Application of Novel Pharmacists' Risk in Pharmacotherapy (PHARIPH) Scale for Identification of Factors Affecting the Safety of Hospital Pharmacotherapy-An Observational Pilot Study.

BACKGROUND: The widespread occurrence of medication errors (MEs) has become a global problem because it poses a serious threat to the health and lives of patients, can prevent the achievement of treatment goals, undermines patient trust in the health care system, and increases treatment costs. The purpose of this study was to develop an appropriate tool to identify key risk factors that hospital pharmacists believe threaten pharmacotherapy safety in the hospital. METHODS: A diagnostic survey method using the authors' PHARIPH (Pharmacists' Risk in Pharmacotherapy) scale and authorial questions was used to identify risks that may result in patient pharmacotherapy errors at the hospital pharmacist level. A total of 125 Polish hospital pharmacists participated in the study. RESULTS: The original authors' created PHARIPH scale was characterized by a Cronbach's alpha coefficient of 0.958. According to the surveyed pharmacists, the greatest threat to pharmacotherapy safety was misreading of a doctor's order (similar drug nomenclature) and preparing a wrong drug (similar drug packaging, similar drug nomenclature). Female pharmacists compared to male pharmacists attributed significantly higher importance to such risk factors such as pharmacist's ignorance of a list of drug substitutes (p = 0.047, risk 8), preparation from an expired/withdrawn drug (p = 0.002, risk 14), preparation from a drug stored in inappropriate conditions (p = 0.05, risk 15), preparation of drugs ordered in hospital and PODs (patients' own drugs) without checking for possible drug duplication (p = 0.011, risk 17) and their potential effect on patient safety. CONCLUSIONS: The PHARIPH scale could be applied as a novel tool for identification of pharmacotherapy risks.

C3435T Polymorphism of the ABCB1 Gene in Polish Patients with Inflammatory Bowel Disease: A Case-Control and Meta-Analysis Study.

P-glycoprotein encoded by the ABCB1 gene constitutes a molecular barrier in the small and large bowel epithelium, and its different expression may influence susceptibility to inflammatory bowel disease (IBD). We aimed to assess the contribution of the C3435T polymorphism to disease risk in the Polish population. A total of 100 patients (50 Crohn's disease (CD), 50 ulcerative colitis (UC)) and 100 healthy controls were genotyped for the single nucleotide polymorphism (SNP) C3435T by using the PCR-RFLP method. Patients were classified on the basis of disease phenotype and the specific treatment used. A meta-analysis was carried out of our results and those from previously published Polish studies. There was no significant difference in allele and genotype frequencies in IBD patients compared with controls. For CD patients, a lower frequency of TT genotype in those with colonic disease, a lower frequency of T allele, and a higher frequency of C allele in those with luminal disease were observed, whereas for UC patients, a lower frequency of CT genotype was observed in those with left-sided colitis. A meta-analysis showed a tendency towards higher prevalence of CC genotype in UC cases. These results indicate that the C3435T variants may confer a risk for UC and influence disease behaviour.

Determinants of disease acceptance in renal transplantation patients assessed with the application of Acceptance Illness Scale (AIS).

PURPOSE: Kidney transplant patients require long-term pharmacotherapy with a significant risk of drug-related complications. The disease acceptance may significantly affect the effectiveness, safety, and patient adherence to their treatment. The purpose of this study was to evaluate, for kidney transplantation patients, the essential determinants for better disease acceptance, and whether a clinical pharmacist may influence its degree. METHODS: The study involved 201 renal graft patients aged 18-81 years. The diagnostic survey method with the questionnaire of the Acceptance Illness Scale (AIS) and authors' query was used to obtain sociodemographic and co-morbidities data, the number of medications taken, the therapy cost, a patient needs for more attention from medical staff, and their willingness to cooperate with a clinical pharmacist. RESULTS: The largest group (55.2%) of patients demonstrated a high level of acceptance of their health. However, in every disease acceptance score range (low, medium, high), the score was statistically lower in patients over 50 years of age (c2=7.27, p=0.026), occupationally inactive (c2 =13.8, p<0.001), over 5 medicines taken (c2=7.77, p=0.020), and declaring too much expenditure on the therapy (c2=14.3, p<0.001). The assessment established a statistically significant negative correlation between the number of chronic conditions and the AIS score (R=-0.32, p<0.001). The lower number of coexisting chronic diseases the better disease acceptance. Moreover, patients reporting the need for more attention from the health service and willing to consult a pharmacist cope in a statistically significant way worse with accepting their health (c2=15.1 and p<0.001, c2=6.76 and p=0.034 respectively).  Conclusion: For post-transplantation patients, factors affecting the acceptance of illness should be taken into consideration while planning medical care. The reported need for professional assistance indicates necessity for establishing a multidisciplinary therapeutic team in which a clinical pharmacist should play a special role.

Quality of Life in Patients with Advanced Non-Small-Cell Lung Cancer Receiving Palliative Chemotherapy.

The goal of this study was to explore quality of life in patients with advanced non-small-cell lung cancer (NSCLC) in an attempt to single out features that could help predict the possibility of non-completion of chemotherapy. The survey tool was the Quality of Life Questionnaire Core-30 (QLQ-C30) with the module Lung Cancer 13 (LC-13) developed by the European Organization for Research and Treatment of Cancer. The assessment of quality of life (QoL) was performed in 58 patients with advanced NSCLC before palliative chemotherapy and it was repeated in 43 patients who completed at least three cycles of chemotherapy. We found that the patients who failed to complete the chemotherapy course distinctly showed, in contradistinction to those who completed it, poor physical functioning in (67.6 ± 16.3 vs. 78.3 ± 21.3 points, respectively, p < 0.05) and the lack of appetite (27.1 ± 38.0 vs. 48.9 ± 37.5 points, respectively p < 0.05). At the end of palliative chemotherapy alopecia, sore throat, and constipation significantly worsened QoL, but global health status remained unchanged. In conclusion, poor physical functioning and loss of appetite seem to harbinger a risk of non-completion of chemotherapy in advanced NSCLC.

Genetic polymorphism of ABCB1 gene (C3435T) in patients with inflammatory bowel diseases. Is there any gender dependency?

BACKGROUND: In recent years, an increasing incidence of inflammatory bowel disease (IBD) has been reported, mainly as Crohn's disease (CD) and ulcerative colitis (UC). The individual susceptibility, the disease's course and response to the applied therapy is likely due to genetic factors such as ABCB1 gene mutations, exemplified by C3435T polymorphism. The aim of the study was to evaluate the distribution of C3435T polymorphism regarding the gender in IBD patients and control subjects from Lower Silesia region and its possible association with IBD susceptibility. METHODS: The research was conducted in groups of 61 IBD patients and 101 healthy subjects from the Lower Silesia region. Polymorphism of C3435T was determined using PCR-RFLP method. RESULTS: Frequency distributions of C3435T genotype and of 3435T or 3435C gene alleles of IBD, CD or UC patients were compared to control group; each treated as a whole or split further by gender. The statistically significant correlation was discovered between gender and C3435T genotype both for IBD and CD patients, with 3435CT heterozygote prevailing in IBD and CD males. Odds ratio calculations revealed statistically significant difference for the 3435CT genotype between control and: IBD group considered as a whole; IBD males; CD males; and for 3435TT variant between control and IBD males. Conclusions. The 3435CT genotype could be a risk factor for IBD and CD in men. The 3435TT genotype in males seems to be associated with the lower chance of IBD presence.

The impact of liposomes on transdermal permeation of naproxen--in vitro studies.

The possibility of applying liposomes as a topical drug delivery system is still a matter of intensive research. The purpose of this study was to determine the suitability of liposomes as carriers of naproxen and to prove their impact on the effectiveness of transdermal permeation of an active substance. The study was conducted with the use of Franz Diffusion Cell System by comparing the efficacy of a preparation containing 20% of phosphatidylcholine (PC) and 10% of naproxen with reference preparations, i.e., a formulation containing 10% of naproxen without PC and the commercial product Naproxen 10%, gel. The largest transdermal penetration flux of naproxen and the highest efficacy of naproxen permeation were obtained for the formulation containing 10% of naproxen and 20% of PC. The study of the influence of liposomes size and topology on the transdermal diffusion of naproxen (large unilamellar vesicle, LUV, multilamellar vesicle, MLV) showed that there was no statistically significant difference in the flux or total amounts of transdermally diffused naproxen between compared formulations. In conclusion, liposomes present in a formulation double the efficacy of the transdermal permeation of naproxen in vitro compared to reference preparations containing no carriers. Better permeation effect of a formulation was not related to the liposome type (LUV or MLV).

[Evaluation of efficacy and safety of hypertension treatment with original angiotensin-converting enzyme inhibitors: the comparison of original and generic formulations]. / Ocena skutecznosci i bezpieczenstwa leczenia nadcisnienia tetniczego inhibitorami konwertazy angiotensyny. Porównanie leków oryginalnych i generycznych.

UNLABELLED: The hypertension is a civilization disease, slowly destroying the cardio-vascular system and leading to serious complications, which may result in patient death. Critical factors enhancing the proper functioning of the body are: properly selected pharmacotherapy and the self-control of the blood pressure. THE AIM OF THIS STUDY: was to evaluate the effectiveness and safety of the hypertension treatment with generic and original formulations of angiotensin converting enzyme (ACE) inhibitors. MATERIAL AND METHODS: To the study, which consisted of an interview and completed a joint survey were enrolled 120 patients with hypertension therapy based on formulations of ACE inhibitors group. Data for the analysis were obtained from surveys conducted in: Department of Angiology, Hypertension and Diabetology, Department and Clinic of Endocrinology, Diabetology and Isotope Therapy and its Clinic for Diabetic Outpatients, in the period from 03/02/2011 to 20/04/2011. RESULTS: Out of 120 surveyed hypertensive patients treated with ACEI, 79 persons (66%) received the original preparations and 41 (34%) generic medications. Most preparations contained ramipril: 78 patients, of whom 50 received the original formulations and 28 a generic one. In this population no differences were found in the reduction of the systolic and the diastolic blood pressure between groups of patients receiving original and generic formulations. The most common adverse effects (AE) reported by patients were cough (n = 16), hypotension (n = 7), paresthesia (n = 6), skin lesions (n = 6), weakness (n = 5), headache and dizziness (n = 5). Some of these, i.e.: cough, weakness, headaches and dizziness, occurred more frequently in patients receiving therapy with generic preparations. CONCLUSIONS: Both the reference and generic preparations showed similar efficacy in reducing systolic and diastolic pressure. The therapy with original drugs leads less frequently to adverse effects such as cough, weakness, headaches and dizziness.

Monitoring of NSAIDs adverse effects based on spontaneous reports from Wroclaw regional adverse drug reactions monitoring center.

The mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs) in majority of cases is responsible for adverse reactions of these therapeutic agents. Obtaining post-registration information on adverse drug reactions (ADRs) by means of the Yellow Card System is a significant element in the process of enhancing the safety of pharmacotherapy. The aim of the study was to analyze ADRs of NSAIDs (anti-inflammatory and analgesic drugs) reported to the Regional Centre for the Monitoring of Adverse Drug Reactions (RCMADR) in Wroclaw in the years 2007-2009. The study material included 232 spontaneous reports, which were sent by physicians and pharmacists to the RCMADR in Wroclaw, out of which 80 concerned mentioned drugs. Analysis of the obtained data revealed a relationship between the incidence and kind of ADRs and the age, gender of the patients, centre from which the data were supplied, geographical region of administered medication. A significant role of post-registration monitoring of adverse drug reactions during therapy with antiinflammatory and analgesic drugs was confirmed in view of geographically conditioned differences affecting the profile of instituted therapy and the source of information. With an increasing global use of these medications, only thorough monitoring of every adverse reaction, encouraging spontaneous reports, as well as analysis at a global level may increase the knowledge on adverse drug reactions and enable correction of the safety profile of every drug from this group.

Factors predicting recurrence of atrial fibrillation after cardioversion.

BACKGROUND: Factors predicting the maintenance of sinus rhythm (SR) after cardioversion of atrial fibrillation (AF) have not been well defined. Little is known about the impact of the recovery of the left atrial mechanical function (RLAMF) on AF recurrences. AIM: To identify the clinical and echocardiographic predictors of AF recurrences after cardioversion. METHODS: Of 112 consecutive patients (39 females, 73 males, mean age 62.1+/-10.6 years) with AF who underwent successful electrical or pharmacological cardioversion, 50 maintained SR during 6 month follow-up whereas the remaining 62 had a recurrence of AF. Clinical examination and 2D Doppler echocardiography were performed. From the Doppler mitral flow, RLAMF was evaluated 1, 7, and 21 days after cardioversion. RESULTS: Patients with or without AF recurrence did not differ with respect to age, gender, aetiology, duration of AF, LA size and ejection fraction. In the univariate analysis the lack of RLAMF detected 1 day after cardioversion (relative risk - RR=1.15, p<0.01), functional NYHA class II or III (RR=1.86, p<0.005) and a history of AF episodes (RR=2.02, p