Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path.

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.

[A Questionnaire Survey of Nurses on Pharmacist Services in the Emergency Rooms at Tokushukai Medical Group].

We conducted a multicenter survey of emergency room nurses to obtain information that would be useful for the establishment of pharmacist services in emergency rooms. Notably, 199 valid responses were obtained from 12 hospitals. The most common expectation from pharmacists in the emergency room was "drug management" (70.9%), followed by "providing information to physicians regarding the patient's medication history" (59.3%), and "auditing of dosage and interaction" (57.3%). The working arrangements that the survey respondents wanted regarding pharmacists in emergency rooms were: 24 h pharmacist (41.7% wanted this arrangement), day-shift pharmacist (24.6% wanted this arrangement), 24 h on-call (17.1% wanted this arrangement), day-shift on-call (5.0% wanted this arrangement), telephone support (11.1% wanted this arrangement), and 0.5% said that there was no need for pharmacists. In the analysis of factors affecting nurse satisfaction, day-shift pharmacist was a significant factor. We hope that the results of this survey will be used as a guide for the development of emergency room pharmacist services tailored to the unique characteristics and actual working conditions of each hospital.

Survey of community and hospital pharmacist involvement in outpatient chemotherapy using Japanese health information data.

In this study, information on injectable anticancer drug use and additional fee for enhanced collaboration (AEC) and additional fee for specific drug management guidance 2 (ASD2) claims from the NDB Open Data Japan (NODJ) dataset and the number of patients with cancer according to sex and age from the National Cancer Registry (NCR) dataset were integrated and evaluated to determine the current status and challenges in pharmacist interventions for patients receiving cancer treatment. The NODJ data, including receipt data billed from 2020 to 2021, were obtained from the Ministry of Health, Labour and Welfare website. The use of injectable anticancer drugs decreased relative to the number of cancer patients aged ≥ 75 years compared to those aged < 75 years. Regarding injectable anticancer drug use, the number of AEC claims was similar between men and women, but the number of ASD2 claims was lower in men than in women. The number of times community pharmacists claimed their ASD2 was approximately 5% of the number of times hospital pharmacists claimed their AEC. This study revealed that several patients did not receive sufficient guidance from community pharmacists compared to hospital pharmacists, suggesting a potential insufficiency in the collaboration between the two groups.

Enhancing Drug Management, Cost Savings, and Staff Satisfaction in Anesthesiology: A Quality Improvement Project in a Chinese Tertiary Hospital.

INTRODUCTION: In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. METHODS: We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. RESULTS: Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. CONCLUSION: The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.

Cost-effectiveness of drug-management of hypertension among patients in selected secondary facilities in Nigeria: Empirical evidence for rational prescription choices / Costo-efectividad del manejo farmacológico de la hipertensión en pacientes de entidades de segundo nivel seleccionados en Nigeria: evidencia empírica para elecciones racionales de formulación

Abstract Background: The financial burden of managing hypertension in developing countries, where most of healthcare is funded out-of-pocket, is huge and poor patients cannot sustainably afford it. This is a challenge for most people, especially in sub-Saharan Africa with poor health indices, and this informed the investigation of the cost-effectiveness of anti-hypertensive drugs. Methodology: This was essentially a before-and-after study without control, in which blood pressure was assessed after commencing treatment with anti-hypertensive drugs among hypertensive patients. A systematic sampling technique was employed to recruit 320 participants from new patients attending cardiology clinic and admitted into the wards in four secondary health facilities offering specialized medical services in Nigeria. Results: The median cost of drug treatment of hypertension per week was N977.50; this cost was much lower for monotherapy than combined therapy. Similarly, the median costs of treatment per decrease in systolic and diastolic blood pressures were higher with combined therapy than monotherapy. The median cost of treatment per decrease in systolic blood pressure was higher than diastolic pressure. Diuretics had the most cost per decrease in diastolic blood pressure, while ACEI had the highest costs per decrease in systolic blood pressure and the highest cost per week. The lowest cost per week was recorded for beta-blockers, which also had the lowest cost per decrease in diastolic blood pressure and similar to the average cost per unit decrease in systolic blood pressure for centrally acting drugs. Conclusion: There was a significant improvement in blood pressure three months following the start of anti-hypertensive drugs. Beta-blockers appeared most cost-effective while diuretics as well as ACE inhibitors were the least. Monotherapy costs less per week, but it could not be proved from this study that it was more cost-effective than combined therapy.

Resumen Antecedentes: la carga financiera del manejo de la hipertensión en países en vías de desarrollo, donde la mayoría de la atención en salud es financiada por cuenta propia, es enorme, y los pacientes de escasos recursos no lo pueden costear de manera sostenible. Este es el reto para la mayoría de las personas, especialmente en África subsahariana que tiene indicadores de salud pobres, y esto fundamentó la investigación de la costo-efectividad de las drogas antihipertensivas. Metodología: esencialmente un estudio antes-después, sin control, en el cual se evaluó la tensión arterial luego de iniciar tratamiento con antihipertensivos en pacientes hipertensos. Se empleó una técnica de muestreo sistemático para reclutar 320 participantes de entre los pacientes nuevos atendidos en consulta de cardiología y hospitalizados en cuatro entidades de salud de segundo nivel en Nigeria. Resultados: el costo medio semanal del tratamiento farmacológico de la hipertensión fue de N977.50; este costo fue mucho menor para la monoterapia que para la terapia combinada. Asimismo, el costo medio de tratamiento por reducción en las cifras de tensión arterial sistólica y diastólica fue mayor con la terapia combinada que con la monoterapia. El costo medio de tratamiento por reducción en la tensión arterial sistólica fue mayor que para la tensión diastólica. Los diuréticos tuvieron el mayor costo por reducción en tensión arterial diastólica, mientras que los IECA tuvieron el mayor costo por reducción en tensión arterial sistólica y el costo más alto por semana. El costo más bajo por semana se registró para los beta-bloqueadores, los cuales también tuvieron el menor costo por reducción en la tensión arterial diastólica y un costo similar al promedio por unidad de reducción en la tensión arterial sistólica para los medicamentos de acción central. Conclusión: hubo una mejoría significativa en la tensión arterial luego de tres meses del inicio de drogas antihipertensivas. Los beta-bloqueadores parecieron ser los más costo-efectivos, mientras que los diuréticos e inhibidores de ECA fueron los menos costo-efectivos. La monoterapia costó menos por semana pero no se pudo comprobar con este estudio que fuera más costo-efectivo que la terapia combinada.

Revisão dos dispositivos legais e normativos internacionais e nacionais sobre gestão de medicamentos e de seus resíduos / Review of national and international legal and regulatory mechanisms on the management of drugs and the residues thereof

Resumo Este trabalho apresenta uma revisão descritiva de leis e normas adotadas pelos países da Europa, das Américas e Austrália sobre gestão de medicamentos e de seus resíduos. Esta revisão integra pontos relevantes de documentos oficiais das agências reguladoras desses países, bem como de trabalhos científicos importantes. Todos os países pesquisados realizam gestão de medicamentos concomitantemente com a gestão de seus resíduos, atuando desde programas de conscientização sobre o uso racional e os riscos dos medicamentos até na coleta e disposição segura de seus resíduos. A Alemanha, os EUA e a Suécia exigem uma avaliação prévia do impacto ambiental provocado pelo medicamento como critério de seu registro. Em destaque, a Suécia que periodicamente atualiza uma lista de medicamentos essenciais baseada na avaliação do risco e do perigo ambiental de seus resíduos. No Brasil, as medidas legais propostas como prescrição racional e logística reversa ainda não foram efetivamente implementadas. A avaliação prévia de impacto ambiental resguarda os riscos à saúde humana e da biota selvagem causados pela exposição aos resíduos de medicamentos. Portanto, esses modelos internacionais poderiam servir de base para discussões e/ou alterações legais e normativas no Brasil.

Abstract This paper presents a descriptive review of laws and regulations on the management of drugs and the residues thereof adopted by countries in Europe, the Americas and Australia. This review integrates relevant points of official documents of regulatory agencies in these countries, as well as important scientific works. All countries surveyed carry out drug management concomitant with the management of the residues thereof, ranging from awareness programs on the rational use and the risks of drugs through to the collection and safe disposal of such residues. Germany, the USA and Sweden demand a prior assessment of the environmental impact caused by a given drug as a criterion for its registration. Sweden is noteworthy in that it periodically updates a list of essential drugs based on risk assessment and the environmental risks posed by the residues thereof. In Brazil, the legal measures proposed including rational prescription and reverse logistics have not yet been effectively implemented. Prior environmental impact assessment safeguards the risks to human health and the wild biota caused by exposure to drug residues. Therefore, these international models could serve as a basis for discussion and/or legal and regulatory changes in Brazil.

Calidad en la administración de medicamentos intravenosos y su efecto en la seguridad del paciente / Quality in the administration of intravenous drugs and its effect on patient safety

El propósito de este estudio es evaluar la calidad en la administración de medicamentos por vía intravenosa que proporciona el profesional de enfermería a través de la aplicación de un instrumento que mide el índice de eficiencia, lo que permitirá determinar las fallas o casi-fallas e implementar estrategias de mejora, pero también identificar sus fortalezas para reforzarlas. Además los resultados, permiten valorar el impacto en la seguridad del paciente y determinar los factores con mayor peso para la ocurrencia de eventos adversos relacionados con la medicación. Es un estudio de tipo descriptivo, transversal, correlacional. La unidad de análisis son los procedimientos de administración de medicamentos intravenosos, que las enfermeras realizaron a los pacientes hospitalizados en los servicios de medicina interna, cardiología, neurología y gastroenterología de un Hospital Pediátrico de alta especialidad (n= 114), con el objeto de conocer el nivel de eficiencia y su relación con las variables intervinientes. Los resultados obtenidos nos permitieron identificar que el índice de eficiencia general es de 85% y al compararlo con respecto al día de observación es estadísticamente significativo para el fin de semana.

The purpose of this study was to assess the quality of the intravenous drug management provided by nursing professionals. We used a specific instrument to measure the efficiency of this process. These estimates will hopefully allow us determine the impact of related factors and thus identify problems and establish improvement strategies. This was a basic descriptive, cross-sectional and correlational study. The sample was formed out of 114 patients hos pitalized in the internal medicine, cardiology, neurology, and gastroentherology units of a high specialty Pediatric Hospital. The results suggest that it is possible to estimate a related index of efficiency close to 85%. We considered these findings as statistically significant.