Impact of pharmaceutical care interventions in improving clinical outcomes among patients with pulmonary tuberculosis: a systematic review.

Background: Pharmacists can play an important role in the fight against tuberculosis (TB) through optimising medication use and safety, promoting adherence to anti-TB drugs, and providing patient education. Limited evidence is available on the effectiveness of pharmacist's interventions on health outcomes in patients with pulmonary TB. This systematic review aims to assess the effectiveness of pharmaceutical care interventions in the management of pulmonary TB. Methods: English language studies assessing the impact of pharmaceutical care interventions in TB management were searched across three electronic databases (PubMed, Embase, Cochrane), a RCT registry ClinicalTrial.gov, a peer-reviewed journal 'The Lancet Infectious Diseases', and the references of retrieved articles. Interventions delivered by pharmacists alone or as part of multidisciplinary teams were included in the review. Data were extracted using the modified Cochrane EPOC standardised data collection tool. The Cochrane Risk of Bias 2 and the NIH quality assessment tools were used to assess the risk of bias among included studies. Data were synthesised narratively. (PROSPERO Protocol Registration CRD42022325771). Results: Thirteen studies, including two randomised controlled trials (RCTs) with a total of 3886 patients were included. Many of the included studies had a high risk of bias and lacked cohert reporting of treatment outcomes. The most common pharmaceutical care interventions were education and counselling regarding adverse drug reactions and resolution of drug-related problems. Five studies showed a relatively high TB completion rate yet only one study reached the targeted treatment success goal of (>90%). Conclusion: The current evidence suggests that pharmaceutical care interventions can potentially improve treatment outcomes among patients with pulmonary TB. However, no definitive conclusion can be drawn given the low methodological quality of the included studies and lack of long-term follow-up data. Well-designed RCTs with careful attention to study methodology, standardised outcomes assessment aligned with the World Health Organization's guidelines are warranted to guide future practice and policy.

Dosimetric assessment of Gadolinium-159 for hepatic radioembolization: Tomographic images and Monte Carlo simulation.

A common therapeutic radionuclide used in hepatic radioembolization is yttrium-90 (90Y). However, the absence of gamma emissions makes it difficult to verify the post-treatment distribution of 90Y microspheres. Gadolinium-159 (159Gd) has physical properties that are suitable for therapy and post-treatment imaging in hepatic radioembolization procedures. The current study is innovative for conducting a dosimetric investigation of the use of 159Gd in hepatic radioembolization by simulating tomographic images using the Geant4 application for tomographic emission (GATE) Monte Carlo (MC) simulation. For registration and segmentation, tomographic images of five patients with hepatocellular carcinoma (HCC) who had undergone transarterial radioembolization (TARE) therapy were processed using a 3D slicer. The tomographic images with 159Gd and 90Y separately were simulated using the GATE MC Package. The output of simulation (dose image) was uploaded to 3D slicer to compute the absorbed dose for each organ of interests. 159Gd were able to provide a recommended dose of 120 Gy to the tumour, with normal liver and lungs absorbed doses close to that of 90Y and less than the respective maximum permitted doses of 70 Gy and 30 Gy, respectively. Compared to 90Y, 159Gd requires higher administered activity approximately 4.92 times to achieve a tumour dose of 120 Gy. Thus; this research gives new insights into the use of 159Gd as a theranostic radioisotope, with the potential to be used as a90Y alternative for liver radioembolization.

Utilizing 3D Slicer to incorporate tomographic images into GATE Monte Carlo simulation for personalized dosimetry in yttrium-90 radioembolization.

PURPOSE: Monte Carlo (MC) simulation is an important technique that can help design advanced and challenging experimental setups. GATE (Geant4 application for tomographic emission) is a useful simulation toolkit for applications in nuclear medicine. Transarterial radioembolization is a treatment for liver cancer, where microspheres embedded with yttrium-90 (90 Y) are administered intra-arterially to the tumor. Personalized dosimetry for this treatment may provide higher dosimetry accuracy compared to the conventional partition model (PM) calculation. However, incorporation of three-dimensional tomographic input data into MC simulation is an intricate process. In this article, 3D Slicer, free and open-source software, was utilized for the incorporation of patient tomographic images into GATE to demonstrate the feasibility of personalized dosimetry in hepatic radioembolization with 90 Y. METHODS: In this article, the steps involved in importing, segmenting, and registering tomographic images using 3D Slicer were thoroughly described, before importing them into GATE for MC simulation. The absorbed doses estimated using GATE were then compared with that of PM. SlicerRT, a 3D Slicer extension, was then used to visualize the isodose from the MC simulation. RESULTS: A workflow diagram consisting of all the steps taken in the utilization of 3D Slicer for personalized dosimetry in 90 Y radioembolization has been presented in this article. In comparison to the MC simulation, the absorbed doses to the tumor and normal liver were overestimated by PM by 105.55% and 20.23%, respectively, whereas for lungs, the absorbed dose estimated by PM was underestimated by 25.32%. These values were supported by the isodose distribution obtained via SlicerRT, suggesting the presence of beta particles outside the volumes of interest. These findings demonstrate the importance of personalized dosimetry for a more accurate absorbed dose estimation compared to PM. CONCLUSION: The methodology provided in this study can assist users (especially students or researchers who are new to MC simulation) in navigating intricate steps required in the importation of tomographic data for MC simulation. These steps can also be utilized for other radiation therapy related applications, not necessarily limited to internal dosimetry.

Estimation of linear and mass attenuation coefficients of soy-lignin bonded Rhizophora spp. particleboard as a potential phantom material using caesium-137 and cobalt-60.

In this study, linear and mass attenuation coefficients of fabricated particleboards intended for use as phantom material were estimated using 137Cs and 60Co radiation sources. Particleboards made of Rhizophora spp. wood trunk bonded with soy flour and lignin were fabricated at a target density of 1.0 g cm-3, with and without gloss finish coating. Elemental composition of the particleboards was obtained by means of energy dispersive X-ray (EDX) spectroscopy. Experimental setups were simulated via the GATE Monte Carlo (MC) package, with particle histories of 1 × 106-1 × 107. Linear and mass attenuation coefficients obtained from measurements and GATE simulations were compared and discussed. The percentage differences between the measured and simulated linear and mass attenuation coefficients of the samples were reasonably small (2.05-4.88% for 137Cs and 3.24-5.38% for 60Co). It is shown that all the particleboards have the potential to be used as phantom materials as the attenuation coefficients measured were in good agreement with those of water (calculated with XCOM) and with those simulated with the GATE toolkit. The use of gloss finish coating also did not show any significant effect on the attenuation coefficient of the phantom material. Verification of experimental results via GATE simulations has been shown crucial in providing reliable data for energy transmission studies. Based on the results achieved in this study, it is concluded that the studied material-Rhizophora spp. wood trunk bonded with soy flour and lignin including gloss finish coating-can be used in radiation dosimetry studies.

Naturally Occurring Radioactive Materials in Bracelets and Necklaces: Radiological Risk Evaluation.

A particular category of jewelry is one involving bracelets and necklaces that are deliberately made to contain naturally occurring radioactive material (NORM)-purveyors making unsubstantiated claims for health benefits from the release of negative ions. Conversely, within the bounds of the linear no-threshold model, long-term use presents a radiological risk to wearers. Evaluation is conducted herein of the radiological risk arising from wearing these products and gamma-ray spectrometry is used to determine the radioactivity levels and annual effective dose of 15 commercially available bracelets (samples B1 to B15) and five necklaces (samples N16 to N20). Various use scenarios are considered; a Geant4 Monte Carlo (Geant4 MC) simulation is also performed to validate the experimental results. The dose conversion coefficient for external radiation and skin equivalent doses were also evaluated. Among the necklaces, sample N16 showed the greatest levels of radioactivity, at 246 ± 35, 1682 ± 118, and 221 ± 40 Bq, for 238U, 232Th, and 40K, respectively. For the bracelets, for 238U and 232Th, sample B15 displayed the greatest level of radioactivity, at 146 ± 21 and 980 ± 71 Bq, respectively. N16 offered the greatest percentage concentrations of U and Th, with means of 0.073 ± 0.0002% and 1.51 ± 0.0015%, respectively, giving rise to an estimated annual effective dose exposure of 1.22 mSv, substantially in excess of the ICRP recommended limit of 1 mSv/year.

Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey.

PURPOSE: To evaluate the association between medication adherence and quality of life (QoL) of patients with diabetes and/or hypertension attending primary care clinics. METHODS: In this cross-sectional study, patients with at least one long-term condition (hypertension or diabetes mellitus) meeting the eligibility criteria were recruited from five primary care clinics in Saudi Arabia. Arabic version of Morisky Medication Adherence Scale (MMAS-8) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool were used to assess medication adherence and QoL, respectively. Patients' sociodemographic, medical and medication data were collected using a structured, pilot-tested data collection form. RESULTS: Three hundred patients with a mean (± SD) age of 56.79 (12.8) years participated in the study. Fifty-eight had hypertension only, 96 had diabetes (Type 1 or 2), and 146 had both hypertension and diabetes. After adjusting for socioeconomic characteristics, multiple linear regression analysis found that adherent patients had significantly higher mean overall perception of QoL and health scores by 14.6 (P = 0.001) and 17.2 (P = 0.001) points, respectively, compared to non-adherent patients. In addition, irrespective of the type of long-term condition, adherence status was found to be an independent predictor of all QoL domains. CONCLUSION: There is an association between medication adherence and QoL among patients with diabetes and/or hypertension attending primary care clinics. Medication adherence should be assessed and emphasised during routine clinical consultations in primary care in order to achieve the desired clinical outcomes and overall well-being of patients.

Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.

PURPOSE: To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. PATIENTS AND METHODS: Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data. RESULTS: Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence. CONCLUSION: Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.

Knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang: a cross-sectional survey.

OBJECTIVE: The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. SUBJECTS AND METHODS: A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher (M.A.H.) using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. RESULTS: The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women (p < 0.001). Only 117 (32.3%) and 120 (33.0%) women were aware of the recommended breast self-examination (BSE) and clinical breast examination (CBE) guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. CONCLUSION: The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer.