فهرست مطالب mahtabal sadat mirjalili

Diabetes imposes an enormous burden on patients, families, societies, and healthcare systems. Determining the affordability of medications is an important complicated and vague task, especially in low- and middle-income countries (LMICs). This study aimed to assess the affordability of diabetes medication therapy in Iran’s health system.

This paper presents a scenario-based assessment of the affordability of all registered anti-diabetes medications in Iran in 2017. To this end, 4 medication therapy scenarios were defined as mono, dual, triple, and insulin therapy in accordance with the existing guidelines and clinicians’ opinions. Then the affordability ratio of each treatment scenario was determined for type 1 and type 2 diabetes drawing on the World Health Organization (WHO)/Health Action International (HAI) Methodology. If the affordability ratio for treatment schedules was more than 1, the patients’ out-of-pocket (OOP) expenses exceeded the lowest-paid unskilled government worker (LPGW)’ wage per day, and the treatment was labelled as non-affordable.

The results revealed that the mono, dual, and triple (non-insulin) medication therapies in type 2 diabetes were affordable, despite an increase in the dosage or a switch from the monotherapy to the combination therapy of oral medications. However, some treatment scenarios in the triple therapy, including oral plus insulin and some insulin only therapies, were proved to be non-affordable. In type 1 diabetes, only insulin glulisine, detemir, and lispro were nonaffordable in monotherapy. Regarding the combination therapy, only isophane insulin with aspart or regular insulin were affordable treatments.

Although oral medication therapies were documented to be affordable, insulin therapy, with current coverage conditions, for patients with lowest paid wages and those receiving even less is unaffordable and a major barrier to treatment; hence, policy-maker should consider targeting and more financial protection policies to improve the affordability of insulin therapies among this group of patients

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.

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.

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).

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.

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.

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.

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.

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.

 Iran has welcomed a large population of immigrants and refugees, which has led to new demands and priorities in many aspects of life, such as healthcare services.

 For the first time in Southern Iran, in Shiraz City, population-based research was conducted on the patterns of medication use in native non-Iranian residents.

 The present cross-sectional study was conducted amongst Shiraz citizens from 2017 to 2018. The population consisted of 43 migrants. Data were collected using a multipart data form. All statistical analyses were performed using SPSS.

 A total of 43 Afghan migrants were included in the study. Most of them were female (72.1%), aged under 40 years (67.4%), and homemaker (62.8%) with an education level of non-completed high school diploma (97.7%). The majority of the subjects did not have insurance or family physician coverage (93%), and 85.7% got medications without prescription. The three most common medications used by the subjects were iron supplements, acetaminophen, and cold medicines.

 Iran is now hosting Afghan nationals as one of the largest population of refugees in the world. The health conditions of the Afghan population need more attention in order to improve the health status of their community in Iran.

Cardiovascular diseases (CVD) have become increasingly life-threatening during recent decades. Several studies have shown that matrix metalloproteinase-9 (MMP-9) plays an important role in the process of atherosclerosis and heart remodeling. On the other hand, Vitamin D deficiency has been recognized as a risk factor for CVD. According to the prevalence of vitamin D deficiency in our country, Iran, we aimed to evaluate the relationship between vitamin D status and the level of MMP-9 in patients undergoing percutaneous coronary intervention (PCI). In this prospective cross-sectional study, patients who were candidates for elective coronary angioplasty were included. Baseline serum MMP-9 and vitamin D levels were measured before intervention. Patients were categorized into three groups: Vitamin D-severely deficient (≤ 10 ng/ml), vitamin D-moderately deficient (11-20 ng/ml), and vitamin D-insufficient/sufficient (> 21 ng/ml). Totally, 150 patients were assessed. The analysis showed that serum MMP-9 levels were higher in patients with lower vitamin-D concentrations. A significant inverse correlation was found between MMP-9 concentration and 25(OH) vitamin D level (P = 0.039). According to our results, it may be concluded that low levels of vitamin D may lead to more vulnerable atherosclerotic plaques and consequently more cardiovascular adverse effects in post-PCI patients.

Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems.

A cross‑sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines.

Ninety‑four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty‑one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively.

In this study, at least three‑fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients’ pharmacotherapy, and more attention should be paid to this issue.

Vitamin D deficiency is a common health problem worldwide, especially in the Middle Eastern region. Although various dosing regimens of vitamin D have been used for the treatment of vitamin D deficiency, it is still unclear as to which dosing regimen can efficiently increase the serum level of vitamin D in different patient population.

This study was designed to compare the efficacy of weekly and daily regimens of vitamin D3 in patients with vitamin D deficiency. Settings and Design: A randomized clinical trial was conducted in the autumn and winter of 2016 and 2017, Hamadan, Iran.

A total of 130 patients with moderate to severe hypovitaminosis D were allocated into two groups: weekly 50,000 IU (routine recommended dose for vitamin deficiency treatment) or daily 4,000 IU (safe upper limit dose of vitamin D per day) of oral vitamin D3 for 8 and 14 weeks, respectively. The serum levels of 25-OH-vitamin D were measured in all patients at baseline and at the end of the treatment period.

Results of this study showed that though both dosing regimens can be effective in increasing the serum level of 25-OH-vitamin D, higher percentage of the subjects in the daily regimen group achieved the sufficient serum level of 25-OH-vitamin D when compared to the weekly regimen group.

Accordingly, probably owing to better bioavailability of daily regimen of vitamin D3 and establishment of a more steady serum concentration compared with weekly regimen, it can be recommended as the preferred dosing regimen for effective treatment of vitamin D deficiency.

Contrast-induced nephropathy (CIN) is the third cause of hospital-acquired renal failure and is associated with significant morbidity and mortality. Several studies have revealed the protective role of omega-3 in prevention and treatment of some kidney injuries. This study was conducted to examine the effect of omega-3 supplementation on the markers of renal function and to evaluate its potential in the prevention of CIN in patients undergoing elective percutaneous coronary intervention (PCI). In this double-blind, randomized clinical trial, 85 eligible patients scheduled for PCI was randomly divided into omega-3 (a single 3750 mg dose of omega-3 as well as routine hydration therapy within 12 hours before PCI) or control (placebo plus routine hydration therapy) groups. Serum creatinine (SCr) and cystatin C levels were measured at baseline and 24 hours after PCI. Our results indicated that post- PCI cystatin C levels were significantly decreased in the omega-3 group compared to the control group (P < 0.001). Although less upward manner was seen in the level of 24-hour creatinine in the omega-3 group, it did not reach the significance level (P = 0.008). The positive effect of omega-3 on cystatin C levels showed that it may have a protective role in the prevention of CIN in post-PCI patients with normal kidney function. However, to better assess this effect, it is highly recommended to design future studies with higher doses and longer duration of therapy with omega-3 plus long-term follow up.

Medication errors may prolong hospitalization period, enhance its costs and make harmful impacts on health. Inappropriate drug history taking is a type of medication errors which may occur on admission, resulting in medication discrepancies. This work presents a report of discrepancies between the drug history acquired by pharmacists and the drugs administered by the physicians at a teaching hospital in Shiraz, Iran. This prospective study was conducted from October 2016 to March 2017 in 7 wards of Namazi hospital affiliated to Shiraz University of Medical Sciences. Both the physicians/nurses and pharmacists obtained medication history from patients recruited in this study during the first 24 hours of their admission. The medications were classified according to the ATC classification. Totally, 103 patients were recruited and 557 medications were recorded in this study. The mean±standard deviation age of patients was 58.52±18.75 years. Comparing pharmacist drug history with medication lists obtained by nurses or physicians revealed 353 discrepancies. On average, 3.42 discrepancies were identified per patient (ranged from 0 to 12). Most (85.8%) of medication discrepancies were related to omission errors. Metformin and aspirin were the most common medications involved in omission errors. The rate of medication discrepancies at admission in our hospital was high. Active contribution of pharmacists and providing accurate medication histories at the time of hospital admission can be considered as possible solutions for this problem.

In most Iranian hospitals, the nurses in the wards prepare intravenous (IV) drugs and unfortunately pharmacists are not involved in this process. The severity of the patients in Intensive Care Unit (ICU) heightens the risk of errors. More over the frequency of using IV drugs in this unit is high, so we decided to determine the frequency and types of errors, which occur in the preparation and administration of commonly, used IV medications in an ICU. A prospective cross sectional study was performed from November 2013 to August 2014, in the intensive care unit in Shahid-Sadoughi hospital in Yazd. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacy student and were evaluated by direct observation, according to the method established by Barker and McConnell. A total number of 843 intravenous doses were evaluated. The most common type of error (34.26%) was the injection of IV doses faster than the recommended rate followed by preparation (15.69%), administration (9.23%) and compatibility with doctor’s order (6.24%). Amikacin was the most common drug involved in errors (41.67%). Most of errors were occurred at afternoon (8 p.m, 28.36%). According to our study the rate of errors in preparation and administration of IV drugs was high in this ICU. Employing more nurses, using developed medical instruments and clinical pharmacists can help to decrease these errors and improve the quality of patient care.