless of gender, and with or without comorbidities, as well as the usage of corticosteroids, and antihistamines. Constipation is connected with a significantly risk factor of AD. Clinicians should be careful of the possibility of AD in people with constipation. Further study is warranted to investigate the possible pathological mechanisms of underlying this relationship.

This paper reviews the tools available to assess outcomes of treatment in irritable bowel syndrome, especially the effect on pain. It critically considers their development, relevance and reliability. Its conclusion is that there are few tools which meet the criteria necessary to place confidence in their validity as appropriate measures of patient outcomes.

Rationale, aims and objectives: Joint contractures are common complications among elderly residents in long-term care facilities, causing activity limitations and participation restrictions and affecting quality of life (QOL). The aim of this study is to examine the psychometric properties of the Chinese version of the PaArticular Scales in joint contractures population. Methods: A cross-sectional study design. A sample of elderly residents aged over 64 years with joint contractures in one important joint who have lived at a facility for more than 6 months in twelve long-term care facilities in Taiwan (n = 243). The Chinese version of the PaArticular Scales of joint contractures was generated through 5 stages: translation, review, back-translation, a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the WHOQOL-BREF and WHODAS 2.0-36 items. Criterion validity was assessed using correlation coefficients to examine changes in the activity limitations and participation restrictions subdomain and predict QOL. Results: The Activities and Participation subscales had excellent internal consistency (Cronbach’s α coefficient = .975; SD = 17.34). The correlation coefficients between the PaArticular Scales and the WHODAS 2.0-36 items (r = .770, p < .001) and WHOQOL-BREF were significant and highly correlated (r = -.553, p < .001). Conclusions: The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan, and the Chinese version has acceptable levels of reliability and validity.

Objectives This study aimed to measure the prevalence of potentially inappropriate medications (PIMs) in Chinese elderly population according to the 2019 Beers Criteria and to evaluate the associative factors of PIMs. Methods Prescriptions of patients aged over 65 years who were hospitalized during January 2017 to December 2017 were retrieved from Hospital Prescription Analysis Cooperation Project, covering seventy-six facilities in six cities in China. PIMs were identified by 2019 Beers Criteria. Results In total, 40.1% elderly patients were treated with at least one PIM independent of their diagnoses or conditions according to the 2019 Beers Criteria. The most frequently prescribed inappropriate medications independent of diagnoses or conditions were proton-pump inhibitors (12.9%). Diuretics (8.2%) and central nervous system medications (6.9%) also showed a relatively high prevalence among the investigated patients. Based on the Beers Criteria’s lists of drug-disease interactions, elderly patients with central nervous system conditions (including delirium, dementia or cognitive impairment) or with a history of falls or fractures were most commonly exposed to PIMs. Logistic regression revealed that inappropriate medication use was associated with age (≥80 years old), number of conditions (≥5), number of medications prescribed (≥10) and class of healthcare facilities. Conclusion This study was able to confirm that the phenomenon of prescribing potentially inappropriate medications was common in China. Our findings support the importance of developing explicit criteria to detect PIMs in China and implementing effective interventions to promote better quality of prescribing for elderly patients.

Objective: Drug-related problems (DRPs) can lead to consequences such as morbidity, mortality and increased costs. An electronic expert support system (EES) has been developed by the Swedish eHealth Agency to help pharmacists in community pharmacies identify potential DRPs, and to resolve actual DRPs. The objective of this study was to examine whether the use of the EES in a Swedish community pharmacy will result in more identified and resolved DRPs. Methods: In an open, prospective and controlled study, prescriptions were dispensed by three pharmacists with the use of EES during two weeks and without EES during two weeks in the spring of 2019. A DRP documentation template was developed and used. Identified DRPs, suggested actions and actions presented to patients and prescribers, and resolved DRPs, were documented and compared using Chi2-tests. Key findings: 100 patients were included in both the EES intervention group and in the control group. At least one actual DRP was identified in 26 intervention patients and 28 control patients. The number of patients with at least 1, 2 or 3–5 DRPs did not differ, but including the total number of DRPs reached statistical significance, favouring the EES-support group. EES-support helped pharmacists to present suggestions to physicians and consequently to resolve DRPs, primarily drug-drug interactions. Conclusion: Our study indicates that the EES dispensing support system contributes to the identification and resolution of DRPs, mainly DRPs related to drug-drug interactions and suggestions to the prescriber.

A document by CHENXIANG CAO. Click on the document to view its contents.

A document by Maximilian Richter. Click on the document to view its contents.

i. Rationale, aims and objectives Antimicrobial Stewardship programs are critical for promoting and monitoring judicious use of antimicrobials, however, there are many well-established barriers to their effective implementation the rural setting. Pharmacist involvement in such programs is recommended as part of a multidisciplinary approach to improve appropriate antimicrobial prescribing. The aim of this study was to describe the impact of implementing a clinical pharmacy service on antimicrobial prescribing in a rural GP led hospital; explore areas of suboptimal antimicrobial prescribing; and review the change in total antimicrobial cost per patient day. ii. Methods: A retrospective case series audit of pre- and post-implementation of a new clinical pharmacy service was undertaken. All adult patients who had presented with sepsis, cellulitis, urinary tract infections and pneumonia between May and August 2015 and repeated for months in 2018 were included. Appropriateness of therapy was assessed using the National Antimicrobial Prescribing Survey guidelines. iii. Results: A total of 115 antibiotic orders from 2015 and 158 orders from 2018 were included. During admission, 86% of patients (55/64) in the post-intervention group were reviewed by a clinical pharmacist. Appropriate prescribing increased from 57% (66/115) in 2015 to 82% (129/158) in 2018 (P=0.001). Ceftriaxone was the most inappropriately prescribed antimicrobial. The cost of antimicrobial therapy was halved from $10.00 to $5.33 per patient day, pre- and post-implementation of a clinical pharmacy service respectively. iv. Conclusions: The implementation of a clinical pharmacy service in a small rural GP led hospital can significantly improve antimicrobial prescribing practices and provide considerable cost savings. Keywords Antimicrobial stewardship; antibiotics; pharmacists; hospitals, Rural; Inappropriate Prescribing

Rationale, aims and objectives The Scottish Stroke Care Bundle (SSCB) aims to significantly improve patient outcomes and the consistency with which stroke patients are managed. The identification of key enablers and barriers to implementation will allow a future focus on the development of appropriate interventions to promote reliability of implementation. The aim of this study was to explore and describe the reasons why doctors and nurses in one Health Board area in Scotland feel that the SSCB is not being applied in a consistent and reliable way. The research objective was ‘to explore and describe the factors associated with compliance and non-compliance with the Scottish stroke care bundle’. Method A qualitative approach was used to understand the perspectives of medical and nursing staff involved in implementing the SSCB. Eight semi-structured interviews were undertaken across two sites. Cane et al’s Theoretical Domains Framework (TDF) guided data collection and analysis providing context-based explanations as to why reliable implementation of the SSCB is not being achieved.1 Results Three significant factors were identified that significantly influence the likelihood of patients receiving the SSCB: knowledge; resources; and organisational culture. The interrelationships between these factors revealed key enablers and barriers to the consistent application of the SSCB in this Health Board area. Conclusions Many of the findings are commonly identified as being crucial to the implementation of care bundles and potentially have national implications for SSCB implementation. Multifaceted quality improvement interventions, based on these findings, would improve the consistency of SSCB implementation in this Health Board area.

On 11/3/2020, the World Health Organization declared that COVID-19 is a pandemic emergency. In this scenario, cancer patients are to be considered at higher risk, being fragile and often with disease-related or treatment-induced immunodepression. Furthermore, this health emergency generates a harmful psychological impact on these patients, who fear a lot about losing the continuity of cancer therapy. This fact must be carefully considered by health personnel, especially in countries where heavy risk containment and social distancing measures, the only epidemiological strategies currently considered adequate, are in force. In short, this is a very delicate challenge for health professionals engaged in oncology. Here, we report some insights and challenges that healthcare professionals face daily in caring for cancer patients.

A document by somayeh noori Hekmat. Click on the document to view its contents.

Rationale, aims and objectives Public health systems are under pressure to meet increasing demand for health care in environments of increasing financial resource constraint. There is therefore a need to maximise health outcomes given limited public healthcare expenditure. This paper aims to establish the extent of literature and approaches to efficiency improvement in public health systems of developed countries. Methods The Rapid Evidence Assessment model was used to address the review question. Two database searches returned a result of 3,526 unique titles, which were individually screened for potential relevance. 144 titles were selected for full review to determine relevance. 73 papers were included in the final review. Results Data on country, study design, key findings and links to efficiency improvement were extracted and synthesized. Synthesis of findings revealed that the literature on this topic is disparate and non-cohesive. A range of isolated approaches were described, and no evidence or consensus on a single best-practice approach to efficiency improvement was identified. Conclusions Combining the factors identified in this review has the potential to inform a framework for supporting efficiency improvement in public health systems. By considering these factors central health system management bodies can support efficiency improvement to deliver both financial and health services benefits.

Rational: In March 2020, the World Health Organization (WHO) declared the coronavirus infectious disease as a pandemic referred to as COVID-19. As an essential service, community pharmacists have been enacting a key role in patient counseling and supply of essential medicines and protective equipment. Objectives: To investigate pharmacists’ perspectives of the role of educational institutes and professional pharmacy organizations in supporting them to take on roles during COVID-19 pandemic and to identify barriers to be able to support themselves and their patients. Methods: This descriptive mixed-method study was conducted via a cross-sectional online survey distributed to pharmacists/pharmacy students in Jordan during the COVID-19 outbreak (15-30 March 2020) using an online questionnaire, followed by an online focus group. Questionnaire items related to participants’ perspectives in being prepared for and supported in their roles during the COVID-19 pandemic and items were tested for face validity. Data were descriptively analyzed using the Statistical Package for the Social Sciences and triangulated with focus group findings. Results: Considering that fear and anxiety are a consequence of mass social distancing/quarantine, study participants (n=726, age=26.9 (SD=8.0) years, 71.9% females), reported needing training on mental healthcare to be able to support themselves and people during pandemics (90.2%). Most respondents agreed/strongly agreed (59.7%) with the statement around pharmacy educators/educational institutes having a key role in preparing pharmacists for practice during epidemics/pandemics, and agreed that their faculties should add a course regarding pandemic preparedness in their curriculum (89.9%). Results were similar regarding roles for the pharmaceutical associations. Focus group findings (n=7) mirrored the survey findings to a large extent. Conclusions: Most participants believed that Pharmacy Educators and pharmaceutical associations have a role in preparing them to deal with the COVID-19 pandemic through online educational workshops/webinars. Online education on mental healthcare is specifically needed.