Journal of Research in Pharmacy Practice

Abstract

Abstract Phamacoeconomics can aid the policy makers and the healthcare providers in decision making 
in evaluating the affordability of and access to rational drug use. Efficiency is a key concept 
of pharmacoeconomics, and various strategies are suggested for buying the greatest amount 
of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost 
minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization 
analysis, which support identification and quantification of cost of drugs, are conducted in a 
similar way, but vary in measurement of value of health benefits and outcomes. This article 
provides a brief overview about pharmacoeconomics, its utility with respect to the Indian 
pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic 
evidences can be utilized to support decisions on licensing, pricing, reimbursement, and 
maintenance of formulary procedure of pharmaceuticals. For the insurance companies to 
give better facility at minimum cost, India must develop the platform for pharmacoeconomics 
with a validating methodology and appropriate training. The role of clinical pharmacists 
including PharmD graduates are expected to be more beneficial than the conventional 
pharmacists, as they will be able to apply the principles of economics in daily basis practice 
in community and hospital pharmacy.

Abstract Objective: Clinical pharmacy services are improving in hospitals. For assessing the impact 
of these services, first it is important to exactly describe them by categorizing into types, 
severity, resolution, and accuracy. The objective of this study is to provide a detailed analysis 
of the clinical pharmacists’ services performed on in‑patients in a teaching hospital during 
28 months. Setting: Masih Daneshvari hospital, Tehran, Iran.
Methods: This is a descriptive study. The authors retrospectively reviewed the notes of 
all services and entered them in a designed SPSS sheet. Documentation was carried out 
based on the “findings, assessment, resolution, and monitoring” method. The data were 
descriptively analyzed. Main outcome measure: Types, subtypes, severities, resolutions, and 
accuracies of services were defined, documented, and analyzed.
Findings: In total 3152 records(2227 interventions and 925 visits with no intervention) were 
classified and analyzed in this study. Among all types of interventions, “improper medication 
use” (36.2%) was the most frequent intervention and among categories (subgroups) of 
“improper medication use,” “untreated indication” was the most frequent (23.7%). From the 
aspect of severity, 75.4% of interventions were estimated as of minor potential inconvenience 
to the patient (severity degree 1). Most interventions (78%) were finally recommended to 
the prescriber and 97.6% of interventions were considered accurate on further evaluation.
Conclusion: Clinical pharmacists’ interventions are highly demanded in the hospitals. Based 
on the results of this study, conditions needing medication to prevent later complications 
in the course of therapy are sometimes ignored, which emphasizes the positive role of the 
clinical pharmacists’ involvements in clinical teams to improve outcome.

Abstract Objective: Medication errors are the most common medical errors, which may result in 
some complications for patients. This study was carried out to investigate what influence 
medication errors by nurses from their viewpoint.
Methods: In this descriptive study, 150 nurses who were working in Qazvin Medical 
University teaching hospitals were selected by proportional random sampling, and data 
were collected by means of a researcher‑made questionnaire including demographic 
attributes (age, gender, working experience,…), and contributing factors in medication 
errors (in three categories including nurse‑related, management‑related, and 
environment‑related factors).
Findings: The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) 
were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their 
overtime working was 64.8 ± 38 h/month. The results showed that the nurse‑related factors 
are the most effective factors (55.44 ± 9.14) while the factors related to the management 
system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. 
The difference between these three groups was significant (P = 0.000). In each aforementioned 
category, the most effective factor on medication error (ranked from the most effective 
to the least effective) were as follow: The nurse’s inadequate attention (98.7%), the errors 
occurring in the transfer of medication orders from the patient’s file to kardex (96.6%) and 
the ward’s heavy workload (86.7%).
Conclusion: In this study nurse‑related factors were the most effective factors on 
medication errors, but nurses are one of the members of health‑care providing team, so their 
performance must be considered in the context of the health‑care system like work force 
condition, rules and regulations, drug manufacturing that might impact nurses performance, 
so it could not be possible to prevent medication errors without paying attention to our 
health‑care system in a holistic approach.

Abstract Objective: The aim of this study is to compare the effects of hypercapnic hyperventilation 
and normocapnic normoventilation on emergence time from propofol and isoflurane 
anesthesia.
Methods: In this clinical trial, the differences in emergence time were evaluated in 80 patients 
undergoing elective abdominal surgery in Alzahra University hospital, Isfahan, Iran, in 2011-
2012. Patients were randomly divided into four groups (groups 1-4) receiving isoflurane 
hypercapnic hyperventilation, isoflurane normocapnic normoventilation, propofol hypercapnic 
hyperventilation, and propofol normocapnic normoventilation, respectively. Hypercapnia was 
maintained by adding CO2
 to the patient’s inspired gas during hyperventilation. The emergence 
time and the duration of stay in recovery room in the four groups were measured and 
compared by one‑way analysis of variance (ANOVA) and least significant difference tests.
Findings: The average emergence time in groups 1, 2, 3, and 4 were (11.3 ± 3.2), (15.2 ± 3.8), 
(9 ± 4.2) and (11.8 ± 5.3) min, respectively. These differences were significant (P = 0.001). In 
patients receiving propofol hypercapnic hyperventilation, the emergence time was faster than 
in other groups. There was also a significant difference in duration of stay in recovery room 
between the groups(P = 0.004). Patients who received isoflurane hypercapnic hyperventilation 
had a shortest length of stay in the recovery room.
Conclusion: The emergence time after intravenous anesthesia with propofol can be 
shortened significantly by using hyperventilation and hypercapnia, without any side effects.

Abstract Objective: The aim of this study was to investigate the effect of adding risperidone to the 
general behavioral treatment of masturbation in children 3‑7 years old.
Methods: A 4 week randomized clinical controlled trial was designed in year 2009. 
Samples have been chosen from children who have been referred to the Child and 
Adolescence Psychiatric Clinic of Isfahan University of Medical Sciences. Ninety children 
were recruited at the study and randomly allocated into the risperidone and control 
groups (44 and 46 respectively). The risperidone group was medicated simultaneously by 
behavioral treatments and 0.25‑1 mg of risperidone daily while the controls only received 
the behavioral treatments.
Findings: The mean ± SD age of the risperidone and control groups was 5.3 ± 1.1 and 
4.9 ± 1.1 years, respectively. The mean ± SD of the period of suffering from masturbation was 
3.4 ± 1.2 and 3.8 ± 1.7 months in the risperidone and the control groups, respectively. At the 
beginning of the study, the mean frequency of masturbation in control and the risperidone 
groups was 2.6 ± 0.9 and 2.7 ± 0.9 times/day, whereas after the 4th week, it decreased to 
1.4 ± 0.6 and 1.1 ± 0.5 times/day, respectively. The results showed a more reduction in the 
mean frequency of masturbation in the risperidone group significantly.
Conclusion: In comparison to the general behavioral treatment, risperidone in addition 
to the behavioral treatment will probably reduce the frequency of masturbation in children 
more effectively.

Abstract Objective: Ibuprofen – a non‑steroidal anti‑inflammatory drug (NSAID)‑ and glucosamine
sulfate – a natural compound and a food supplement‑ are two therapeutic agents which have
been widely used for treatment of patients with temporomandibular joint (TMJ) disorders.
This study was aimed to compare the effectiveness and safety of these two medications in
the treatment of patients suffering fromTMJ disorders.
Methods: After obtaining informed consent, 60 patients were randomly allocated to two
groups. Patients with painful TMJ,TMJ crepitation or limitation of mouth opening entered
the study. Exclusion criteria were history of depressive disorders, cardiovascular disease,
musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction
or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin,
or concomitant treatment of TMJ disorder with other agents or methods.Thirty patients
were treated with ibuprofen 400  mg twice a day,  (mean age 27.12  ±  10.83  years) and
30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily.
Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular
opening were checked and compared within and between two groups.
Findings: Comparing with baseline measures, both groups had significantly improved
post‑treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001
for glucosamine sulfate and 0.03 for ibuprofen).Post treatment pain and mandibular opening
showed significantly more improvement in the glucosamine treated patients (P < 0.0001 and
0.01 respectively).Rate of adverse events was significantly lower in the P value glucosamine
sulfate group (P < 0.0001).
Conclusion: This investigation demonstrated that comparing with a commonly prescribed
NSAID – ibuprofen‑, glucosamine sulfate is a more effective and safer therapeutic agent for
treatment of patients with TMJ degenerative join disorder.

Abstract Objective: Nearly two-third of the patients with type 2 diabetes have degrees of fatty liver; 
this may induce some side effects in them. This study aimed to find effect of salsalate on 
treatment of steatohepatitis and correlation of fatty liver with metabolic syndrome in the 
setting of impaired glucose metabolism.
Methods: In a double-blind randomized trial within two distinct groups, i.e., recently 
diagnosed diabetics and prediabetic cases allocated in two arms of the intervention to 
receive 3 g salsalate or placebo. All cases underwent glucose and lipid level studies and 
liver ultrasound study.
Findings: Out of 46 patients with diabetes, 34 (74%) had fatty liver in ultrasound; this 
ratio was 75% in 113 prediabetic cases. Relative frequency of fatty liver stages did not differ 
between diabetics and prediabetics. Within diabetics, mean aspartate aminotransferase 
(AST) level of fatty liver cases (23 ± 7 IU/dl) was higher than others (18 ± 3 IU/dl) (P < 
0.05). Changes in transaminase levels following intervention did not significantly differ, 
comparing drug and placebo arms in two subgroups.
Conclusion: According to the findings, if diabetes could be assumed as the logical 
consequence of prediabetic state, it seems that fatty liver did develop before this 
preliminary status. In this study, salsalate could not change biochemical markers of fatty 
liver significantly.

Abstract Objective: To characterize adverse drug reactions (ADRs) reported by European (EU) 
consumer for antineoplastic and immunomodulating medications.
Methods: ADRs reported by consumers of antineoplastic and immunomodulating 
medications (anatomical therapeutic chemical [ATC]) group L from 2007 to 2011 and 
located in the EU ADR database, EudraVigilance, were analyzed. Data were categorized 
with respect to age and sex, category, and seriousness of reported ADRs and medications. 
The unit of analysis was one ADR.
Findings: We located 9649 ADRs reported for antineoplastic and immunomodulating 
medications, which approximately 15% of were serious, including 26 deaths. Less than 5% 
of ADRs were reported in children. Totally 73% of ADRs were reported for women and 
27% for men. The majority of ADRs were of the type “general disorders and administration 
site conditions” (54% of total ADRs), followed by “skin and subcutaneous disorders” 
(7% of total ADRs), and “infections and infestations” (6% of total ADRs). Reports 
encompassed medicines from the therapeutic groups: Imunosupressants (ATC group L04) 
(90% of all ADRs), immunostimulants (ATC group L03) (6% of all ADRS), and antineoplastic 
agents (ATC group L01) (4% of all ADRs). Many ADRs were reported for etanercept (Enbrel®), 
Interferon beta (Betaferon®/Extavia®), and imatinib (Glivec®) with only few being serious.
Conclusion: In general, consumers reported a high number of ADRs from the use of 
antineoplastic and immunostimulant medications and many of these were classified as 
non‑serious. This indicates that consumers are interesting in reporting ADRs, but since 
the investigated substances potentially have the risk of causing many ADRs, we expected a 
higher number of serious ADRs.