Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Background: Geriatric syndrome is a condition of decreased organ function that causes DRPs, especially drugs with special dosage forms, such as an inhaler, insulin pens, and modified release drugs. Objective: To identify DRPs of drugs with special dosage forms in geriatric patients at the Outpatient Pharmacy Unit of RSUA Surabaya. Methods: It was an observational and prospective study with the interview method. Each problem identified was given a score to be analyzed descriptively and statistically. Data collection was carried out from April to June 2022. Results: The sample is 82 special dosage forms, there are drug delivery devices including inhaler (26%) and insulin pen (29%), and drug delivery systems including OROS (33%), retard (6%), and sustained-release (6%). DRPs were found in 40% of them. In inhaler form, the DRPs of DPI are failure to load the dose, shaking after the dose was loaded, and not checking the remaining dose after using the device. While in MDI, no DRPs were found. The DRPs of insulin pens are errors in device storage (25%), injection position (8%), and repeated use of blunt/broken needles (38%). While in modified release drugs is an error in drug storage (5%). The percentages of nonadherence are Turbuhaler 33%, Breezhaler 60%, Diskus 25%, MDI 0%, insulin pen 29%, and modified release drugs 24%. The solution is given by using verbal education such as leaflets. Statistical analysis showed a significant difference in the insulin pen and the modified release drug, while there was no significant difference in the inhaler. Conclusion: Each type of drug with a special dosage form has its problems and problem-solving in the form of interventions has not given maximum results. (AU)

Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study.

Background: This study aimed to assess medication adherence, glycemic control, and their influencing factors among outpatients at an Indonesian clinic with type 2 diabetes. Methods: A cross-sectional study was conducted among patients with type 2 diabetes at a hospital-based clinic in Surabaya, Indonesia, from September to December 2018. A purposive sampling was used; patients aged 18 years and older, had diabetes and any comorbidity, received hypoglycemic agents, and provided written informed consent were included. The previously validated Brief Medication Questionnaire was used to measure medication adherence, while glycosylated hemoglobin (A1C) levels were used to evaluate glycemic control. Binary logistic regression was used to identify factors associated with medication adherence and glycemic control. Results: Of 321 patients enrolled in the study, 268 (83.5%) patients were medication nonadherent. Patients who did not engage regularly in physical activity (aOR: 0.49, 95% CI: 0.26-0.93) was more likely to be medication adherent. Poor glycemic control (A1C: >7%) was observed in 106 (33.0%) of the patients. Patients who used a combination of oral hypoglycemic agents and insulin (aOR: 2.74, 95% CI: 1.09-6.86), did not take biguanide (aOR: 2.73, 95% CI: 1.16-6.43), reported hyperglycemia (aOR: 4.24, 95% CI: 1.53-11.81), and had comorbid diseases (aOR: 4.33, 95% CI: 1.08-17.34) increased the risk of having poor glycemic control. Patients who were more likely to achieve good glycemic control were male (aOR: 0.39, 95% CI: 0.20-0.74) and aged older (aOR: 0.95, 95% CI: 0.92-0.99). Conclusions: The proportion of patients who were medication nonadherent was much higher than those with poor glycemic control. Whereas regular exercise was a predictor of nonadherence, age, sex, diabetes medication, not taking biguanide, acute complications, and comorbidity were predictors of poor glycemic control. Therefore, strategies are needed to improve medication adherence and glycemic control.

The sodium does not affect joint pain and functional activity of knee osteoarthritis patients.

Background: The sodium may aggravate synovial inflammation and cartilage thinning. This incidence can cause joint pain and reduce functional activity. Not many people know the effect of sodium on the incidence of osteoarthritis. Objective: This study aims to determine the relationship between sodium in the body and knee joint pain which results in functional activity. Methods: The quantitative descriptive study used accidental sampling. The study was conducted at three outpatient polyclinic orthopedics of hospitals and was approved by the Health Ethics Committee. All data were collected during the interview. The Semi-Quantitative Food Frequency Questionnaire and the Nutrisurvey Indonesia 2007 application were used as a tool to collect daily sodium intake (mg). Knee joint pain score was measured using the Visual Analog Scale (VAS), while functional body activity was measured using the Western Ontario McMaster Osteoarthritis Index (WOMAC). The Pearson and Spearman test (P<0.05) were used as a correlation test. Results: 80 subjects were recruited according to the inclusion criteria. Characteristics of the subjects were pre-elderly (32, 40%), women (74, 92.5%), body mass index ≥30 kg/m2 (54, 67.5%) and occupation (43, 53.75%). Average sodium intake = 2090.78±1084.33 mg, VAS score = 6.28±1.95 and WOMAC score = 32.65±14.88. The correlation sodium, VAS, and WOMAC were not significant (P=0.196, P=0.372). Conclusions: Increased sodium intake is not associated with knee joint pain and functional body activity.

Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis.

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.

The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia.

OBJECTIVES: This study aimed to determine the burden of sepsis with focal infections in the resource-limited context of Indonesia and to propose national prices for sepsis reimbursement. METHODS: A retrospective observational study was conducted from 2013-2016 on cost of surviving and non-surviving sepsis patients from a payer perspective using inpatient billing records in four hospitals. The national burden of sepsis was calculated and proposed national prices for reimbursement were developed. RESULTS: Of the 14,076 sepsis patients, 5,876 (41.7%) survived and 8,200 (58.3%) died. The mean hospital costs incurred per surviving and deceased sepsis patient were US$1,011 (SE ± 23.4) and US$1,406 (SE ± 27.8), respectively. The national burden of sepsis in 100,000 patients was estimated to be US$130 million. Sepsis patients with multifocal infections and a single focal lower-respiratory tract infection (LRTI) were estimated as being the two with the highest economic burden (US$48 million and US$33 million, respectively, within 100,000 sepsis patients). Sepsis with cardiovascular infection was estimated to warrant the highest proposed national price for reimbursement (US$4,256). CONCLUSIONS: Multifocal infections and LRTIs are the major focal infections with the highest burden of sepsis. This study showed varying cost estimates for sepsis, necessitating a new reimbursement system with adjustment of the national prices taking the particular foci into account.