Physicians' and pharmacists' views and experiences regarding use of direct oral anticoagulants in clinical practice

AIM

Direct oral anticoagulants (DOACs) are increasingly used compared to vitamin K antagonists (VKAs). Guidelines advocate a structured multidisciplinary approach in the management of patients treated with DOACs. The aim of this study was to assess the views and experiences of physicians and pharmacists regarding DOAC use in clinical practice.

METHODS

An online questionnaire was sent to both primary (general practitioners [GPs], community pharmacists) and secondary healthcare professionals (cardiologists, residents in internal medicine and hospital pharmacists) between March and July 2020. The questionnaire covered four topics: (i) current practice, (ii) prescribing behaviour (only for physicians), (iii) self-perceived knowledge about DOACs and (iv) views and opinions about DOACs versus VKAs.

RESULTS

In total, 110 physicians and 111 pharmacists completed the survey. Healthcare professionals in secondary care had more experience with DOACs and felt more confident with higher self-perceived knowledge about DOACs compared to their colleagues in primary care. Healthcare professionals' self-perceived knowledge was more or less complementary, for example physicians felt less confident in managing drug-drug interactions (DDIs) where pharmacists reported being more confident in this topic. Physicians reported uncertainties on the potential impact of risk factors - such as older age, lower body weight and DDIs - on appropriate DOAC dosing.

CONCLUSION

Complementarity in physicians' and pharmacists' self-perceived knowledge levels of DOACs may facilitate and necessitate future multidisciplinary collaboration initiatives for the management and follow-up of DOAC patients.

The accuracy and completeness of drug information in Google snippet blocks

Introduction:

Consumers commonly use the Internet for immediate drug information. In 2014, Google introduced the snippet block to programmatically search available websites to answer a question entered into the search engine without the need for the user to enter any websites. This study compared the accuracy and completeness of drug information found in Google snippet blocks to US Food and Drug Administration (FDA) medication guides.

Methods:

Ten outpatient drugs were selected from the 2018 Clinical Drugstats Database Medical Expenditure Panel Survey. Six questions in the medication guide for each drug were entered into the Google search engine to find the snippet block. The accuracy and completeness of drug information in the Google snippet block were quantified by two different pharmacists using a scoring system of 1 (less than 25% accurate/complete information) to 5 (100% accurate/complete information). Descriptive statistics were used to summarize the scores.

Results:

For five out of the six questions, the information in the Google snippets had less than 50% accuracy and completeness compared to the medication guides. The average accuracy and completeness scores of the Google snippets were highest for “What are the ingredients of [the drug]?” with scores of 3.38 (51–75%) and 3.00 (51–75%), respectively. The question on “How to take [drug]?” had the lowest score with averages of 1.00 (<25%) for both accuracy and completeness.

Conclusion:

Google snippets provide inaccurate and incomplete drug information when compared to FDA-approved drug medication guides. This aspect may cause patient harm; therefore, it is imperative for health care and health information professionals to provide reliable drug resources to patients and consumers if written information may be needed.

Video killed the multiple-choice quiz: capturing pharmacy students' literature searching skills using a screencast video assignment

Background:

In a flipped, required first-year drug information course, students were taught the systematic approach to answering drug information questions, commonly utilized resources, and literature searching. As co-coordinator, a librarian taught three weeks of the course focused on mobile applications, development of literature searching skills, and practicing in PubMed. Course assignments were redesigned in 2019 based on assessment best practices and replaced weekly multiple-choice quizzes used in prior iterations of the course.

Case Presentation:

Following two weeks of literature searching instruction, students were assigned a drug information question that would serve as the impetus for the search they conducted. Students (n=66) had one week to practice and record a screencast video of their search in PubMed. Students narrated their video with an explanation of the actions being performed and were assessed using a twenty-point rubric created by the course coordinator and librarian. The librarian also created general feedback videos for each question by recording screencasts while performing the literature searches and clarifying troublesome aspects for students. The librarian spent about twenty-four hours grading and six hours writing scripts, recording, and editing feedback videos.

Conclusion:

Most students performed well on the assignment and few experienced technical difficulties. Instructors will use this assignment and feedback method in the future. Screencast videos proved an innovative way to assess student knowledge and to provide feedback on literature searching assignments. This method is transferrable to any medical education setting and could be used across all health professions to improve information literacy skills.

Bilastine 10 and 20 mg in paediatric and adult patients: an updated practical approach to treatment decisions

Background

Bilastine, a non-sedating H₁-antihistamine, is indicated to treat the symptoms of allergic disorders (e.g. rhinoconjunctivitis and urticaria) in adults and adolescents and, more recently, in children. Following its marketing approval, many questions regarding the ideal use of bilastine in various clinical practice situations have been received by the Medical Information Department (MID) of Faes Farma Spain. This article is an update of a previous review, with a focus on recent clinical information on the use of bilastine in paediatric and other populations.

Methods

Results of recent clinical studies in paediatric and other populations as well as questions received and responses provided by the Faes Farma MID.

Results

The information regarding the use of bilastine in paediatric patients is the most relevant aspect of this updated review. The stepwise approval of the paediatric formulations in various countries started with the European Medicines Agency approval in 2017 in accordance with a 2009 Paediatric Investigation Plan, followed by approval in other countries. The queries that are most commonly received by the Faes Farma MID include the potential for drug interactions involving bilastine and other frequently used drugs, and the use of bilastine in special populations or to treat specific symptoms related to allergic conditions. As the concomitant use of many medications is not permitted during clinical trials, the advice provided regarding the concomitant use of other medications with bilastine considers the pharmacological properties of both the drug in question and bilastine, as well as expert opinion. Likewise, advice regarding the use of bilastine in special populations (e.g. patients with renal impairment, obesity, lactose intolerance, and elderly or pregnant individuals) or to treat specific symptoms (e.g. treatment-resistant urticaria, pruritus or BASCULE syndrome) considers the best evidence from a variety of sources, including clinical studies, real-world experience, guideline recommendations and expert opinion.

Conclusion

This updated review provides current data regarding the best use of bilastine in specific situations and patients and identifies areas in which further knowledge is required. Although decisions regarding the use of bilastine may be aided by expert opinion that relies on knowledge of the underlying science, additional research and evidence are required to answer certain queries regarding the use of bilastine.

Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non-adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9-15] medications listed and 3 [IQR 1-5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non-adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.

Community knowledge and attitude in recognizing asthma symptoms and using medication for asthma attacks: a cross-sectional study

OBJECTIVES

Uncontrolled asthma may be life-threatening. Poor understanding of disease process and appropriate medication use appears to influence community attitude in facing asthmatic patients in an emergency, thereby contributing to increasing the risk of mortality. This study aimed to analyze community-level knowledge about asthma and attitude towards asthma management.

METHODS

This observational, cross-sectional study was conducted among the community in Gresik, Indonesia, from March to July 2019. Participants included in this study were adults, who could read, write, and communicate well. Data were collected through questionnaires to evaluate the level of knowledge and attitude towards asthma.

RESULTS

In total, 100 respondents were selected with 91% of women, with a mean age of 49.11 ± 14.42 years and with various levels of education. The respondents had good knowledge by getting a score of 76%. Knowledge regarding recognition of asthma symptoms was scored the highest (83%). However, knowledge about medication use for asthma was lacking, especially in identifying the medicine choice (21%) and inhaler use (48%). The respondents also showed a 'positive' attitude with a score of 89%. Most respondents (72%) agreed that when inhaled drugs were unable to relieve the asthma attack, they need to bring the patient to a hospital.

CONCLUSIONS

The level of respondent's knowledge in recognizing asthma symptoms was good, but there were misconceptions about asthma medication, especially in inhaler use. Overall, the respondents had a positive attitude towards asthma perception and management.

Drugs to Be Used With a Filter for Preparation and/or Administration-2019

This chart is an update to the 2012 article published in Hospital Pharmacy on injectable drugs to be used with a filter. To update the chart, drugs approved from December 2011 to April 2019 were reviewed to determine if they require filtration and drugs included in the 2012 table were reviewed for accuracy. Readers are urged to review national standards of practice for information about clinical situations that warrant the use of a filter for medication preparation or administration, independent of the drug being given, and the reader should consult the Food and Drug Administration (FDA)-approved prescribing information for the most up-to-date information.

[Drug Information Provided to Patients and Public-Present Regulatory Status and Future Prospects]

When taking a drug one must keep in mind certain risks and benefits based on the safety and efficacy information. One of the most reliable sources of information that enables patients to use drugs properly is package inserts, which are regulated under the law and therefore should include valid and accurate contents. With the recent revision of the Pharmaceutical and Medical Device Act, the information contained in the package insert, which was provided together with the drug, will now also be provided electronically and separately from the drug itself. In addition, a digital code will be displayed on the product packaging so that the latest information of the drug can be obtained from outside the package by scanning the code. The more drug information gets shared among healthcare professionals, patients and the public, the less the asymmetry in drug information among them will exist. It is necessary now more than ever to establish a framework and a system to ensure that sufficient information is provided to patients and the public to encourage their proper use of drugs. I believe that it is important for patients and the public to strive for a better understanding of drug information. It is also crucial for all relevant parties involved in drug information to work together on how best to utilize the information. In this way they would keep trying so that therapeutic effects could be maximized and the risks of side effects are minimized.

[Current Status and Development of Drug Information Infrastructure System for the Public in Japan and Overseas]

With the progress of medical treatment, information on drugs, etc. is overflowing on the media and the Internet, and some of them are leading to uncertain information for the purpose of profit, and some of them are wrong information or inaccurate information, and the effect on the patient is regarded as a problem. In Japan, information on public pharmaceuticals for patients and consumers is provided on the Internet, but its utilization is not sufficient. In the Pharmaceuticals and Medical Devices Act, it is stated that "Citizens shall endeavor to use pharmaceuticals, etc., properly and deepen their knowledge and understanding of their efficacy and safety". On the other hand, there is a variety of information available on the Internet, and simply searching does not necessarily lead to reliable information. It is necessary to provide information with a mechanism to ensure that the information is reliable so that it can lead to appropriate medical care. Overseas, medical information infrastructure systems, including highly reliable public pharmaceuticals based on evidence, have been developed. Examples include National Health Service (NHS) in the United Kingdom, MedlinePlus in the United States, and National Prescribing Service (NPS) MedicineWise in Australia. In the era of digital health, it is necessary to discuss issues and prospects for the construction and dissemination of information provision infrastructure that meets the needs of patients and consumers from the perspective of industry, government, academia, and patients.

Implementation of a Teaching Electronic Medical Record within Didactic Instruction Using a Drug Information Question Assignment

BACKGROUND

Pharmacy graduates are expected to be practice-ready to deliver quality patient care, which includes having comprehensive knowledge of health informatics and electronic medical records (EMRs). The purpose of this study was to (1) incorporate an EMR within a pharmacy student assignment, and (2) assess student perceptions of use of the EMR.

METHODS

Student pharmacists received a patient-specific drug-related question and were required to use an EMR to provide an accurate response. Following completion of the assignment, students were invited to complete a retrospective, pre-post survey instrument to collect their perceptions.

RESULTS

Only 28.8% of respondents reported prior experience using an EMR. Student perceptions about use of an EMR within the didactic setting significantly improved from before to after the assignment. Differences were found in respondents who agreed that didactic use of an EMR increased their confidence in obtaining information from an EMR (20.5% to 82.8%) and improved their knowledge of EMR systems (61.4% to 89.3%).

CONCLUSIONS

Implementation of an EMR within didactic instruction may serve as the first exposure to health informatics for students and positively impacts student perceptions of these tools prior to entry into pharmacy practice.

Prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients

Self-medication is common with dermatology patients. Yet, studies on this phenomenon are few. The pattern and reasons for self-medication are not clear. The objective of this study was to document the prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients. This was a prospective cross-sectional study of 468 adult dermatology patients over a 9-month period. A self-administered questionnaire was administered to all new patients to the dermatology outpatient clinic. The questionnaire had questions on sociodemographic data, self-medication, what specifically was used by the patients, source of information, and reasons for self-medication. Data were analyzed using the SPSS 22.0. Statistics such as means, medians, and frequencies. t test and chi-square test are presented. The mean age of the patients was 37.9 ± 16.3. The prevalence of self-medication was 63.7%. The pattern of self-medication was herbal only in 11.7%, western medication only in 45.6%, and western and herbal in 42.6%. Reason for self-medication was easy accessibility in 54%, difficulty seeing a doctor in 16.8%, and difficulty accessing medical care in 13.8%. Source of drug information was Pharmacist in 46.3% and friend in 26.5%. Self-medication was significant in males and in those with inflammatory diseases. Self-medication was common and this was due to ready accessibility of drugs and poor access to doctors. Self-medication was common in males and in those who have inflammatory diseases. The pattern of self-medication was dependent on age and the level of education. Source of information on drugs was pharmacists, friends, and family.

Creation and maintenance of a table for assessment of evolving evidence for COVID-19-related treatments

Disclaimer

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose

This report describes the development and maintenance of a table to present an assessment of evidence for treatments used in patients with coronavirus disease 2019 (COVID-19).

Summary

AHFS Drug Information (AHFS DI) (American Society of Health-System Pharmacists, Bethesda, MD) is ASHP’s evidence-based drug compendium that contains drug monographs written for pharmacists and other healthcare professionals. The professional editorial and analytical staff of pharmacists critically evaluate published evidence to develop drug monographs for AHFS DI. In response to the global COVID-19 pandemic, these skills were applied to assess emerging evidence for COVID-19–related treatments, and the information was compiled into a new resource for pharmacists and other healthcare professionals to use at the point of care. A list of therapies was developed and prioritized based on review of scientific and public discussions on the use of these therapies in patients with COVID-19; certain therapies used for supportive care and therapies that might theoretically be harmful to patients with COVID-19 also were considered for inclusion. Potential treatments were identified, and the evidence for use in patients with COVID-19 was assessed and summarized in a table format. Information presented for each therapy included the rationale for use, summaries of clinical trials or experience, trial registry numbers, and dosage regimens. Comments on safety and efficacy, including limitations of available data, were presented along with recommendations from recognized authorities. The editorial team continued to add new therapies to the table and update existing entries as new evidence emerged.

Conclusion

A comprehensive table that summarized available evidence for potential treatments for patients with COVID-19 was developed. The table format enabled the drug information editorial staff to provide ongoing updates as new information emerged during the pandemic.

Riociguat: Clinical research and evolving role in therapy

Riociguat is a first-in-class soluble guanylate cyclase stimulator, approved for the treatment of adults with pulmonary arterial hypertension (PAH), inoperable chronic thromboembolic pulmonary hypertension (CTEPH), or persistent or recurrent CTEPH after pulmonary endarterectomy. Approval was based on the results of the phase III PATENT-1 (PAH) and CHEST-1 (CTEPH) studies, with significant improvements in the primary endpoint of 6-minute walk distance vs placebo of +36 m and +46 m, respectively, as well as improvements in secondary endpoints such as pulmonary vascular resistance and World Health Organization functional class. Riociguat acts as a stimulator of cyclic guanosine monophosphate synthesis rather than as an inhibitor of cGMP metabolism. As with other approved therapies for PAH, riociguat has antifibrotic, antiproliferative and anti-inflammatory effects, in addition to vasodilatory properties. This has led to further clinical studies in patients who do not achieve a satisfactory clinical response with phosphodiesterase type-5 inhibitors. Riociguat has also been evaluated in patients with World Health Organization group 2 and 3 pulmonary hypertension, and other conditions including diffuse cutaneous systemic sclerosis, Raynaud's phenomenon and cystic fibrosis. This review evaluates the results of the original clinical trials of riociguat for the treatment of PAH and CTEPH, and summarises the body of work that has examined the safety and efficacy of riociguat for the treatment of other types of pulmonary hypertension.

A systematic review examining the characteristics of users of NHS patient medicines helpline services, and the types of enquiries they make

BACKGROUND AND OBJECTIVE

Patient medicines helpline services (PMHS) are available from some National Health Service Trusts in the UK to support patients following their discharge from hospital. The aim of this systematic review was to examine the available evidence regarding the characteristics of enquirers and enquiries to PMHS, in order to develop recommendations for service improvement.

METHODS

Searches were conducted using Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science, on 4 June 2019. Forward and backward citation searches were conducted, and grey literature was searched. Studies were included if they reported any characteristics of enquirers who use PMHS, and/or enquiries received. Study quality was assessed using the Axis tool. A narrative synthesis was conducted, and where appropriate, weighted means (WMs) were calculated. Where possible, outcomes were compared with Hospital Episode Statistics (HES) data for England, to establish whether the profile of helpline users may differ to that of hospital patients.

RESULTS

Nineteen studies were included (~4362 enquiries). Risk of bias from assessed studies was 71%. Enquirers were predominantly female (WM=53%; HES mean=57%), elderly (WM=69 years; HES mean=53 years) and enquired regarding themselves (WM=72%). Out of inpatient and outpatient enquirers, 50% were inpatients and 50% were outpatients (WM). Six of 15 studies reported adverse effects as the main enquiry reason. Two of four studies reported antimicrobial drugs as the main enquiry drug class. From two studies, the main clinical origin of enquiries were general surgery and cardiology. Across six studies, 27% (WM) of enquiries concerned medicines-related errors.

CONCLUSIONS

Our findings show that PMHS are often used by elderly patients, which is important since this group may be particularly vulnerable to experiencing medicines-related issues following hospital discharge. Over a quarter of enquiries to PMHS may concern medicines-related errors, suggesting that addressing such errors is an important function of this service. However, our study findings may be limited by a high risk of bias within included studies. Further research could provide a more detailed profile of helpline users (eg, ethnicity, average number of medicines consumed), and we encourage helpline providers to use their enquiry data to conduct local projects to improve hospital services (eg, reducing errors).

PROSPERO REGISTRATION NUMBER

CRD42018116276.

Dementia-Like Symptoms Associated With Posaconazole

Posaconazole is widely used in lung transplant recipients as pre-emptive therapy or universal fungal prophylaxis. In this patient group, posaconazole is increasingly used instead of voriconazole due to the concerns of an increased risk of squamous cell carcinoma (SCC) with voriconazole, particularly with its long-term use. Dose dependent toxicity has not been identified for posaconazole in the registration trials of intravenous (IV) and modified-release tablet formulations. This is supported by post-marketing experience. We describe a lung transplant recipient who experienced dementia-like symptoms almost 3 years after commencing posaconazole for treatment of Aspergillus fumigatus complex and Lomentospora prolificans (formerly Scedosporium prolificans) fungal infections. Symptoms resolved upon discontinuation of posaconazole, but recurred when re-challenged at a lower dose more than a year later. To the best of our knowledge, this is the first case reporting a dementia-like state with posaconazole.

Hospital-Wide Medication Reconciliation Program: Error Identification, Cost-Effectiveness, and Detecting High-Risk Individuals on Admission

Background

Medication reconciliation (MR) on admission has potential to reduce negative patient outcomes. The objectives of this prospective observational study were to 1) measure the impact a hospital-wide MR program has on home medication error identification at hospital admission, 2) demonstrate cost-effectiveness of this program, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies.

Methods

Technicians obtained medication histories on adult patients admitted to the hospital that managed their own medications. Frequency and type of medication errors were recorded. Cost avoidance estimations were determined based on expected adverse drug event rates. Logistic regression analysis was used to test for associations between medication errors and patient characteristics. Results were considered significant when p-value was less than 0.05.

Results

The study included 817 patients. Technicians recorded a mean of 6.1 medication discrepancies per patient (SD ± 0.4) and took 28.5 minutes (SD ± 1.2 minutes) to complete a medication history. Omission, commission, and dosing/frequency errors occurred in 82%, 59%, and 50% of medication histories, respectively. We estimated cost avoidance of $210.33 per patient with this program. Female gender, age, and high alert/risk medication use were linked to an increase in the likelihood of occurrence of a medication discrepancy.

Conclusion

This study validated the ability of a pharmacy technician to identify errors, demonstrated economic cost-effectiveness, provided new data on time to obtain a BPMH, and further identified factors that contribute to the occurrence of medication discrepancies. Potentially harmful medication discrepancies were identified frequently on admission. With further research, it may be possible to identify those at highest risk for home medication discrepancies upon admission.

Utilization of a Librarian in a Pharmacy Laboratory Course

This report describes utilization of a librarian in a pharmacy laboratory course over two academic years. Library instruction evolved from a simple drug information review session to case-based, hands-on instruction, collaboratively taught with pharmacy faculty. Additionally, LibChat, an online chat service, was piloted in the pharmacy laboratory course so the librarian could be available to students at their point-of-need. Development of the drug information review sessions across both years, student utilization of LibChat, lessons learned, and ideas for improvement for future iterations of the course are described.

The Influence of the Food and Drug Administration Pregnancy and Lactation Labeling Rule on Drug Information Resources

BACKGROUND

Drug information resources are commonly used by health-care providers answering pregnancy-related medication questions. In 2015, the United States Food and Drug Administration approved a new pregnancy and lactation medication labeling content and format, removing the pregnancy category, and using a narrative. Despite labeling requirements changing, it is unknown if drug information resources updated monographs to reflect these changes.

OBJECTIVE

The primary objective was to evaluate if commonly used drug information resources provide pregnancy information listed similar to the requirements of the Pregnancy and Lactation Labeling Rule (PLLR). Secondary analyses included evaluating the references and inclusion of the pregnancy category rating.

METHODS

Pregnancy recommendations for 23 medications were evaluated in 9 drug information resources (Clinical Pharmacology, Drugs in Pregnancy and Lactation, Epocrates®, First Databank, LexiComp® Online, LexiComp® Online Pregnancy & Lactation, In-Depth, Medi-Span®, Micromedex®, and Multum®). The number of references per drug monograph and most recent reference publication year was obtained.

RESULTS

LexiComp® Online Pregnancy & Lactation, In-Depth mimics the new PLLR structure and consistently had the highest number of and most recent references when the medication was included. Drugs in Pregnancy and Lactation was the next most similar in content with the PLLR and second in most references per monograph; however, the most recent reference was the textbook publication year.

CONCLUSION AND RELEVANCE

LexiComp® Online Pregnancy & Lactation, In-Depth and Drugs in Pregnancy and Lactation provided pregnancy information in a format most similar to the PLLR. However, several drug information resources contained pregnancy categories ratings that were to be removed from medication labeling per the PLLR.

[Relevance between Methods of Obtaining Drug Information and the Utilization of the Information in Community Pharmacies -Research on Awareness of Drug Information of "Increased Risk of Developing Diabetes in Patients Treated with HMG-CoA Reductase Inhibitors" in Community Pharmacies]

Lipid lowering therapy using statins prevents the risk of cardiovascular events. However, since the year 2000, there have been some reports that statins increased the risk of developing diabetes (SIRDD). It is socially demanded that pharmacists must apply pharmacotherapy to patients by utilizing drug information like the above, such as selecting appropriate drugs and providing correct drug information. Accordingly, pharmacists must correct drug information, and they should analyze and evaluate such information. Therefore, we conducted a questionnaire survey for pharmacists in community pharmacies with an aim to verify relevance between methods of obtaining drug information and the utilization of the information of "SIRDD" as a subject. We sent a questionnaire by letter to 1522 pharmacists in Fukushima and Mie prefecture, and received the results of the questionnaire from them using "Google forms" that is software to make web questionnaire and letters. We obtained responses from 356 (23.4%) pharmacists out of 1522. The number of responses from the pharmacists that "know" the information of "SIRDD" was 135 (37.9%). We found that these pharmacists obtained the information by websites of pharmaceutical companies, m3, Inc. (Portal site for medical professionals), and Pharmaceuticals and Medical Devices Agency (PMDA), as the sources of information. Our results suggested that pharmacists responded that they "know" "SIRDD" utilized websites as a quick information tool. The difference in network environments will relate to the difference of providable medical quality. So, it is very important to maintain appropriate network environment in cooperation with medical institutions, professional associations and the government.

A Systematic Review on the Use of Sacubitril/Valsartan Initiated Prior to Discharge in Hospitalized Patients With Heart Failure

OBJECTIVE

Systematically review the evidence of sacubitril/valsartan initiated in the hospital setting prior to discharge in patients with acute decompensated heart failure (HF).

DATA SOURCES

A literature search using keywords related to sacubitril/valsartan, HF, and inpatient use was performed using MEDLINE, CINAHL, and Google Scholar from inception through May 8, 2020.

STUDY SELECTION AND DATA EXTRACTION

Eligible studies included patients initiated on sacubitril/valsartan while inpatient and reported efficacy and safety outcomes.

DATA SYNTHESIS

A total of 10 articles were included for study review, of which 9 were full text and 1 was a conference poster. Key outcomes of interest were related to tolerability, N-terminal proB-type natriuretic peptide (NT-proBNP), functional capacity, target dose attainment, or rehospitalization rates. NT-proBNP levels were improved in 4 trials, and the results of functional capacity were mixed based on 2 studies. Rehospitalization rates were reported as secondary outcomes, and only 1 large study showed numerical and statistical improvement. The most frequent dose initiated prior to discharge was sacubitril/valsartan 24/26 mg twice daily. Hypotension was the most commonly reported adverse drug reaction and was commonly cited as a reason for not tolerating inpatient initiation with sacubitril/valsartan therapy.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Inpatient initiation of sacubitril/valsartan may improve surrogate and clinical outcomes after hemodynamic stabilization. Clinicians should consider patient-specific factors to ensure that benefits outweigh the risks and monitor for hypotension when initiated prior to hospital discharge.

CONCLUSION

Initiating inpatient treatment with sacubitril/valsartan after hemodynamic stabilization is reasonable based on available evidence.

Overview, Challenges and Future Prospects of Drug Information Services in Nepal: A Reflective Commentary

Drug information center (DIC) or Medicine information services provides impartial, well-referenced, critically evaluated, updated information on various aspects of medications to healthcare professionals and consumers. Medicine information services also contribute to the minimization of medication errors by promoting medication education and supporting pharmaceutical services. The main objective of this reflective commentary is to highlight the recent scenario of medicine information services in Nepal, challenges for DIC, how DICs can be strengthened and future perspectives of DIC. The availability of medicine information in various online drug information sites and numerous applications (apps) have made it easier to assess the information in the country such as Nepal. However, the reliability and validity of such information should be considered before dissemination. DIC plays a crucial role in improving drug safety by aiding clinicians in safer use of medications and promoting adverse drug reaction (ADR) reporting in Nepal. Financial support for operating the DIC efficiently is scarce in Nepal resulting in operational problems. The performance of the medicine information services in the country should be evaluated periodically to ensure the good quality of the service. Steps should be taken by the government, private hospitals and regulatory bodies to sustain the already established DIC and to establish additional DICs in the future to provide quality health care service to the community.

Media coverage of drug regulatory agencies' safety advisories: A case study of citalopram and denosumab

AIMS

Drug regulators issue safety advisories to warn clinicians and the public about new evidence of harmful effects of medicines. It is unclear how often these messages are covered by the media. Our aim was to analyse the extent of media coverage of two medicines that were subject to safety advisories from 2007 to 2016 in Australia, Canada, the United Kingdom and the United States.

METHODS

Two medicines widely used to treat mental health or physical conditions were selected: citalopram and denosumab. Media reports were identified by searching LexisNexis and Factiva. Reports were included if they stated at least one health benefit or harm. A content analysis of the reports was conducted.

RESULTS

In total, 195 media reports on citalopram and 239 on denosumab were included. For citalopram, 43.1% (84/195) of the reports mentioned benefits, 85.6% (167/195) mentioned harms and 9.7% (19/195) mentioned the harm described in the advisories (cardiac arrhythmia). For denosumab, 94.1% (225/239) of the reports mentioned benefits and 39.7% (95/239) mentioned harms. The harms described in the advisories were rarely mentioned: 10.9% (26/239) of the reports mentioned osteonecrosis and ≤5% mentioned any of the other harms (atypical fractures, hypocalcaemia, serious infections and dermatologic reactions).

CONCLUSIONS

We found limited media coverage of the harms highlighted in safety advisories. Almost two-thirds of the media stories on denosumab did not include any information about harms, despite the many advisories during this time frame. Citalopram coverage covered harms more often but rarely mentioned cardiac arrhythmias. These findings raise questions about how to better ensure that regulatory risk communications reach the general public.

Decentralize-Change-Recentralize Model of Drug Information Networks in Health Centers: Decentralized Drug Information Services

Large health centers usually decentralize their services to small self-sufficient sub-centers of care delivery. These small centers are part of an extensive network of practitioners who are connected. The drug information services of independent clinical pharmacists in a health center could be fragmented. Drug information centers thus need to have a new definition of the mode of operation. While maintaining autonomy in information exchange, professionals are integrated to form a large community of practitioners. Technological advancements in communication and access to resources enable efficient collaborations to happen. Immersed in patient-centered collaborative practice environments, networks of professionals integrate drug information services. Drug information networks thus hold a similar philosophy of health centers to decentralize-change-centralize its services. Further research is required to measure the impact of this model of drug information services.