Saira Azhar

Enlisting the scientifically unnoticed medicinal plants of Pakistan as a source of novel therapeutic agents showing anti-venom activity

Snake bite envenoming is a global occupational hazard and most of the people of the world trust in traditional medicine for snake poisoning. The present review elaborates scientifically un-investigated/ ignored medicinal plants of Pakistan showing chemical constituents of natural origin with possible mechanisms showing anti-venom activity. This review enlists 35 plants with their families, distribution in Pakistan, parts used traditionally for snake bite treatment and various active principles present in them. Compositae is the most excessive family, with 3 species, followed by Amaranthaceae, Apocynaceae, Asclepiadaceae, Caesalpinaceae, Labiatae, Pinaceae, Polygonaceae and Verbinaceae having 2 species of medicinal plants. While, one plant species belongs to each, Aizoaceae, Araceae, Boraginaceae, Chenopodiaceae, Cucurbitaceae, Euphorbiaceae, Flacourtiaceae, Gentianaceae, Malvaceae, Menispermaceae, Mimosaceae, Oxalidaceae, Papilionaceae, Plantaginaceae, Salvadoraceae and Solanaceae. As an antidote to snake poisoning, the traditional use of leaves (35%) is higher than roots (25%), whole plant (21%), flower (7%), wood (5%), fruit (5%) and milky juice (2%). Among life forms of plants, herbs (55%) are more excessively used as snake bite remedy than shrubs (31%) and trees (14%). This article may help the researchers to bring novelty in the field of natural products for the treatment of snake bite. However, chemical and pharmacological studies are necessary to confirm the anti-venom claims about these medicinal plants of Pakistan.

Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

Drug–drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug–drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug–drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug–drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001), hospital stay of 7 days or longer (p < 0.001) and taking 7 or more drugs (p < 0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

Randomized controlled trials covering pharmaceutical care and medicines management: A systematic review of literature

Objective To review the effects of pharmaceutical care on hospitalizations, mortality and clinical outcomes in patients. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases to identify studies that were published between 2004 and January 2017. Studies included in this review were randomized controlled trials (RCTs) that spanned across both community and hospital settings. Using strict inclusion/exclusion criteria studies were included if they reported level 1 or 2 outcomes in the hierarchy of outcome measure i.e. clinical and surrogate outcomes (e.g. blood pressure (BP) control, blood glucose level, cholesterol BMI). Each study was assessed for quality using the Jadad scoring system. Results Fifty‐four RCTs were included in the present review. Forty‐six of these studies ranked high quality according to the Jadad scoring system. Studies were categorized into their general condition groups. Interventions in patients with diabetes, depression, respiratory disorders, cardiovascular disorders, epilepsy, osteoporosis, and interventions in older adults were identified. In the majority of studies pharmaceutical care was found to lead to significant improvements in clinical outcomes and/or hospitalizations when compared to the non‐intervention group. Some conditions had a large number of RCTs, for example for cardiovascular conditions and in diabetes. Statistically significant improvements were seen in the majority of the studies included for both of these conditions, with studies indicating positive clinical outcomes and/or hospitalizations rates. Within the cardiovascular condition, a subset of studies, focusing on cardiac heart failure and coronary heart disease, had more mixed results. In other conditions the number of RCTs conducted was small and the evidence did not show improvements after pharmaceutical care, i.e. in depression, osteoporosis, and epilepsy. The majority of interventions were face to face interactions with patients, whilst a smaller number were conducted via the telephone and one via a web‐based system. Patient education was a key component of most interventions, either verbal and/or written. Longitudinal data, post intervention cessation, was not collected in the majority of cases. Conclusions RCTs conducted to evaluate pharmaceutical care appear to be effective in improving patient short‐term outcomes for a number of conditions including diabetes and cardiovascular conditions, however, other conditions such as depression are less well researched. Future research should attempt to evaluate the conditions where there is a lack of data, whether the positive effects of pharmaceutical care persist in patient populations after the interventions cease and what the long‐term clinical outcomes would be of continued pharmaceutical care.

What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study

The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers.

Chapter 17 – Quality of Pharmacy Health Services

Abstract The quality of pharmacy health services can only be assured by the presence of qualified and competent pharmacists. In developing countries, healthcare facilities are insufficient for providing good-quality health services to patients. Major reforms are needed to ensure quality improvement in pharmacy health service organizations. These reforms could take place with the support of visionary leadership, effective planning and utilization of resources, direct involvement of pharmacists in patient care activities, as well as interprofessional collaborative care. At present, developing countries encounter several obstacles in providing quality pharmacy services, and these obstacles need to be resolved. In the developing countries, the lack of government interest and commitment in the profession is a serious concern. This chapter will explore the status of quality of pharmacy healthcare services in the developing countries and discuss the supportive factors that ensure its quality.

Nurses' Perception Towards the Benefits of Pharmaceutical Care Services in Tertiary Health Care Settings Pakistan: A Qualitative Insight.

pharmacy. Written consent was obtained from the participants prior to the interview. Results: Among the respondents interviewed. Thematic content analysis yielded 4 major themes: (a) Lack of documentation, (b) Improper patient counseling, (c) Unavailability of pharmaceutical care guidelines, (4) Lack of collaboration with other health care providers. ConClusions: This study concludes that community pharmacies are not very much involved in provision of pharmaceutical care to patients. Documentation and patient counseling is also very poor due to lack of enough time and no financial encouragement. There is also no effective professional relationship of community pharmacists with other health care providers.

Community Pharmacists Attitude and Perceived Need Towards the Provision of Pharmaceutical Care Services: A Qualitative Approach

The main objective of present study is to assess the perception of community pharmacists regarding the quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) province, Pakistan. A qualitative study design was adopted. To identify the community pharmacists, snowball sampling technique was used. An interview guide (semi-structured) was designed and face to face interviews were conducted until point of saturation reached. Twelve pharmacists were interviewed working in community pharmacies of different cities of KPK, Pakistan. The participants were interviewed at the community pharmacies. Prior to the interview, written consent was signed by each of the participants. All the respondents interviewed were male pharmacists. Four major themes were yielded from thematic content analysis: (a) Lack of documentation, (b) improper patient counseling, (c) unavailability of pharmaceutical care guidelines, and (d) lack of collaboration with other health care providers. This study concludes that community pharmacists are not actively involved in provision of pharmaceutical care to patients. Documentation and patient counseling is also very poor due to shortage of time and low financial or promotional encouragement. There is also lack of effective professional relationship between the community pharmacists and other health care providers. RESUMEN. El objetivo principal del presente estudio es evaluar la percepción de los farmacéuticos comunitarios en cuanto a la calidad de los servicios de atención farmacéutica en Khyber Pakhtunkhwa (KPK), Pakistán. Se adoptó un diseño de estudio cualitativo. Para identificar los farmacéuticos comunitarios, se utilizó la técnica de muestreo de bola de nieve. Fue diseñada una guía de entrevista (semi-estructurada) y entrevistas cara a cara se llevaron a cabo hasta el punto de saturación alcanzado. Fueron entrevistados doce farmacéuticos que trabajan en farmacias comunitarias de diferentes ciudades de KPK. Los participantes fueron entrevistados en las oficinas de farmacia. Antes de la entrevista, el consentimiento por escrito fue firmado por cada uno de los participantes. Todos los encuestados fueron entrevistados porfarmacéuticos masculinos. Cuatro temas principales fueron cedidos de temática análisis de contenido: (a) La falta de documentación, (b) el asesoramiento incorrecto del paciente, (c) la falta de disponibilidad de directrices de atención farmacéutica, y (d) la falta de colaboración con otros proveedores de atención médica. Este estudio concluye que los farmacéuticos comunitarios no participan activamente en la prestación de la atención farmacéutica a los pacientes. La documentación y el asesoramiento del paciente también es muy pobre debido a la escasez de tiempo y al bajo estímulo financiero o promocional. También hay falta de relación profesional efectiva entre los farmacéuticos de la comunidad y otros proveedores de atención médica.

A Qualitative Assessment of Doctors Perception Towards the Quality of Pharmaceutical Care Services in Khyber Pakhtunkhwa, Pakistan

Primary non-adherence was defined as a binary outcome representing failure to fill a new prescription within 30 days after the medication was prescribed to the patient and secondary non-adherence was defined as a number of refills obtained by a patient within a 12 month follow up period. Various measured patient, prescription, and prescribing physician characteristics were included in the model. Hurdle model results indicate that important predictors are missing from the single-component models, but exist in the joint model of primary and secondary non-adherence. ConClusions: The authors conclude that a hurdle modeling approach enables the taking of simple, well-understood models primary (logistic regression) and secondary non-adherence (count regression) and combine them in a way that provides a better description of the data than a single-component models provide separately.