Clinical pharmacists: Bridging the gap between patients and physicians.

The clinical pharmacy has spread out drastically in terms of its professional services throughout the past few years. The clinical pharmacist become a crucial element of healthcare team and promotes patient care by interacting with physician and patient. The aim of this paper is to highlight the role of clinical pharmacists in various departments. It concludes that the features of interactions occurring between clinical pharmacists and physicians influence the teamwork between pharmacists and physicians and provide better patient care.

Innovations in epilepsy management - an overview.

In the past twenty years, thirteen new antiepileptic drugs (AEDs) have been introduced, each differing in their efficacy spectrum, mechanism of action, pharmacokinetics, safety and tolerability profiles. These newer AEDs symbolize a welcoming future in the management of epilepsy because they are able to produce a remarkable reduction in seizure frequency in up to 40% to 50% of the patients who had been refractory to old generation drugs. Despite the current availability of these new drugs, only a few patients with truly refractory seizures can be made seizure free. Although the newer agents are not superior to that of the older drugs, some have been shown to be non-inferior in terms of their efficacy. They offer additional advantages like better tolerability, ease of use, reduced interaction profile. Even though in most situations the older generation drugs still represent the best choice, advancing studies show that in many conditions, new generation drugs may be entirely vindicated for initial therapy. This urges a need for the search of novel and more efficacious new antiepileptic drugs in the management of uncontrollable seizures. More direct comparisons of newer versus newer and newer versus older drugs in clinical trials, both for monotherapy and adjunctive therapy must be conducted. More than 20 compounds with promising antiepileptic and neuroprotective properties have been discovered and are under various stages of drug development. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Dabigatran: Clinical correlation of drug and its dose with risk of stroke and bleeding.

Background: Dabigatran is the first oral direct thrombin inhibitor which is endorsed by Food and Drug Administration in the prevention of embolic events in patients with nonvalvular atrial fibrillation. Suitable dose of the drug for the patient is selected based on CHA2DS2-VASc score and HAS-BLED score. Aim: To determine and compare the risk of occurrence of stroke and bleeding after the initiation of dabigatran therapy in patients prescribed with this drug. Methods: Patients with more than 18 years who were prescribed with dabigatran during 2017-2019 in a tertiary care hospital were selected for the study. Most of the patient's prescriptions contained an antiplatelet, so a comparison was made between the clinical outcomes of patients given with dabigatran alone and dabigatran with an antiplatelet because antiplatelet can have effects on the safety as well as efficacy profile of dabigatran. Results: Out of 75 patients enrolled in the study, 42 patients were in the dabigatran with the antiplatelet group and 33 were in the dabigatran alone group. In both the groups, there was a significant reduction in CHA2DS2-VASc score, i.e., 2.58 ± 1.32-1.94 ± 1.21 in dabigatran-treated patients within 6 months, and the score was lowered from 3.76 ± 1.22 to 2.92 ± 1.22 in other groups. The mean value of the HAS-BLED score of dabigatran was reduced from 1.15 ± 0.83 to 0.84 ± 0.78 and that of dabigatran with antiplatelet group from 2.10 ± 0.94 to 1.74 ± 0.92. Conclusion: It was observed that within 6 months, both the treatment groups showed a reduction in the risk scores. The dabigatran group had lower background risks of stroke and bleeding in comparison to the dabigatran plus antiplatelet group.

Multiple myeloma: Unveiling the survival data with different lines of treatments.

Purpose: The incidence of multiple myeloma (MM) is rising and there are fewer Indian studies; a comprehensive research of MM patients' survival data in a real-world population is needed. This study aims to analyze the survival status of MM patients with different treatment regimens along with its correlation to other parameters such as treatment-free interval (TFI) and time-to-next treatment (TTNT). Materials and Methods: This was a retrospective observational study, done in the department of oncology, at a tertiary care hospital in Kerala, from August 2019 to July 2020, to analyze the survival data in patients diagnosed with MM from 2015 to 2019. The effectiveness endpoints include time-to-event analyses such as TTNT and TFI. After receiving various therapy regimens, the survival rates were analyzed; the Kaplan-Meier estimator was used to determine the cumulative survival. The correlations between overall survival (OS) and duration of therapy, TFI, TTNT, and other parameters were calculated using the Karl Pearson's correlation coefficient. Results: 72 (82.80%) of the patients survived to the end of the study (OS), with a mean survival time of 4.02 ± 2.81 years. 52 (59.80%) patients had progression-free survival (PFS), while the remaining 35 (40.22%) had no significant disease prognosis. Both OS and PFS showed a significant positive correlation (P > 0.05) with TTNT and TFI. Conclusions: Completely adherent chemotherapy for 1 year can promise a survival time not <2 years. Longer TFI resulted in better OS and PFS. Extending the duration of the second LOT correlated with the better OS and PFS.

Clinical outcomes of levosimendan versus dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function.

To assess the clinical outcomes of levosimendan and dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function in Indian scenario. Cardiac, renal, electrolytes and hepatic parameters as well as the clinical outcomes were assessed. Levosimendan and dobutamine improved ejection fraction significantly. Levosimendan in comparison to dobutamine, increased cardiac output (0.76 vs. -0.38 at 48 h, 1.15 vs. -0.31 day 7, -2.02 vs. -1.51 day 30), cardiac index (0.89 vs.-0.13 at 48 h, 1.16 vs. -0.07 at day 7 and 1.05 vs. -0.25 at day 30) and eGFR (-1.4 vs. -0.75 at day 30) significantly. Levosimendan reduced ICU stay (p = 0.038) significantly whereas dobutamine decreased the hospital stay duration (p = 0.015). There was no major difference in re-hospitalization and mortality between groups. Ventricular tachyarrhythmia was the main adverse event noted in Levosimendan arm. Levosimendan showed improved cardiac as well as renal outcomes within a month when compared to dobutamine and it is the first study to determine the renal parameters of Levosimendan in an Indian setting.

Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department.

BACKGROUND: The usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality. However, majority of the HF patients do not receive GDMT or do not achieve the target dose. Literature has shown that the patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD's). It was a retrospective hospital-based study in which patients treated in HF clinic and other cardiology OPD in the year of 2017 were included (200 patients in each arm). The aim of this study was to assess the impact of heart failure clinics in medication therapy management including usage of guideline-directed medical therapy, if target dose specified by the guideline is achieved and time to reach target dose in comparison to other general cardiology OPD's. IRB and IEC approval were obtained before the commencement of the study. Data relevant to the study were obtained from the electronic medical record (EMR) and were compared between the study groups to see for the adherence to guideline and achievement of target doses. Data storage and analysis were performed using SPSS Version 24. A significance level of 5% was used. RESULTS: The usage of GDMT was higher in HF clinic when compared to other cardiology OPD (81% vs 55%, P = 0.001). A significantly higher number of patients in HF clinic achieved target dose when compared to other cardiology OPD (58% vs 29% -betablockers, 45% vs 9% -ACEI/ARB/ARNI, P = 0.000). Moreover, the number of eligible patients receiving DMD was found to be higher in HF clinic (98% vs 85% -betablockers, 69% vs 44% -ACEI/ARB/ARNI, 76% vs 44% -MRA). Also, the patients in HF clinic attained the target doses faster when compared to other cardiology OPD. In addition, there was better improvement in ejection fraction, as well as decreased rate of rehospitalisation and mortality in patients managed in HF clinic. CONCLUSION: HF clinics were compared with other cardiology OPD for various parameters and it was observed that HF clinics were better than other cardiology OPD in maintaining the medication therapy management.

Cellular telephones and electronic communication patterns among families in metropolitan New York.

OBJECTIVE: The authors gathered survey data regarding the use of cellular telephones among families who reside in the New York metropolitan area and whose children receive medical care in a hospital-affiliated general pediatrics clinic. METHODS: Two investigators distributed a 34-question, self-administered survey in pencil-and-paper format to pediatric patients and the adults who accompanied them in the waiting room of a hospital-affiliated, outpatient pediatric practice in Mineola, New York. RESULTS: Completed surveys were obtained from 35 families. Twenty-eight (80%) of the 35 families completing surveys reported that at least one family member owned and used a cellular telephone. Of these 28 families, 9 (32%) reported that at least one household member aged to 18 years owned and used a cellular telephone. The mean age at which children obtained their first cellular telephone was 15.3 years. The primary reason these respondents cited for providing children with cellular telephones was safety (75%). CONCLUSION: The authors conclude that cellular telephone use is widespread among families in the New York metropolitan area. Although the primary reason families provide for obtaining cellular telephones is safety, convenience to household members and peer pressure also play roles.

Myths and Facts about Vitiligo: An Epidemiological Study.

Vitiligo is a pigmentary disorder associated with many disease conditions that necessitates multiple drug regimens, which make the treatment complicated. This stigmatic disease forces the patient to approach all system of medicines as well as alternative medicines of non proven value, which further worsens the situation. At the same time the nonadherence to the treatment reflects poor prognosis, which is misunderstood for lack of response resulting in poor faith to the medications. The aim of this work was to assess the patient compliance and the factors affecting, and to monitor the adverse effects as well as drug interactions. The study was carried out in the Institute of Applied Dermatology for a period of one year. Patient compliance was assessed using Morisky Medication Adherence Scale and found that 71% of the patients were low adherent to medications. Family support, faith in doctor, higher educational status and effectiveness of the treatment were some of the reasons for medication adherence whereas forgetfulness, feasibility, occupational problem, polypharmacy, longer duration of treatment and the feeling that the disease under is control were some of the reasons listed for nonadherence. Three adverse reactions were reported with narrow band ultraviolet B and topical tacrolimus therapy and they were categorized into possible and probable according to causality assessment by Naranjo scale. Five drug interactions were reported and the causality assessment was done using drug interaction probability scale. None of the reactions were serious or life threatening. The present study revealed the hurdles in providing safe and effective treatment to the patients and also it suggest the need of doing more research on this disease since there is a general belief that vitiligo is an incurable disease.

Assessment of quality of life in patients on hemodialysis and the impact of counseling.

Chronic renal failure is an irreversible progressive condition responsible for high morbidity and mortality. Because it requires life-long treatment in the form of renal replacement therapy, the quality of life (QOL) of patients may significantly impair. Studies have revealed that patient education can play a significant role in improving the QOL in these patients. The primary objective of this study was to assess the QOL of patients on hemodialysis by using the World Health Organization Quality of Life assessment scale and also to study the impact of patient counseling in these patients. Fifty patients were selected for the study and they were randomly divided into two groups, control and test; counseling was given to the test group of patients. There was an increase in score in all the four domains (physical, psychological, environmental and social) among the test group when compared with the control group. Also, we found that the psychological domain showed significant increase in score compared with others. Our findings demonstrate that patient counseling plays an important role in improving the QOL by changing their psychological thinking and bringing them toward spirituality.