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Willems J, Heyndrickx A, Schelstraete P, Gadeyne B, De Cock P, Vandendriessche S, Depuydt P. The use of information technology to improve interdisciplinary communication during infectious diseases ward rounds on the paediatric intensive care unit. Sci Rep 2024; 14:1657. [PMID: 38238516 PMCID: PMC10796760 DOI: 10.1038/s41598-024-51986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Prospective audit with feedback during infectious diseases ward rounds (IDWR) is a common antimicrobial stewardship (AMS) practice on the Paediatric Intensive Care Unit (PICU). These interdisciplinary meetings rely on the quality of handover, with high risk of omission of information. We developed an electronic platform integrating infection-related patient data (COSARAPed). In the mixed PICU of a Belgian tertiary hospital we conducted an observational prospective cohort study comparing patient handovers during IDWRs using the COSARAPed-platform to those with access only to conventional resources. The quality of handover was investigated directly by assessment if the narrative was in accordance with Situation-Background-Assessment-Recommendation principles and if adequate demonstration of diagnostic information occurred, and also indirectly by registration if this was only achieved after intervention by the non-presenting AMS team members. We also recorded all AMS-recommendations. During a 6-month study period, 24 IDWRs and 82 patient presentations were assessed. We could only find a statistically significant advantage in favor of COSARAPed by indirect evaluation. We registered 92 AMS-recommendations, mainly resulting in reduced antibiotic pressure. We concluded that the IDWR is an appropriate platform for AMS on the PICU and that the utilisation of COSARAPed may enhance the quality of patient handover.
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Affiliation(s)
- Jef Willems
- Department of Critical Care, Paediatric Intensive Care Unit, Ghent University Hospital, 1K12-D, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | | | - Petra Schelstraete
- Department of Paediatrics, Paediatric Pneumology and Infectious Diseases, Ghent University Hospital, Ghent, Belgium
| | - Bram Gadeyne
- Department of Critical Care, Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Stien Vandendriessche
- Department of Laboratory Medicine, Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Pieter Depuydt
- Department of Critical Care, Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
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2
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Echeverria-Esnal D, Hernández S, Murgadella-Sancho A, García-Paricio R, Ortonobes S, Barrantes-González M, Padullés A, Almendral A, Tuset M, Limón E, Grau S. Cross-Sectional Survey on the Current Role of Clinical Pharmacists among Antimicrobial Stewardship Programmes in Catalonia: Much Ado about Nothing. Antibiotics (Basel) 2023; 12:antibiotics12040717. [PMID: 37107079 PMCID: PMC10135239 DOI: 10.3390/antibiotics12040717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Antimicrobial resistance killed 1.27 million people in 2019, so urgent actions are desperately needed. Antimicrobial stewardship programmes (ASPs) are essential to optimize antimicrobial use. The objective was to acknowledge the current role of clinical pharmacists engaged in ASP activities in Catalonia. METHODS This was a cross-sectional survey shared through the Catalan Infection Control Programme (VINCat). The survey consisted of four sections and was sent by e-mail. RESULTS A total of 69.0% of the centres answered. Pharmacists dedicated a median of 5.0 h per week (2.1 h/week/100 acute care beds), representing 0.15 full time equivalents. The ASP lacked information technology (IT) support, as only 16.3% of centres automatically calculated defined daily doses and days of therapy. Those with less than 15% of their time available for ASPs conducted fewer clinical activities, especially prospective audits and feedback. Those without official infectious diseases training also performed fewer clinical activities, but training was less determinant than IT support or time. Pharmacists performed interventions mostly through annotation in the medical records. CONCLUSIONS Clinical pharmacists from Catalonia dedicated to ASPs present an important lack of time and IT support to perform clinical activities. Pharmacists should also improve their clinical skills and try to conduct clinical advice to prescribers, either by phone or face-to-face.
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Affiliation(s)
- Daniel Echeverria-Esnal
- Pharmacy Department, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain
| | - Sergi Hernández
- VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain
| | - Anna Murgadella-Sancho
- Pharmacy Department, Hospital Moisès Broggi, Consorci Sanitari Integral (CSI), C/Oriol Martorell, 12, 08970 Sant Joan Despi, Spain
| | - Ramón García-Paricio
- Pharmacy Department, Hospital Municipal Badalona, Badalona Serveis Assistencials, 08911 Badalona, Spain
| | - Sara Ortonobes
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | | | - Ariadna Padullés
- Department of Pharmacy, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alexander Almendral
- VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain
| | - Montse Tuset
- Pharmacy Department, Clinic Barcelona, 08036 Barcelona, Spain
| | - Enric Limón
- VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Public Health, Mental Health and Mother-INFANT Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
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3
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Making the APPropriate choice: Utilization of a smartphone application to optimize antimicrobial decisions among internal medicine trainees. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e194. [PMID: 36712475 PMCID: PMC9879860 DOI: 10.1017/ash.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Abstract
Utilization of a smart phone application paired with a time-spaced learning curriculum was investigated to determine its impact on antimicrobial stewardship practice among internal medicine trainees. Stewardship behaviors increased, barriers decreased, and trainees had increased confidence in managing common infectious disease syndromes after the intervention.
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Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
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Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY,Address correspondence to Robert Garcia, BS, MT(ASCP), CIC, FAPIC, Department of Healthcare Epidemiology, State University of New York at Stony Brook, 100 Nicolls Rd, Stony Brook, NY, 11580
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | | | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M. Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G. Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
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Arteche-Eguizabal L, Corcuera-Martínez de Tobillas I, Melgosa-Latorre F, Domingo-Echaburu S, Urrutia-Losada A, Eguiluz-Pinedo A, Rodriguez-Piacenza NV, Ibarrondo-Olaguenaga O. Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services. Antibiotics (Basel) 2022; 11:antibiotics11101336. [PMID: 36289994 PMCID: PMC9598292 DOI: 10.3390/antibiotics11101336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. OBJECTIVE Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital-Osakidetza Basque Country Health Service (Spain). METHODS Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). RESULTS Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. DISCUSSION The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential.
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Affiliation(s)
- Lorea Arteche-Eguizabal
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
- Correspondence:
| | | | - Federico Melgosa-Latorre
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Emergency Service, 20500 Arrasate/Mondragón, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Ainhoa Urrutia-Losada
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Amaia Eguiluz-Pinedo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Internal Medicine Service, 20500 Arrasate/Mondragón, Spain
| | | | - Oliver Ibarrondo-Olaguenaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Research Unit, 20500 Arrasate/Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
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Abstract
PURPOSE OF REVIEW Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients requiring endotracheal intubation and mechanical ventilation. Recently, the emergence of multidrug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales, multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species, has complicated the selection of appropriate antimicrobials and contributed to treatment failure. Although novel antimicrobials are crucial to treating VAP caused by these multidrug-resistant organisms, knowledge of how to optimize their efficacy while minimizing the development of resistance should be a requirement for their use. RECENT FINDINGS Several studies have assessed the efficacy of novel antimicrobials against multidrug-resistant organisms, but high-quality studies focusing on optimal dosing, infusion time and duration of therapy in patients with VAP are still lacking. Antimicrobial and diagnostic stewardship should be combined to optimize the use of these novel agents. SUMMARY Improvements in diagnostic tests, stewardship practices and a better understanding of dosing, infusion time, duration of treatment and the effects of combining various antimicrobials should help optimize the use of novel antimicrobials for VAP and maximize clinical outcomes while minimizing the development of resistance.
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Peghin M, Vena A, Graziano E, Giacobbe DR, Tascini C, Bassetti M. Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19. Ther Adv Infect Dis 2022; 9:20499361221095732. [PMID: 35591884 PMCID: PMC9112312 DOI: 10.1177/20499361221095732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022] Open
Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being
one of the most significant challenges of health care systems worldwide.
Bacterial and fungal infections in hospitalized patients with coronavirus
disease 2019 (COVID-19) are uncommon but consumption of antibiotics and
antifungals has increased dramatically during the ongoing pandemic resulting in
increased selective pressure for global antimicrobial resistance. Nosocomial
bacterial superinfections appear to be more frequent than community-acquired
coinfections, particularly among patients admitted to the intensive care unit
(ICU) and those receiving immunosuppressive treatment. Fungal infections
associated with COVID-19 might be missed or misdiagnosed. Existing and new
antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19
pandemic and are urgently needed to contain the high rates of misdiagnosis and
antimicrobial prescription. The aim of this review is to describe the role of
bacterial and fungal infections and possible strategies of AMS to use in daily
practice for optimal management of COVID-19.
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Affiliation(s)
- Maddalena Peghin
- Clinica di Malattie Infettive, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33010 Udine, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | | | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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Yoon YK, Kwon KT, Jeong SJ, Moon C, Kim B, Kiem S, Kim HS, Heo E, Kim SW. Guidelines on Implementing Antimicrobial Stewardship Programs in Korea. Infect Chemother 2021; 53:617-659. [PMID: 34623784 PMCID: PMC8511380 DOI: 10.3947/ic.2021.0098] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Ki Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Chisook Moon
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Bongyoung Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungmin Kiem
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyung-Sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Eunjeong Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction. Antibiotics (Basel) 2021; 10:antibiotics10080996. [PMID: 34439046 PMCID: PMC8388942 DOI: 10.3390/antibiotics10080996] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.
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Affiliation(s)
- Deirdré Engler
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Correspondence:
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Arcadia 0007, South Africa;
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- School of Pharmaceutical Sciences, University Sains Malaysia, George Town 118000, PNG, Malaysia
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