Class of 2013 Abstract / Specific Aims: To evaluate three complementary and alternative medicines (CAM), tai-chi, acupuncture, and melatonin, for treating insomnia using meta-analysis assessment of randomized controlled trials. Methods: The electronic database MEDLINE (PubMed) was searched from May of 2012 to November of 2012 by using the terms “sleep initiation and maintenance disorders” AND “tai-chi” OR “melatonin” OR “acupuncture”. All of the searches ended at November of 2012. Data extraction was conducted independently by 2 investigators and any disagreements were resolved by consensus. If the 2 investigators could not agree, the study was reviewed by all 4 investigators. Main Results: Out of 500 studies that were initially retrieved, 12 studies were included; 3 for tai-chi; 4 for acupuncture; 5 for melatonin. We found that the effect of each type of intervention was significantly different than zero, p<0.01 thus all were effective in treating insomnia. From our analysis, acupuncture was the most effective (standard mean difference, SMD=-0.66; p<0.01) followed by tai-chi (SMD=-0.43; p<0.01) whereas melatonin was the least effective (SMD=-0.26; p=0.04) but difference between acupuncture and melatonin was not significant (p=0.15).       Conclusion: All three interventions were found to be effective in treating insomnia. However, due to mixed and inconsistent data of the studies, poorly designed trials, and small sample size, further large, well-controlled trials are warranted.

No abstract available / Dissertation (LLM)--University of Pretoria, 2012. / gm2014 / Centre for Human Rights / Unrestricted

Purpose: The United State health system is fractionated: most patients travel from location to location to see various clinicians about specific aspects of their health. The poor outcomes and high cost we currently see in the United States health system has challenged clinicians to explore better processes. This study sought to identify the potential impact of utilizing interprofessional transitional care (IPTC) teams in the primary care setting following hospitalization. One outcome measured was the relationship between pharmacist’s participation and number of medications a patient was taking after their IPTC visit. Electronic Health Records were utilized to extract patient data and it was analyzed using SPSS and R programming to examine relationships between patient populations, disease states, number of medications, and pharmacist intervention. This study was conducted as part of an overall investigation into benefits of IPTC teams in Primary Care. We expect that the number of the medications to be reduced for patients that had a pharmacist involved in their transitional care visit.

Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.

1 ABSTRACT BELIEFS ABOUT MEDICINES, COMPLEMENTARY AND ALTERNATIVE MEDICINE USE AND MEDICATION ADHERENCE Student: Drapáková Tereza Tutor: PharmDr. Matoulková Petra, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic Introduction: Medication non-adherence is a very complex problem across different diseases leading to failure of treatment and increasing costs for medical care. Medication adherence is influenced by various factors and is also connected with different patients' attitudes to classical pharmacotherapy and complementary and alternative medicine (CAM). CAM is nowadays quite often used option for chronically treated patients. Aim of the study: The aim of the study was to analyse medication adherence at chronically treated patients visiting pharmacies in the Czech Republic, their attitudes to CAM including percentage of using CAM, the most common reasons using CAM and which types of CAM are the most spread among asked patients. Methods: Questionnaires were distributed in pharmacies in the Czech Republic among patients 18 years old and older who were chronically treated for at least 3 months. Selected patients were asked to complete a questionnaire containing questions about CAM, Czech version of Medication Adherence...

Magister Public Health - MPH / Chronic non-communicable diseases (NCDs) have not received adequate attention in Eswatini (formerly Swaziland) due to the high burden of HIV/AIDS, tuberculosis and other communicable diseases. However, in 2019, NCDs were estimated to account for 45.86% of all deaths in the country with cardiovascular diseases, diabetes mellitus and chronic respiratory conditions amongst the top ten causes of death. Persistent shortages of medicines in public health facilities in Eswatini have been observed resulting in patients purchasing their medicines from private retail pharmacies.

Magister Pharmaceuticae - MPharm / Evidence indicates that most South African households do not dispose of unused medicines in the manner prescribed by the medicine’s regulatory authority. This trend is not unique to South Africa, but several developing nations have also lagged. An in-depth understanding of practices of disposal of unused as well as expired medicines is cardinal and critical to the development of an effective programme to reverse the situation. This study aimed to identify factors influencing the disposal practices of household unused and expired medicines, and the role of pharmacists in creating an efficient and robust system for proper disposal of unused medicine from households in the southern suburbs area of Cape Town.

Charles University, Faculty of Pharmacy in Hradci Králové Department of: Social and Clinical Pharmacy Author: Roman Vorel Supervisor: PharmDr. Jan Kostřiba, Ph.D. Title of Diploma Thesis: Pharmacovigilance of active substance zolpidem Introduction: Drug safety became very important topic in the second half of 20th century, even beyond pharmacy. It relates to increasing impact on testing of drugs before launch onto the market, but also following monitoring, so the benefit and risk ratio of drug can be determined. Pharmacovigilance takes care of monitoring of drug use risk. Zolpidem is active substance from class hypnotics and it is used for short-term treatment of insomnia. Most professionals recommend zolpidem as first line treatment of acute insomnia. That is why it can be considered as one of the most important hypnotic drugs. Objectives: The aim of this diploma thesis is to analyze spontaneous reports for adverse drug reaction for zolpidem from years 2004 to 2017. The thesis focus on reports from the Czech republic but also from the whole world. The information in SPC of medicinal products containing zolpidem which were distributed from 2004 to 2017 are compared. Methods: Following data from years 2004 to 2017 were used: 1) List of spontaneous reports for adverse reaction from the Czech republic...

Improving medication management at transitions of care is a national and international priority. People with dementia, who transition between hospitals and care homes, can be at an increased risk of adverse events, harm and costly re-hospitalisation. There is limited research which examines factors which may influence the quality and continuity of medication management in this context, particularly in the UK. This research uses a systems approach to explore the factors which may influence the quality and continuity of medication management when people, with dementia, move between the care home and hospital setting. This multi method, multi-phase study included interviews with hospital staff, care home staff, residents with dementia and relatives and examination of policies and documents used to support medication management at transition. Overall, policy recommendations and implementation strategies to support medication management at transition were limited. Residents, staff and relatives emphasised the importance of administration routines and preferences, but there were no strategies to support the communication of this information. Procedures, tools and training to support care homes based medication reconciliation was also limited. Residents and relatives were rarely involved in medication management due to limited resources and decision making. This sustained, rather than challenged, the power imbalance between residents and staff. Better defined roles and integrated processes which take account of the needs of this transition may help residents, relatives and care home staff to feel valued and empowered to provide information which supports person-centred medication management and boost resilience by helping to identify medication errors or adverse events. / Alzheimer’s Society

Medicines optimisation requires healthcare professionals to work collaboratively to meet the medication needs of patients. A grounded theory was produced which explains how doctors, nurses and pharmacists work to optimise the use of medicines in acute hospital settings in Northern Ireland. Seventeen semi-structured, one-to-one interviews were conducted with doctors, nurses and pharmacists. Concurrent data collection and analysis was carried out using coding, particular to grounded theory, adopting a constant comparative approach, writing memos and using theoretical sampling as described by Strauss and Corbin (1998). The core category was managing risk. Participants had an implicit understanding of the need to continually manage risk when working with the complex and the routine. They used personal and systemic checks and balances which could be viewed either as duplication of effort or indicative of a culture of safety. Multi-professional interdependencies and support for new, professional, non-medical roles were highlighted. Working together was a further strategy to ensuring each patient gets the right medicine. Establishing an agreed framework for working with medicines at ward level could support the safer use of medicines. It is anticipated that this theory will contribute to the design of systems involved in medicines use in acute hospitals in Northern Ireland. / Part-funded by: Northern Ireland Centre for Pharmacy Postgraduate Learning and Development (NICPLD), Western Health and Social Care Trust