Journal of Research in Pharmacy Practice

Abstract Despite growing debates about the health systems' nonmedical performance, there has not been any empirical research on nonmedical performance and patients' rights consideration as a driver of human rights in the pharmaceutical sector. This study's main objective was to assess the nonmedical performance of community pharmacies of Shiraz, Iran. Methods: A cross-sectional study was conducted using two self-administrated Likert-based questionnaires based on the World Health Organization (WHO) responsiveness framework and the legal charter communicated by the Ministry of Health and Medical Education of Iran. The population was patients older than 18 years who took a prescription from community pharmacies located in Shiraz and willing to answer the questions voluntarily, from 2018 to 2019. Considering the weights of subdimensions of responsiveness provided by the WHO framework, the total score of responsiveness was calculated ranging from 0 to 100. Findings: The response rate was 80.5%. The mean (standard deviation) overall score of responsiveness was 57.18 (21.61), with a median of 56.71. The mean score of client orientation was lower in respondents with a high education level than those with a diploma and under diploma (P = 0.028). Conclusion: Nonmedical pharmacy performance was considered either medium or high in more than half of the cases based on the participants' views. Regarding client, orientation was seen less often in patients with high education level compared to those with a lower education level.

Abstract  The purpose of this study was to document the demographic data, to assess the proportion of consumed medicines and the amounts and types of drugs available to households, and to to estimate the probable prevalence of certain diseases in the southern region of Iran. Methods: In this cross-sectional population-based study carried out in Shiraz (the central city in the Southern part of Iran), we documented and evaluated the drug usage details in a random sample of 1000 households during 2018–2020. We analyzed the usage of drug categories based on the anatomical therapeutic chemical classification, which the World Health Organization recommends. Findings: In the studied population, the average age (± standard deviation) was 45.54 ± 15.82, ranged 18–91 years. More than 90% had medical insurance coverage. About 81.8% of the participants had individual family medicine practitioners, and most of them (93.8%) received medications with a physician's prescription. The most frequently used medications were cough and cold preparations (12.9%), nervous system drugs (12.6%), and cardiovascular system drugs (11.6%). Conclusion: Despite the easy access to medications for most participants, few individuals (about 6%) received their medications without a prescription. The most frequently prescribed medicines were the common cold, acetaminophen, and metformin. Common cold, gastrointestinal (GI) disorder, and diabetes were the most commonly used medication classes. Furthermore, we have found a probably higher than average prevalence of cardiovascular, GI, and endocrine disorders. This information could be used by the local policymakers as a basis for the estimation and allotment of health-care resources.

Abstract Coronavirus 19 (COVID-19) is an extremely transmittable microbial infection that has emerged in Wuhan (China) in late 2019, leading to severe acute respiratory syndrome coronavirus 2 syndrome, and caused a pandemic all over the globe. This study is a systematic review of all 927 clinical trial studies performed worldwide from the beginning of the COVID-19 mysterious pandemic in China. These researches have registered in different databases. According to the best of our knowledge, China (74.82%), the United States (4.49%), and France (2.72%) have the most significant number of clinical trials, respectively. Clinical trials can be randomized or nonrandomized. Due to our results, 32.58% of studies were randomized, and 7.12% were not randomized. Most of the studies were open-labeled studies (22.44%), and double-blinded (4.42%) and quadruple blinded (2.48%) studies stand in second and third place regarding the number of trials, respectively. The direction and quantity of clinical trials attempted to identify a possible cure for COVID-19 demonstrates the depth of this crisis. As we are writing this article, a significant international endeavor will find a cure or vaccine for containing this devastating and mysterious disease.

Abstract  Patients' complain regarding pharmaceutical services at community pharmacies is a fundamental issue as it can directly affect people's service utilization. For the first time in Iran, this survey aimed to investigate the experience of people regarding declare a complaint against the pharmacy sectors as a community-based study. Methods: In this cross-sectional study, over 100 samples based on postal codes were randomly selected from the city of Shiraz in 2017–2018. The data collection instrument was designed in two parts (demographic and social profile which record the complaint experiences against pharmacists, pharmacy services, etc.). The data were analyzed by SPSS. Findings: All 1035 eligible participants had a mean age of 45.54 ± 15.82 years (ranged from 14 to 91). Nearly 70% of the participants were female. Around 81.8% had a family physician coverage, whereas 7.4% of them had no medical insurance coverage. The frequency of complaints from the pharmacies was 35.6%. Nearly 55% of the complaints were related to governmental pharmacies. Homemakers were 1.36 times more likely to have experienced complaints in comparison with their employed female counterparts. Health status had an inverse association with complaints. Those participants who had received prescription medication were about two times more likely to have filed a complaint in comparison with those who received medication without a prescription. In addition, females aged 40–59 and above 60 and unemployed participants were more satisfied with respect to complaint follow-up process. Conclusion: Low level of satisfaction with respect to the complaint process is a concerning issue; hence, strategies are warranted to improve the quality of services provided in the pharmacies.

Abstract Nonvariceal upper gastrointestinal bleeding (NUGIB) is a common cause of hospitalization and is associated with considerable mortality and morbidity. Octreotide has been shown to be an effective treatment in the control of variceal UGIB. Theoretically, octreotide could be effective in the treatment of other types of bleeding ulcers. Methods: This randomized, double-blind, placebo-controlled trial was carried out on patients with NVUGIB who had been admitted to two referral centers in Shiraz, Iran. Patients were randomized to two groups: Group A (n = 58) received octreotide and Group B (n = 58) received a placebo. Patients in both groups received pantoprazole 40 mg as an initial dose, then 40 mg every 12 h intravenously. In addition to the pantoprazole, patients in Group A received 100 μg octreotide subcutaneously every 8 h for 72 h or until they were discharged. Patients in Group B received pantoprazole and a placebo at the same dose schedule. Findings: There were no statistically significant differences between Groups A and B in terms of mortality (0 vs. 5.17%; P = 0.21,) rebleeding rate (5.17% vs. 1.72%; P = 0.5), blood transfusion requirement (1.65 ± 0.47 units vs. 1.70 ± 0.45 units; P = 0.45), length of hospital stay (1.96 ± 1.00 days vs. 1.65 ± 0.84 days; P = 0.44), and need for surgery (1.72% vs. 1.72%; P = 0.7). Conclusion: The results showed that use of subcutaneous octreotide as an adjuvant treatment did not have a beneficial effect on the treatment of NVUGIB.

Abstract  We aimed to find the toxicoepidemiological indicators of tramadol poisoning in children and also the relationship of these indicators (such as demographic characteristics, and referral time) with the final therapeutic outcome. Methods: In this cross-sectional study with retrospective data collection, we included the records for all the patients under 18 that have been admitted due to tramadol poisoning between 2010 and 2015 to Noor and Ali-Asghar (PBUH) University hospital which serves as the referral medical center for acute poisonings management in the central part of Iran and is located in Isfahan. Demographic characteristics, ingested dose, dosage forms, clinical manifestations, coingested drugs, and the outcome of treatment for all pediatric patients were documented and descriptively analyzed. Findings: Demographic and clinical data of a total of 189 patients including 101 male (53.4%) with a mean age of 16.66 ± 2.64 years were abstracted and included in this study. The average time between tramadol ingestion and hospital admission was 3.39 ± 3.23 h. Mean duration of hospitalization was 12.3 ± 10.7 h. In all cases, the route of drug exposure was oral, and the most common form of drug dosage form was 100 mg tablets (n = 122) proceeded by 200 mg tablets (n = 32). The mean estimated dose of ingested tramadol was 1126 ± 1061 mg (median, 900 range, 50–7000 mg). 43.9% of the poisoned patients were high school students, and 23.3% had a high school diploma. Intentional intoxications were reported in 93.1% cases and 42.9% had coingestions. Activated charcoal (87.3%), gastric lavage (59.3%), oxygen therapy with mask (46.6%), naloxone (11.6%), anticonvulsants (13.2%), and intubation and ventilation (5.3%) were done as first-line therapeutic measures. Conclusion: Our results suggest that the trend of acute tramadol poisoning among children is decreasing, mostly accidental in adolescents and commonly intentional among young children. Proper education to improve emotional intelligence for young adults and to keep drugs out of reach of the children and safer packaging is recommended to reduce tramadol poisoning incidence in the pediatric population

Abstract  We aimed to detect and report the frequency of occurrence of drug-related problems (DRPs) in a Middle Eastern University Children's Hospital (Isfahan, Iran) and classify them in terms of their nature and cause to clarify the responsibility of clinical pharmacists for the safe utilization of medications in hospitalized children. Methods: In this cross-sectional study which was carried out in Imam Hossein Children's University Hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran) from September 2017 to May 2018, DRPs during the hospitalization of pediatric patients in three medical wards, the pediatric intensive care unit, and two neonatal intensive care units were detected and identified concurrently with the treatment process using Pharmaceutical Care Network of Europe data gathering form for DRPs v. 8.01. All cases were verified and validated in a professional focus group before documentation. Findings: We detected 427 DRPs in 201 out of 250 randomly included hospitalized children in which 86% of them were directly reported by the hospital's clinical pharmacist. The highest frequency of DRPs (47.3%) was observed in the age range of 1 month–2 years. Safety of treatment was the most frequently reported as the nature of the problem (43.5%), followed by effectiveness issues (36.8%). The most frequent cause of DRPs was dose selection issues (34.2%), followed by drug-type selection (25.5%), and unavailability of appropriate dosage forms (13.6%). Ninety-eight interventions were proposed by the clinical pharmacist, in which 59.2% of them were accepted. Conclusion: This study confirms the necessity for the active role of clinical pharmacists before, during, and after drug therapy in hospitalized pediatric patients for the safety and proper utilization of drugs in this vulnerable population.

Abstract Evidence-based practice in medical sciences needs to publish confidential evidence that strongly depends on the research publications. This bibliometrics and network analytic study aims to evaluate the research publications of Iranian authors in pharmacology and pharmacy. Methods: Through the pharmacology and pharmacy category of Web of Science (WOS), all published articles affiliated with an Iranian researcher as an author were retrieved. Full records of retrieved articles in the WOS, including author name and affiliation, journal name, citation number, cited references, and keywords, were exported to a plain text file. Network analysis through VOSviewer was used for mapping the characteristics of the retrieved articles. All statistical analyses were done using the Microsoft Excel and SPSS version 25. Findings: The total number of Iran's publications (citations) rose from 1557 articles (10,085 citations) in 2000–2009 years to 6271 articles (77791 citations) in 2010–2018 years. Tehran University of Medical Sciences was the most productive university. The total number of RCTs rose from 82 publications in 2000–2009 to 278 publications in 2010–2018. The same numbers for systematic reviews and meta-analyses were four publications in 2000–2009 and 169 publications in 2010–2018. The five major topics of researches in pharmacology and pharmacy were drug delivery, basic pharmacology, oxidative stress, animal study, and molecular aspect of pharmacy. Conclusion: This study showed a marked increasing rate of publications and received citations by Iranians in pharmacology and pharmacy. After 2010, the rate of articles in the high-impact journals had growth. Furthermore, research articles in the highest level of evidence were more published by Iranians.

Abstract Suicide is a social health problem worldwide. Anemia has been associated with depression. Since it remains debated whether anemia is associated with suicide independently of depression, we evaluate this probable association in women who attempted suicide through acute poisoning. Methods: The study design was cross-sectional and performed on women who attempted suicide through intentional poisoning with age more than 18 years old. Different variables were evaluated and compared in patients with respect to anemia, depression, other psychiatric diseases and history of suicide. Independent t-tests and binary logistic regression were used for statistical analysis. Findings: Nearly 26.2% of the women had anemia (n = 55). Most women with anemia were in the age group of 20–40 years (68.8%). 52.2% of the women were married. Mixed-drug poisoning was the most common (60.1%) followed by pesticide (8.9%), and antipsychiatric medications (8.4%). There was a significant difference in duration of hospitalization between anemic and nonanemic patients. Nearly 72.7% of the patients survived without complications. Anemia and depression were not significant predictive factors for depression and suicide. However, in our patients, the presence of other underlaying psychiatric disorders was a risk factor for suicidal attempt through acute poisoning. Conclusion: In women who attempted suicide through acute poisoning, anemia and depression were not predicting factors for suicide. However, the presence of other underlying psychiatric psychiatric disorders had a predictive value for the outcome of treatment. Length of hospital stay was also correlated with anemia.