RESUMEN
Background: Nephrotoxic drugs may hasten the decline in kidney function and worsen the progression of renal impairment as a result; these drugs should be avoided or used with caution in patients with pre-existing renal insufficiency. The purpose of this study was to assess the burden of nephrotoxic medication use and its predictors among patients with underlying renal impairment. Methods: A multicenter, institution-based, cross-sectional study was conducted from May 30, 2021 to July 30, 2021, at medical wards. Renal impaired patients admitted during the data collection period who took at least one medication were enrolled in the study. A simple random sampling technique was used to select the study participants. Data was collected through an interview and a medical card review. Both bivariable and multivariable binary logistic regression analyses were fitted to identify factors associated with nephrotoxic drug use. Results: Among the 422 participants, more than half of them (53.6 %) were male. The mean patient's age was 47.5 (±16.7) years. A total of 1310 drugs were prescribed for 422 patients with renal impairment, of which 80.15 % were nephrotoxic. Nephrotoxic drugs were prescribed for 66.4 % of patients. The burden of nephrotoxic medication prescription was significantly associated with variables like the presence of comorbidity (AOR = 6.31, 95 % CI: 2.01-19.79), the number of medications prescribed (AOR = 1.43, 95 % CI: 1.05-1.93), and the age of participants (AOR = 1.12, 95 % CI: 1.07-1.17). Conclusion: The present study demonstrated that two-third of the patients with renal impairment were exposed to nephrotoxic medications. Furosemide, Enalapril, and vancomycin were the most frequently prescribed nephrotoxic medications. The study suggests that prescribers need to give special attention to older patients who have underlying renal insufficiency, a comorbid condition, and polypharmacy regarding exposure to contraindicated nephrotoxic medication.
RESUMEN
INTRODUCTION: A change of therapy from one to another antipsychotic medication is currently the main challenge of therapy. This study aimed to assess the prevalence of antipsychotic medication switches and determinants among patients with schizophrenia in Northwest Ethiopia. METHODS: Multi-center hospital-based cross-sectional study was conducted at five Comprehensive Specialized Hospitals found in Northwest Ethiopia from April 30, 2021, to August 30, 2021. Data were extracted from both patients' medical charts and interviews. Data were entered into Epi-data software version 3.5.1 and exported to SPSS version 25.0 for analysis. A multivariable logistic regression model was fitted to identify factors associated with medication regimen switch. The level of significance of the study was kept at a p-value of 0.05 with a 95% confidence interval. RESULT: A total of 414 patients are involved in the study, and 188 (45.5%) of patients switched antipsychotics within one year. The unavailability of the medication is the commonest reason for switching. Being male [AOR = 2.581, 95% CI (1.463, 4.552)], having relapse [AOR = 2.341,95% CI (1.169,4.687)], history of hospitalization in the past year [AOR = 3.00,95% CI (1.478,5.715)] and taking typical antipsychotics [AOR = 3.340, CI (1.76, 6.00)] had a significant association with antipsychotics switching. CONCLUSIONS AND RECOMMENDATIONS: There is a high prevalence of antipsychotic switches among schizophrenia patients. Prescribers need to be careful while dosing, selecting, and switching antipsychotics, hence may help reduce discontinuation and unnecessary switch and thus achieve optimal clinical management.
RESUMEN
Background: The education and training of health professions students in geriatric care is critical to their future clinical practice. However, the knowledge and attitude of health science students toward geriatric care are barely studied in Ethiopia. Objective: This study aimed to assess the knowledge and attitude of graduating medical, pharmacy, and nursing (MPN) students towards geriatric care at the College of Medicine and Health Sciences, University of Gondar, North West Ethiopia. Methods: A cross-sectional study was conducted among 301 graduating MPN students using stratified random sampling from June 30, 2022, to July 30, 2022. The data was collected by using previously validated self-administered structured questionnaires and analyzed using SPSS version 26. Both descriptive and inferential statistics were done. A statistical significance was declared at a p-value < 0.05. Results: The majority of graduating MPN students had either neutral (70.76%) or positive (16.28%) attitudes towards older people; however, a greater amount (88%) of them had poor knowledge of geriatric care. The knowledge of female students was significantly less favorable than the knowledge of male students (p-value < 0.001). The knowledge and attitudes of pharmacy and nursing students were significantly lower than medical students (p-value < 0.001). The attitude mean rank score of students aged ≤25 years was significantly lower than students aged >25 years (p-value < 0.001). Conclusion: The majority of graduating MPN students had poor knowledge despite having either a neutral or positive attitude toward geriatric care. Female students had lower knowledge scores than male students. Similarly, pharmacy and nursing students had lower knowledge and attitude scores than medical students, and the attitude score of students aged ≤ 25 years was lower than students aged >25 years. Their respective departments should implement a strategy to improve the knowledge of MNP students.
RESUMEN
BACKGROUND: Medication errors are the most common cause of preventable adverse drug events at the emergency ward. OBJECTIVES: This study assessed medication errors and associated factors among adult patients admitted to the emergency ward at the University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia. METHODS: A cross-sectional study was conducted from June 1, 2022, to August 30, 2022. Data were entered into EpiData Manager 4.6.0.0 for clearing and exported to SPSS version 24 for analysis. Descriptive statistics such as frequencies, medians with an interquartile range and inferential statistics like binary logistic regression were used for data analysis. The level of significance was declared at a p value less than 0.05 with a 95% confidence interval. RESULTS: From 422 study participants, medication errors were found in three-fourths (74.4%) of study participants. The most frequent type of medication error was omitted dose (26.27%). From a total of 491 medication errors, 97.75% were not prevented before reaching patients. More than one-third (38.9%) of medication errors had potentially moderate harmful outcomes. More than half (55.15%) of possible causes of medication errors committed by staff are due to behavioral factors. Physicians accepted 99.16% and nurses accepted 98.71% of clinical pharmacist intervention. Hospital stay ≥ 6 days (AOR: 3.00 95% CI 1.65-5.45, p < 0.001), polypharmacy (AOR: 5.47, 95% CI 2.77-10.81 p < 0.001), and Charlson comorbidity index ≥ 3 (AOR: 1.94, 95% CI (1.02-3.68), p < 0.04) significantly associated with medication error. CONCLUSIONS: About three-fourths of adult patients admitted to the emergency ward experienced medication errors. A considerable amount of medication errors were potentially moderately harmful. Most medication errors were due to behavioral factors. Most clinical pharmacists' interventions were accepted by physicians and nurses. Patients who stayed longer at the emergency ward, had a Charlson comorbidity index value of ≥ 3, and were on polypharmacy were at high risk of medication error. The hospital should strive to reduce medication errors at the emergency ward.
RESUMEN
Background: Subjective beliefs about chronic disease conditions and their drug management are among factors determining adherence to medications that are amenable to interventions. Patient-level factors such as personal, cultural, and religious beliefs about diseases, and medication use may have a significant impact on medication adherence. The purpose of this study was to assess the impact of personal, cultural and religious beliefs on medication adherence behavior among patients with chronic follow-up. Patients and Methods: An institutional-based cross-sectional study design was conducted among chronic ambulatory patients from July to August 2021. The data was collected through an interviewer administered questionnaire. Initially stratified sampling technique was used to include proportional participants from different disease conditions, and systematic random sampling was employed to enroll eligible patients from each subgroup. Descriptive statistics such as frequencies and percentages were computed for categorical variables and mean with (standard deviation ±SD) used for continuous variables. Logistic regression model was employed to determine variable with poor adherence. A 95% confidence interval with P-value ≤0.05 was used to declare statically significance. Results: Among the 404 participants, more than half (51%) were males. The mean (±SD) age of the patients was 47.8 ± 14.8 years. Patients with strong belief in the harm of medications were found 4 times more likely to have poor medication adherence than those with weak belief in the harm of medications (AOR = 4.027, 95% CI:1.232-13.161, P = 0.021). In contrast, having strong personal belief regarding the necessity of medications were found to be less likely to have poor medication adherence (AOR = 0.368, 95% CI: 0.220-0.615, P < 0.001). Conclusion: This study generalized that most of the patients were poor adherent to their medications. Personal beliefs were found to influence medication adherence of the patients. Future studies could be needed to explore and identify how these factors affect patients' medication adherence.
RESUMEN
BACKGROUND: There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia. OBJECTIVE: The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital. METHOD: A retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients. RESULT: 387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03-0.78] and AOR:0.17[0.03-0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital stay than DKA precipitated by other causes; AOR: 4.59 [1.08-19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76-2.63]. CONCLUSIONS: New onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality.
