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   Table of Contents - Current issue
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April-June 2021
Volume 10 | Issue 2
Page Nos. 59-105

Online since Tuesday, August 3, 2021

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ORIGINAL ARTICLES  

Assessing the performance of community pharmacies in iran by measuring responsiveness to non-medical needs: An application of who responsiveness framework p. 59
Saba Afifi, Amir Hossein Alizadeh Bahmani, Leila Zarei, Motahareh Mahi-Birjand, Mehdi Hoorang, Marziyeh Zare, Iman Karimzadeh, Farzad Peiravian, Mahtabalsadat Mirjalili, Payam Peymani
DOI:10.4103/jrpp.JRPP_21_23  
Objective: Despite growing debates about the health systems' nonmedical performance, there has not been any empirical research on nonmedical performance and patients' rights consideration as a driver of human rights in the pharmaceutical sector. This study's main objective was to assess the nonmedical performance of community pharmacies of Shiraz, Iran. Methods: A cross-sectional study was conducted using two self-administrated Likert-based questionnaires based on the World Health Organization (WHO) responsiveness framework and the legal charter communicated by the Ministry of Health and Medical Education of Iran. The population was patients older than 18 years who took a prescription from community pharmacies located in Shiraz and willing to answer the questions voluntarily, from 2018 to 2019. Considering the weights of subdimensions of responsiveness provided by the WHO framework, the total score of responsiveness was calculated ranging from 0 to 100. Findings: The response rate was 80.5%. The mean (standard deviation) overall score of responsiveness was 57.18 (21.61), with a median of 56.71. The mean score of client orientation was lower in respondents with a high education level than those with a diploma and under diploma (P = 0.028). Conclusion: Nonmedical pharmacy performance was considered either medium or high in more than half of the cases based on the participants' views. Regarding client, orientation was seen less often in patients with high education level compared to those with a lower education level.
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Metabolic acidosis in multi drug poisoning with antidepressants and antipsychotics p. 65
Nastaran Eizadi-Mood, Saba Dehghanzad, Ali Mohammad Sabzghabaee, Ziba Farajzadegan
DOI:10.4103/jrpp.JRPP_20_106  
Objective: In this study, we evaluated the predictive factors for the occurrence of metabolic acidosis in patients with multi-drug poisoning, including antidepressants (Ad)/antipsychotics (Ap). Methods: This cross-sectional study was carried out in the referral poisoning center, Khorshid University Hospital, affiliated with Isfahan University of Medical Sciences. All patients with multi-drug ingestion, including Ad/Ap, were included in the study. Patients were divided into two groups with and without metabolic acidosis. Demographic factors, time from ingestion to admission, clinical manifestations, length of hospital stay, and outcome were compared in two groups. Binary logistic regression was used to identify factors associated with the risk of metabolic acidosis occurrence. Findings: Among the 206 evaluated patients, 45 patients (21.8%) had metabolic acidosis whom the majority were female (73.3%) with intentional purposes (77.8%). 31.1% of the patients with metabolic acidosis had tachycardia on admission (P = 0.03). Among all variables, time from ingestion to admission (P = 0.02) and lengths of hospital stay (P = 0.002) were significantly different between patients with and without metabolic acidosis. Tachycardia on admission (adjusted odds ratio [OR], 2.24; 95% confidence interval [CI]: 1.05–4.76; P = 0.036) and time from ingestion to admission (adjusted OR, 1.06; 95% CI: 1.00–1.13; P = 0.04) were also the predictive factors in occurrence of metabolic acidosis. Most of the patients survived without any complications (94.6%), of whom 72.3% had no previous underlying somatic diseases (P = 0.05). Conclusion: Admission tachycardia and the time elapsed from ingestion to admission may be considered important factors for predicting metabolic acidosis in multi-drug poisoning, including Ad/Ap.
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Effect of 2 mg versus 4 mg of intravenous zoledronic acid on bone mineral density at the lumbar Spine in Indian postmenopausal women with osteoporosis: A Double-blind parallel-arm randomized controlled trial p. 71
Harsh Durgia, Sadishkumar Kamalanathan, Govindarajalou Ramkumar, Sonali Sarkar, Sagili Vijaya Bhaskar Reddy, Jayaprakash Sahoo, Rajan Palui, Henith Raj
DOI:10.4103/jrpp.JRPP_20_130  
Objective: The primary purpose was to compare the effect of 2 mg and 4 mg of intravenous zoledronic acid (ZA) on change in the lumbar spine (LS) bone mineral density (BMD) at the end of 1 year in postmenopausal women with osteoporosis. The secondary objectives were changes in BMD at the total hip and femoral neck, change in bone turnover markers (BTMs), and the incidence of new fractures. Methods: This was a double-blind, parallel-arm, randomized control trial with an allocation ratio of 1:1 done in 70 postmenopausal women with osteoporosis. Findings: The mean (±standard deviation) percentage increase in LS BMD at the end of 1 year was 4.86% ± 3.05% and 5.35% ± 3.73% in the 2 mg and 4 mg group, respectively. The dose of 2 mg ZA proved to be inferior to 4 mg with a noninferiority margin of 0.5%. There was no difference in BMD change at hip and BTMs between the two groups at the end of 1 year. Only one patient in 4 mg group developed two new vertebral fractures during a 12-month follow-up. Acute-phase reactions were the most common (43%) side-effects noted without any difference between the two groups (P = 0.63). Conclusion: This study failed to show the noninferiority of 2 mg ZA compared to 4 mg ZA for change in LS BMD at the end of 1 year.
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Consumer's satisfaction with community pharmacies in Sindh, Pakistan p. 78
Yun Jin Kim, Muhammad Shahzad Aslam, Syed Muhammad Fahim, Waris Ali Khan, Linchao Qian
DOI:10.4103/jrpp.JRPP_20_108  
Objective: The present research is the first comprehensive cross-sectional study of consumer satisfaction with community pharmacies in Sindh, Pakistan. Moreover, the study has also designed a nonorder theoretical model for consumer satisfaction with community pharmacies. Methods: This is a cross-sectional descriptive study from a general population of Sindh, Pakistan, with a total of four hundred and fifteen (n = 415) participants. A confirmatory factor analysis was used to verify the factor structure between Pharmaceutical services (PS), the Skill of Pharmacists, Non-pharmaceutical services (NPS), and pricing (P). Pearson correlation analysis, Kendall's tau correlation analysis, and Spearman's rho correlation analysis were used to identify the correlation between different factors, such as PS, SKP, NPS, and P. Findings: The 23-item scale that consisted of four elements have shown an acceptable root mean squared error of approximation (0.076), Cronbach's alpha (0.787), and Chi-square value (3.381) (P < 0.001). Of the respondents, 56.4% rated their satisfaction on pharmacist attitude, whereas 67.2%, 41.4%, and 51.8% were satisfied with other services, such as receipt provided on medication they take, prescription drug service and availability of pharmacies on the weekend and public holidays, respectively Conclusion: This cross-sectional study confirms that there are relationships among PS, SPK, NPS, and P. Moreover, there is a lack of facilities in community pharmacies in Sindh, such as the unavailability of a consultation room, immunization services, information on routine health matters, and medication record.
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The pattern of medication usage in the southern region of Iran: A population-based pharmacoepidemiological study p. 83
Marziyeh Zare, Saba Afifi, Amir Hossein Alizadeh Bahmani, Iman Karimzadeh, Mohammad Salehi-Marzijarani, Leila Zarei, Behnam Honarvar, Sulmaz Ghahremani, Kamran B Lankarani, Ali Mohammad Sabzghabaee, Payam Peymani
DOI:10.4103/jrpp.JRPP_21_5  
Objective: The purpose of this study was to document the demographic data, to assess the proportion of consumed medicines and the amounts and types of drugs available to households, and to to estimate the probable prevalence of certain diseases in the southern region of Iran. Methods: In this cross-sectional population-based study carried out in Shiraz (the central city in the Southern part of Iran), we documented and evaluated the drug usage details in a random sample of 1000 households during 2018–2020. We analyzed the usage of drug categories based on the anatomical therapeutic chemical classification, which the World Health Organization recommends. Findings: In the studied population, the average age (± standard deviation) was 45.54 ± 15.82, ranged 18–91 years. More than 90% had medical insurance coverage. About 81.8% of the participants had individual family medicine practitioners, and most of them (93.8%) received medications with a physician's prescription. The most frequently used medications were cough and cold preparations (12.9%), nervous system drugs (12.6%), and cardiovascular system drugs (11.6%). Conclusion: Despite the easy access to medications for most participants, few individuals (about 6%) received their medications without a prescription. The most frequently prescribed medicines were the common cold, acetaminophen, and metformin. Common cold, gastrointestinal (GI) disorder, and diabetes were the most commonly used medication classes. Furthermore, we have found a probably higher than average prevalence of cardiovascular, GI, and endocrine disorders. This information could be used by the local policymakers as a basis for the estimation and allotment of health-care resources.
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Cost-effectiveness and cost–utility analysis of the use of clopidogrel and pantoprazole in comparison with clopidogrel and omeprazole for the secondary prevention of myocardial infarction in Iran p. 90
Mohammadreza Amirsadri, Valiollah Hajhashemi, Amir Shahriar Asemi
DOI:10.4103/jrpp.JRPP_21_22  
Objective: Gastrointestinal bleeding, a side effect of clopidogrel, is usually prevented by proton-pump inhibitors (PPIs). Due to omeprazole's inhibitory effects on the liver enzyme CYP2C19, its concomitant use with clopidogrel is argued to increase the risk of myocardial infarction (MI) recurrence, as CYP2C19 activates clopidogrel. Pantoprazole as an alternative PPI has shown no inhibitory effect on CYP2C19. This study investigates the cost-effectiveness of concomitant use of clopidogrel and pantoprazole in MI patients compared to the simultaneous use of clopidogrel and omeprazole. Methods: We used the Markov-modeling technique with a hypothetical cohort of 1000 acute MI patients aged 55 years using Microsoft Excel 2013 software. The study was done from the payer perspective, and a lifetime horizon with 1-year cycles was considered in the model. Life-years gained (LYG) and quality-adjusted life-years (QALYs) were used to quantify the health effects of these interventions. Two separate scenarios of public tariffs and private tariffs with various discount rates (0%, 3%, and 7.2% discounts (only for costs)) were evaluated, and an incremental cost-effectiveness ratio (ICER) was used to report the results. One-way and probabilistic sensitivity analyses were used to deal with uncertainty. Data were sourced from published literature and tariff book of the Iranian ministry of health. Findings: The estimated ICERs were 342 USD/QALY and 236 USD/LYG per patient for the base-case scenario. Conclusion: Abiding by the WHO threshold for cost-effectiveness, the concomitant use of pantoprazole and clopidogrel can be considered cost-effective compared to the use of omeprazole and clopidogrel.
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Efficacy of the combination of indomethacin and methocarbamol versus indomethacin alone in patients with acute low back pain: A double-blind, randomized placebo-controlled clinical trial p. 96
Shiva Samsamshariat, Mehdi Sharifi-Sade, Shafeajafar Zoofaghari, Asieh Maghami Mehr, Ali Mohammad Sabzghabaee
DOI:10.4103/jrpp.JRPP_21_31  
Objective: Acute low back pain is a common ailment and causes pain and disability. Physicians often prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to treat acute low back pain; however, due attention has recently been drawn to muscle relaxants to reduce the severity of patients' daily physical dysfunction. Therefore, this study aimed to evaluate the therapeutic effect of the administration of indomethacin alone compared with methocarbamolas a muscle relaxant and indomethacin as an NSAID on the treatment of acute low back pain. Methods: The present double-blind clinical trial was performed on 64 patients with acute low back pain. The patients were categorized into two groups and received the treatments as follows. Indomethacin capsules of 25 mg every 8 h and placebo tablets every 8 h were administered in the first group (Group I). Indomethacin capsules of 25 mg every 8 h and methocarbamol tablets of 500 mg every 8 h were administered in the second group (Group I + M). Patient pain intensity and physical function based on Back Pain Function Scale (BPFS) were recorded before and 1 week after the intervention. Findings: The present study results revealed that the mean pain reduction of patients in Group I + M was significantly higher than that of Group I (3.66 ± 3.17 vs. 1.84 ± 1.53; P < 0.001). Moreover, the mean BPFS increase in Group I + M was significantly higher than that of Group I (19.44 ± 8.66 vs. 4.75 ± 4.35; P < 0.001). Conclusion: According to the results of the present study, concomitant administration of indomethacin and methocarbamol can be more effective in reducing pain intensity and improving the patient's physical function (or performance).
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Assessment methods and competency mapping in pharmacy education: Understanding of components and quality parameters p. 102
Syed Wasif Gillani, Kishore Gnana Sam, Fithawit Bahran Gebreigziabher, Jumana Al-Salloum, Rizah Anwar Assadi, Shabaz Mohiuddin Gulam
DOI:10.4103/jrpp.JRPP_21_29  
Centre of advanced pharmaceutical education have developed 15 subsets of competencies required to be competent pharmacist and able to provide optimum care. These competencies were further categorized; Level 1 intermediate, Level 2 efficient, and Level 3 professional. These competencies are cross-mapped to achieve desirable outcomes. Where personal and professional development skills incorporate knowledge, for being a holistic pharmacist. In healthcare education curriculums, active learning tools such as simulation-based patient cases and other innovative learning activities are used to teach clinical skills, patient assessments, and pharmacotherapy concepts. The advance team-based learning technique for the development of stepwise understanding of disease management (simple-complex cases) and students can communicate and collaborate for the critical thinking and decision-making process. Many studies showed the positive impact of the peer teaching on the students; enhanced their academic performance, increase the cognitive congruence, and allows the students to share their own learning struggles to come up with solutions to overcome these challenges. Pharmacy is a healthcare professional required intensive training and professional skills to provide optimum care to patients. The emerging clinical role of pharmacy focused on the patient-centered model, comprehensive assessment, and teaching methods are required to fulfill the professional competencies.
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