Pharmacists' viewpoint towards their professional role in healthcare system: a survey of hospital settings of Pakistan.

BACKGROUND: Pharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist's role as healthcare professional is limited. This study aimed to document pharmacists' attitude towards their role in Pakistan's healthcare system, their experience with doctors and their perceptions towards involvement in medicines management. METHODS: A 4-month cross-sectional survey (Jan - Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists' attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer's V ≥ 0.3 was considered cut-off for establishing statistical significance. The study was approved by ethical committee and local hospital committees. RESULTS: Three hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors. CONCLUSION: Pharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist's role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan's healthcare system.

Report: Interactions and conflicts of interests between prescribers and medical sales representatives (MSRs) regarding prescribing and drug promotion practices in Karachi, Pakistan.

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions.

The development of a predictive model to identify potential HIV-1 attachment inhibitors.

Despite the significant progress in managing patients infected with HIV through the development of Highly Active Anti-Retroviral Therapy (HAART), major challenges and opportunities remain to be explored. Of particular interest, is the binding of glycoprotein 120 (gp120) to the primary cellular receptor Cluster of Differentiation 4 (CD4). In this work we describe our two phased computational process to identify useful compounds capable of binding to the gp120 protein for therapeutic purposes. We identified 187 compounds from the literature that conform to active binding sites on these proteins and use these as training/test sets. The data in the form of quantitative structure-activity relationships (QSAR) is downloaded from the ZINC database and transformed using principal components analysis. In the first phase we developed a Radial Basis Function neural network model that identifies potential inhibitors from a virtual screen of a subset of the ZINC database. In the second phase we modelled the top performing compounds using the Discovery Studio docking and screening software. By employing this approach, we identified that those compounds with a LogP value of approx 2-4 performed well in the binding simulations while the lower scoring compounds do not bind well.

Doctors' perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan.

Background The inclusion of pharmacist in health care system is essential to ensure optimal patient care. However, with the passage of time, pharmacist's role has transcended from dispensing, compounding and counting of pills, to more sophisticated clinical duties. Objective To evaluate doctors' experience, perceptions and expectations regarding pharmacists' role in Pakistani healthcare settings. Setting All tertiary care hospitals across 26 cities of Pakistan. Method A cross-sectional study using a self-administered questionnaire was carried out targeting doctors practising in Pakistan. The survey was conducted from January to April 2018. Chi square (χ2) test was used to analyse responses of doctors regarding pharmacist's role in the healthcare system of Pakistan. The associations were considered significant at p value less than 0.05. The study was approved by concerned ethical committee. Main outcome measure Doctors' experience, perceptions and expectations regarding pharmacists' role. Results A total of 483 questionnaires were received and analysed (response rate; 87.9%). Most participants (67.5%) reported interaction with pharmacists at least once daily, and that was mostly related to drug availability inquiry (73.7%). 86.7% of doctors expected pharmacists to ensure safe and appropriate use of medicines to patients. 87.6% of doctors expected pharmacists to monitor patient's response to drug therapy (p < 0.05) and 66.5% expected pharmacists to review patient's medicines as well as discuss possible amendments to therapy (p < 0.05). Besides, most doctors (84.9%) disagreed with the notion of pharmacists prescribing medicine for patients (p < 0.05). Most participants (81.6%) did not want pharmacists to prescribe independently. Conclusion The study highlights that doctors considered pharmacists as drug information specialists, dispensers, educators and counsellors; however, their expectation of pharmacists performing the clinical role and being involved in direct patient care was limited. They negated the idea of prescription intervention and direct involvement of pharmacists in pharmacotherapy plan for patients. It is imparative  to increase doctors' awareness regarding the role pharmacists could play in Pakistan's healthcare system. Currently, the clinical role of pharmacists in Pakistan's healthcare system seems minimal and is seen with scepticism within the community of doctors.

Ultrasound monitoring during first-cycle treatment with clomifene citrate: a national survey of compliance with NICE.

The National Institute for Health and Care Excellence Clinical Guideline 156 advises that transvaginal ultrasonography (TVUS) should be used in the first cycle of treatment with clomifene citrate, to assess for multifollicular development and hence the risk of multiple pregnancy. This guidance is based on expert opinion rather than research evidence. We conducted a cross-sectional online and postal survey among UK-based consultant gynaecologists and fertility specialists, to explore compliance with this guideline. A total of 110 responses met the inclusion criteria. During first-cycle treatment with clomifene, 50.9% of respondents were not always using TVUS, and 21.8% never were. Clinicians who did not have immediate access to TVUS were significantly less likely to scan (p < 0.01). Other key factors influencing practice were, personal experience of the clinician, lack of an evidence base to support the guideline and a willingness to accept the risk of multiple pregnancy. Several respondents questioned the value of scanning the first cycle only and highlighted that over-response may be seen in subsequent cycles. This study confirms that there is variation in adherence to the guideline and uncertainty about the clinical need for scan monitoring. Further evidence to support or refute the guideline is required.

Complex network theory for the identification and assessment of candidate protein targets.

In this work we use complex network theory to provide a statistical model of the connectivity patterns of human proteins and their interaction partners. Our intention is to identify important proteins that may be predisposed to be potential candidates as drug targets for therapeutic interventions. Target proteins usually have more interaction partners than non-target proteins, but there are no hard-and-fast rules for defining the actual number of interactions. We devise a statistical measure for identifying hub proteins, we score our target proteins with gene ontology annotations. The important druggable protein targets are likely to have similar biological functions that can be assessed for their potential therapeutic value. Our system provides a statistical analysis of the local and distant neighborhood protein interactions of the potential targets using complex network measures. This approach builds a more accurate model of drug-to-target activity and therefore the likely impact on treating diseases. We integrate high quality protein interaction data from the HINT database and disease associated proteins from the DrugTarget database. Other sources include biological knowledge from Gene Ontology and drug information from DrugBank. The problem is a very challenging one since the data is highly imbalanced between target proteins and the more numerous nontargets. We use undersampling on the training data and build Random Forest classifier models which are used to identify previously unclassified target proteins. We validate and corroborate these findings from the available literature.

A multi-layered approach to protein data integration for diabetes research.

OBJECTIVE: Recent advances in high-throughput experimental techniques have enabled many protein-protein interactions to be identified and stored in large databases. Understanding protein interactions is fundamental to the advancement of science and medical knowledge, unfortunately the scale of the requires an automated approach to analysis. We describe our graph-mining techniques to identify important structures within protein-protein interaction networks to aid in human comprehension and computerised analysis. METHODS AND MATERIALS: We describe our techniques for characterizing graph type and associated properties which is constructed from data collated from the Human Protein Reference Database. Using random graph rewiring comparative techniques and cross-validation with other identification methods a further analysis of the identified essential proteins is presented to illustrate the accuracy of these measures. We argue for using techniques based upon graph structure for separating and encapsulating proteins based upon functionality. RESULTS: We demonstrate how rational Erdos numbers may be used as a method to identify collaborating proteins based solely upon network structure. Further, by using dynamic cut-off limit it demonstrates how collaboration subgraphs can be generated for each protein within the network, and how graph containment can be used as a means of identifying which of many possible graphs are likely to be actual protein complexes. The demonstration protein interaction network built for diabetes is found to be a scale-free, small-world graph with a power-law degree distribution of interactions on nodes. These findings are consistent with many other protein interaction networks.

A Survey of Bariatric Surgical and Reproductive Health Professionals' Knowledge and Provision of Contraception to Reproductive-Aged Bariatric Surgical Patients.

BACKGROUND: Over 80 % of bariatric surgical patients are women with obesity in their reproductive years. Obesity adversely affects fertility; the rapid weight loss following bariatric surgery can increase fecundity. Current guidelines recommend avoiding pregnancy for up to 24 months following surgery, but little is known about current contraceptive care of women who undergo bariatric surgery. Two surveys were undertaken with bariatric surgical and contraceptive practitioners in England to establish current contraceptive practices in both groups. METHODS: Two anonymous on-line surveys were sent to all 382 members of the British Obesity and Metabolic Surgery Society (BOMSS) and an estimated 300 contraceptive practitioners in the North East of England. RESULTS: The BOMSS survey elicited a response rate of 17 % (n = 65), mainly from bariatric surgeons (n = 24 (36 %)). Most respondents (97 %) acknowledged the need to educate patients, but contraceptive information was only provided by 7 % (n = 4) of respondents in bariatric surgical clinics. Less than half of respondents were confident discussing contraception, and the majority requested further training, guidance and communication with contraceptive practitioners. The majority of respondents to the contraceptive practitioner survey were general practitioners (28 %, n = 20). Three quarters of respondents reported little knowledge of bariatric surgery, and many reported not seeing women with obesity requiring contraception before (66 %, n = 45) or after surgery (71 %, n = 49). CONCLUSIONS: There is a need to increase knowledge levels of contraception within bariatric surgical teams and to understand why, despite increasing levels of bariatric surgery, women do not seem to be appearing for advice in contraceptive settings.