naser vahdati-mashhadian

"Health for All by 2000" was launched by WHO in 1978 and is based on primary healthcare availability worldwide. During the month of Safar, many people from neighboring cities and countries travel to Mashhad. Since the qualitative approach can lead to a better understanding of access to healthcare from the perception of consumers, this study aimed to assess the perception of Pilgrims and healthcare providers of healthcare services and gain more profound knowledge about healthcare consumers’ experiences.  This qualitative study was conducted in Mashhad during Safar based on conventional content analysis from September 20-27, 2022. This study used a semi-structured in-depth interview on 36 participants, including pilgrims (n=27) and healthcare providers (n=9) such as medical doctors, nurses, and health experts selected through purposeful sampling. The interviews were transcribed word for word. The MAXqda software and Graneheim and Lundman’s qualitative content analysis were used for data analysis.  Data analysis revealed three categories, including 1. Understanding the challenges of the treatment services in terms of three subcategories: A. Lack of medical doctors, drug shortages, and higher prices of medicines, B. Experiencing the diseases (skin, cardiovascular diseases, poisoning, and digestive problems, musculoskeletal pain and asthma), and C. Lack of an appropriate place for patient examination and serum injection. 2. Understanding the challenges of health services, including three subcategories: A. Time and place insufficiency of services, B. Lack of access to sanitary detergents, C. Improper cleaning of resting spaces and places, and finally, 3. Understanding the challenges of welfare services, including two subcategories: A. Inadequacy and lack of access to the appropriate rest place, and B. poor quality and sortage of food.  The results indicated that access to healthcare, treatment, and welfare is more than just these services. Health policymakers’ commitment to improving healthcare equity, hopefully, leads to positive changes in the healthcare system. Therefore, enhancing social participation in the healthcare system and providing comprehensive education on the optimal use of healthcare services is necessary to empower pilgrims to access better healthcare.

 In pediatrics, many drugs are used without marketing authorization. Recommendations are often based on clinical experience. Therefore, the risk of inappropriate prescription (IP) is high. It is necessary to have a tool for pediatric IP detection.

 This study was performed to develop and validate a Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) screening tool to facilitate its use in pediatric practice in Iran.

 Using forward- and backward-translation procedures, an efficient and effective tool was provided in the current study and clinical settings. The two-round Delphi technique established content validity. The criteria were then piloted in a cross-sectional study in the pediatric patients of Khorasan Razavi and East Azerbaijan in Iran.

 A total of 104 explicit criteria (79 IPs and 25 omissions) were obtained and submitted to an 18-member expert panel (including 8 pharmacists, 2 clinical pharmacists, and 8 pediatricians working in a hospital or the community). Then, 98 out of the 104 criteria submitted to the experts were selected after two Delphi rounds (75 IPs and 23 omissions). The content validity and reliability of the tool were obtained by expert assessment (Cronbach’s alpha for the entire criteria: 0.60). At least, the rate of one inappropriate prescribed medication was 69% in Mashhad, almost twice that of Tabriz (35%).

 The modified POPI criteria comprise the first screening tool to assess rational prescriptions for pediatric patients in hospital and outpatient settings. Clinical validation and reliability studies are needed and planned by the authors to evaluate the usability and reliability of this tool.

The role of therapeutic drug monitoring (TDM) in patient care has grown rapidly since its introduction three decades ago. The aim of present study was to evaluate the possible relationship between serum levels and the clinical response of valproic acid (VPA). In the present study we evaluated a homogeneous group of adult patients receiving VPA monotherapy. A total of 18 epileptic patients who fulfilled inclusion and exclusion criteria were entered this prospective study. Steady state trough plasma concentration was determined by fluorescence polarization immunoassay (FPIA). The correlation between therapeutic response and VPA serum concentration was evaluated. Mean VPA dose and mean total VPA plasma concentrations were 8.35±1.49 mg/kg/day and 50.40±4.18 µg/ml respectively. Mean VPA clearance was 8.84±4.43 (ml/kg/h). Plasma levels within the therapeutic range were found in 33% of epileptic patients. Plasma levels were below the therapeutic range in 67% of study population. Of patients 75% and 17% with sub-therapeutic levels achieved complete control and partial control respectively. Poor correlation was found between the plasma concentration of VPA and its therapeutic effects. Therefore, this study showed that TDM of VPA will be useful only when individuals are non-responsive to treatment or vulnerable to adverse reactions with standard doses.