Teamwork in Health Care Services Delivery in Nigeria: A Mixed Methods Assessment of Perceptions and Lived Experiences of Pharmacists in a Tertiary Hospital.

BACKGROUND: Lack of teamwork is the bane of weak and ineffective health care systems in many countries. This study examined the perceptions and lived experiences of pharmacists working in a Nigerian government-owned (public) multispecialty tertiary hospital regarding teamwork in their workplace. METHODS: A sequential explanatory mixed methods study using phenomenological approach of inquiry, was conducted among pharmacists with experience in multidisciplinary health care provision in a public tertiary hospital in Nigeria. Questionnaires with 16 close-ended questions based on a Likert scale, which scored from strongly disagree (1) to strongly agree (5), were administered. The mean (M) scores were determined using SPSS Version 20; M ≥ 3.00 indicated agree, while M < 3.00 disagree. Subsequently, focus group discussions were conducted, and the audio recorded responses transcribed and subjected to thematic analysis using NVivo 11. RESULTS: Some participants (50%) had worked for 5-10 years in the hospital's Department of Pharmacy, 25% (11-20 years), and 16.7% (21-30 years). Participants agreed that effective teamwork leads to positive patient outcomes (M = 3.67) and is in the public's interest (M = 4.25). However, they disagreed that their workplace supports teamwork (M = 2.33), effective interprofessional collaborative practices exist in the hospital (M = 1.08), and their remuneration reflects their worth to the organization (M = 2.33). Doctors' dominance and claim of ownership of patients, allied professionals' attitudes and ignorance of pharmacists' roles, salary disparity, poor communication, and defective leadership style among others were identified as impediments to teamwork. CONCLUSION: The hospital pharmacists demonstrated positive disposition towards teamwork, and agreed that effective teamwork would improve health care delivery. However, they identified some factors that hinder interprofessional teamwork in the hospital. Principles and practices of teamwork should be incorporated into the curriculum of each discipline; interdisciplinary collaborative practices, health system structure, institutional policies and leadership should be strengthened to enhance teamwork.

Pharmacological Evaluation of the Anticancer Activity of Extracts and Fractions of Lannea barteri Oliv. (Anacardiaceae) on Adherent Human Cancer Cell Lines.

In western Africa ethnomedicine, Lannea barteri Oliv. (Anacardiaceae) is believed to have activity against gastrointestinal, neurological and endocrine diseases. Previous studies on this plant have revealed antimicrobial, anticholinestrase, anticonvulsant, antioxidant and anti-inflammatory activities. However, the anticancer potential of L. barteri has not been studied to date. The aim of this study was to evaluate the anticancer potential of hot and cold extracts and silica gel column chromatographic fractions of L. barteri leaf and stem bark. The extracts and fractions were tested for anticancer activity by using the crystal violet cell proliferation assay on four adherent human carcinoma cell lines-5637 (bladder), KYSE 70 (oesophagus), SiSo (cervical) and HepG2 (hepatic). The inhibitory concentration (IC50) of fractions IH, 1I, 2E and 2F were: 3.75 ± 1.33, 3.88 ± 2.15, 0.53 ± 0.41, and 0.42 ± 0.45 µg/mL against KYSE 70 and 1.04 ± 0.94, 2.69 ± 1.17, 2.38 ± 3.64, 2.17 ± 1.92 µg/mL against SiSo cell lines respectively. Fraction 2E showed weak apoptotic activity at double the IC50 and some sign of cell cycle arrest in the G2/M phase. Thus, phytoconstituents of L. barteri leaf and stem bark can inhibit the proliferation of cancer cell lines indicating the presence of possible anticancer agents in this plant.

Evaluation of the anti-asthmatic and antitussive potentials of methanol leaf extract of Napoleona vogelii in rodents.

Napoleona vogelii is used in ethnomedicine for the treatment of asthma and cough. This study evaluated antiasthmatic and antitussive properties of its methanol leaf extract (NVE) in rodents. Phytochemical screening was conducted using established methods. Acute oral toxicity test was done in mice and guinea pigs. Ovalbumin (OA)-sensitized guinea pigs were orally pretreated with 100, 200 or 400 mg/kg/day of NVE or 0.5 mg/kg/day of salbutamol for 14 days before exposure to 0.2% histamine aerosol. Latency to preconvulsive dyspnea (PCD), tracheal fluid volume (TFV), flow rate (FR), and tracheal morphometry (TM) were evaluated. Tracheal rings from sensitized guinea pigs were tested in organ baths for antispasmodic and spasmolytic effects. Citric acid and ammonium hydroxide cough models were used to evaluate antitussive effects in guinea pigs and mice respectively. Tannins, alkaloids, flavonoids, and phenolic substances were found in NVE. LD50 values in mice and guinea pigs were greater than 5000 mg/kg. NVE caused a significant (P < 0.05) increase in the latency to PCD and a decrease in TFV in the group treated with 200 mg/kg. TM indicated a reduction in airway narrowing in NVE-treated groups. The presence of NVE significantly attenuated responses of tracheal rings to carbachol. Its addition to carbachol precontracted rings resulted in significant relaxation. Emax for calcium concentration-response was significantly (P < 0.01) decreased in the presence of NVE. Cough bouts dose-dependently decreased significantly (P < 0.05) in guinea pigs and mice. We conclude that NVE seems safe and possesses anti-asthmatic effect that involves inhibition of calcium influx. It also has antitussive properties that may be peripherally mediated.

Anti-inflammatory activity of Buchholzia coriacea Engl. (Capparaceae) leaf extract: evaluation of components of the inflammatory response involved.

BACKGROUND: Earlier studies in our laboratory demonstrated the anti-inflammatory activity of Buchholzia coriacea Engl. (Capparaceae) leaf extract, a herbal remedy used to treat disorders of inflammation. This study was undertaken to evaluate its anti-inflammatory mechanism(s). METHODS: The effects of methanol leaf extract of B. coriacea (200 and 400 mg/kg) on vascular permeability and leukocyte migration were studied in rodents, while activity on complement system and membrane stabilization were evaluated in vitro. RESULTS: The extract (200 and 400 mg/kg) inhibited acetic acid-induced increase in vascular permeability in a non-dose-related manner and significantly (p < 0.05) reduced the total and differential leukocyte counts, respectively, in a dose-related manner. It also significantly (p < 0.05) inhibited complement-induced hemolysis of sheep red blood cells (40-72%) and moderately inhibited heat- (6%) and hypotonic solution-(24%) induced hemolysis in vitro in a non-dose-related manner. CONCLUSIONS: Results demonstrated that the anti-inflammatory activity of B. coriacea leaf extract is mediated through inhibition of increase in vascular permeability, leukocyte migration and complement system, and enhanced membrane stabilization.

Immunomodulatory effects of Stachytarpheta cayennensis leaf extract and its synergistic effect with artesunate.

BACKGROUND: The leaves of Stachytarpheta cayennensis C. Rich. (Verbenaceae) have been reported to possess potent anti-inflammatory and anti-malarial activities. Due to close association between inflammatory and immune responses, we evaluated the immunomodulatory activity of leaves extract of S. cayennensis. The combined effects of the leaves extract and artesunate, a standard antimalarial agent with immunomodulatory effects, were also evaluated. METHODS: The immunomodulatory activity of the methanol extract of the leaves of S. cayennensis (MESC) was evaluated in mice using the Delayed-Type hypersensitivity response (DTHR), primary and secondary humoral immune responses and the in vivo leucocyte mobilization tests. The immunomodulatory effect of artesunate and the combined effects of MESC and artesunate were evaluated using the phagocytic activity of polymorphonuclear neutrophils. Acute toxicity and lethality test in addition to the preliminary phytochemical studies of MESC were also performed. RESULTS: The MESC exhibited 64.21% inhibition of DTHR at 500 mg/kg dose and evoked 139.64% of phagocytic stimulation at 100 µg/ml dose. Also MESC significantly (p < 0.05) showed dose related stimulation of humoral immunity and a highest percentage leucocyte mobilization of 10.15% at 250 mg/kg dose. Artesunate offered a non-significant (p > 0.05) percentage phagocytic stimulation (PPS) while the combined effect of artesunate and MESC exhibited a significant (p < 0.05) dose dependent PPS with highest PPS of 393.77% at 100 µg/ml. The LD50 of the MESC was estimated to be greater than 5000 mg/kg since there were no lethality and signs of acute intoxication after 48 h observation. Preliminary phytochemical analysis revealed the presence of carbohydrates, glycosides, flavonoids, saponins, alkaloids, terpenoids and steroids. CONCLUSIONS: The results of this study indicated that MESC possesses immunostimulatory action with significant synergistic effects with artesunate, and can therefore, offer immune boosting activities in disorders of immune suppression.

Evaluation of the acute and sub acute toxicity of Annona senegalensis root bark extracts.

OBJECTIVE: To investigate the safety profile of Annona senegalensis (A. senegalensis). METHODS: Dried powdered root-bark of A. senegalensis was prepared by Sohxlet extraction using methanol-methylene chloride (1:1) solution and concentrated to obtain the methanol-methylene chloride extract (MME). MME was fractionated to obtain the n-hexane (HF), ethylacetate (EF) and methanol (MF) fractions. Acute toxicity (LD(50)) test was performed with MME, HF, EF and MF in mice by oral route. The sub acute toxicity studies were performed in rats after 14 days of MME administration while haematological and biochemical parameters were monitored. RESULTS: Medium lethal (LD(50)) values of 1,296, 3,808, 1,265 and 2,154 mg/kg were obtained for the MME, MF, HF and EF, respectively. The sub-acute toxicity studies indicated a significant (P<0.05) increase in the body weight of both the treated rats and the control. The haematological tests indicated no change in the packed cell volume values but a significant (P<0.05) increase in the total WBC count at 100 and 400 mg/kg doses. The differential analysis showed a decrease in the nutrophils and a non-significant increase in the lymphocyte counts. The liver transaminase enzymes, alanin transaminase and aspartate transaminase showed no significant increase compared to the control. Histopathological examination of the liver sections also indicted no obvious signs of hepatotoxicity except with the 400 mg/kg dose that showed degeneration and necrosis of the hepatocytes. CONCLUSIONS: These results indicated that the root bark extracts of A. Senegalensis are safe at the lower doses tested, and calls for caution in use at higher doses in treatment.

Experimental evidence for the antidiabetic activity of cajanus cajan leaves in rats.

The antidiabetic activity of methanol leaves extract of Cajanus cajan (L.) Millsp. (Fabaceae) was studied in alloxan-diabetic and in oral glucose loaded rats. The acute toxicity and lethality (LD50) and the phytochemical analysis of the extract were also evaluated. The results showed that the extract (400 and 600 mg/kg) significantly (P<0.05) reduced fasting blood sugar of alloxan diabetic rats in a dose-related manner, with maximum hypoglycemic effect at 4 - 6 h. The extract (400 and 600 mg/kg) also significantly (P<0.05) suppressed the peak postprandial rise in blood glucose of normal rats by 101.8 and 57.40% respectively. Acute toxicity and lethality test of the extract in rats gave an oral LD50 greater than 5 g/kg. The findings indicate that the leaves of C. cajan may be beneficial as an antidiabetic therapy.