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UNIVERSITY OF MALTA
FACULTY OF MEDICINE & SURGERY Pharmacy Department 2004 Final Project Previews |
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Evaluation of information for patients receiving chemotherapy Chiara Lanfranco
Background Cancer patients may often feel that they receive inadequate information. The pharmacist could evaluate patients’ need for information and provide individually tailored information.
Objective To evaluate the impact of the intervention of the pharmacist on patients receiving chemotherapy for cancer.
Design A questionnaire was adapted from one used in another study 1. Eligible subjects (n=41) were interviewed as follows: Group 1: n=16 were interviewed pre-treatment and after their 1st, 3rd and 6th chemotherapy cycle. Group 2: n=25 were interviewed randomly. The booklet ‘Il-Kimoterapija u Int’ was updated and distribution to chemotherapy patients.2
Setting Chemotherapy clinic Sir Boffa Hospital
Main outcome measures Knowledge and expectations of cancer patients, incidence and severity of chemotherapy side effects, the efficacy of self-care activities used to manage these side effects.
Results Out of 41 patients 71% were on Cyclophosphamide, Methotrexate, 5-Fluorouracil, whilst 17%, 10% and 2% were on 5-Fluorouracil, Adriamycin, Cyclophosphamide; Adriamycin, Cyclophosphamide; Mitoxantrone, Methotrexate, Mitomycin-C respectively. 48% felt they received sufficient information regarding their treatment whilst 96% wanted more information about the use and side effects of the drugs they were receiving. Hair loss (93%) followed by nausea (88%) and fatigue (85%) were the most common side effects reported.
Conclusion There is a clear indication that patients are not fully satisfied with the information they receive in relation to their side effects. The pharmacist has an important role in providing patients with sufficient information to help improve their quality of life and enhance their well-being while at the same time providing optimal patient care.
References 1. Nail LM, Jones LS, Greene D, Schipper DL, Jensen R. Use and perceived efficacy of self-care activities in patients receiving chemotherapy. ONS 1991;18(5):883-887. 2. Azzopardi L. Side effects of chemotherapy treatment in breast cancer patients: [project].Msida (Malta): University of Malta; 1994.
Pharmacist intervention in infant colic Noel Saliba
Background Colic is characterized by excessive crying and irritability which is often thought to be associated with gastro intestinal problems like flatulence and abdominal pain (1). Uncertainty about the cause, diagnosis and management results in ineffectiveness when dealing with the condition (1, 2).
Objective To evaluate knowledge of pharmacists about infant colic and to provide information for treatment and counseling when responding to symptoms of colic.
Design A psychometrically tested questionnaire was developed to assess pharmacist knowledge. A pharmacist information leaflet and treatment protocol were produced. These were evaluated and distributed. A comparative analysis on the pre- and post- distribution of the information package was carried out.
Setting Community pharmacies in Malta and Gozo
Main Outcome Measures Determination of pharmacist knowledge, type of intervention used and evaluation of the impact of the information pack.
Results 109 (59.5%) out of the 183 questionnaires distributed were received back and analysed. Pharmacists showed an increase in score obtained in the post distribution questionnaire for the four main categories i.e. aetiology (86%), symptoms (72%), management (91%) and overall score (99%) (p<0.05). 14 (13%), 24 (22%), 10 (9%) and 1(<1%) pharmacists showed no change in score for the 4 categories.
Conclusions There was an improvement in the pharmacist knowledge after the distribution of the data package. This showed that the developed material is a useful resource.
References 1. Mallia G. Evaluating the treatment of infant colic [Dissertation]. Malta: University of Malta; 2001. 2. Miller AR, Barr RG. Infantile colic – is it a gut issue? Pediatr Clin North Am 1991; 38: 1407-1423.
Responding to skin care problems Alessandra Farrugia
Background Nowadays, the pharmacist is more focused on patient’s needs with an aim to enhance the pharmacist-patient relationship, resulting in better management of the presenting complaint and enhanced concordance.
Objective To validate the pharmacist’s intervention and patient’s response when a patient presents with a skin problem.
Design Pharmacies were visited for a three-hour visit every 15 days, over a period of 8 months with a total of 160 visits. The direct method of observation was used and four validation tools were used.1
Setting Ten community pharmacies, 150 patients.
Main outcome measures Calculation of the average total scores for the professional services provided by the community pharmacist and patient’s satisfaction with the services.
Results Out of a total of 150 cases, 65 (43%) involved dispensing prescription medicines, 73 (49%) involved responding to presented symptoms and 12 (8%) involved requests for non-prescription medicines. The average total scores calculated, with respective range includes: 70 (54-91) dispensing prescription medicines, 68 (46-81) responding to presented symptoms and dispensing non-prescription medicines, 65 (46-88) communicating with the patient and 80 (51-88) patient’s satisfaction with the services.
Conclusion The findings indicate that the community pharmacist has lost grip on her traditional role as a compounder and became increasingly interested in adopting the professional role as a diagnostician and adviser of medicines. The results suggest the need to implement strategies to improve the services offered by the community pharmacist who plays a significant role in the management of skin conditions with an average of 4 to 5 skin related cases presented daily at the pharmacy.2
References 1. Azzopardi LM. Validation Instruments For Community Pharmacy. Pharmaceutical Care for the Third Millennium. Binghamton: The Haworth Press; 2000. 2. Mifsud S. Pharmacist Intervention in Skin Care [dissertation]. Msida (Malta): University of Malta; 2000. Fiona Galea Compliance with Hormone Replacement Therapy in Maltese Post Menopausal women Fiona Galea
Background HRT is a highly successful treatment for postmenopausal symptoms. However, long-term compliance rates are generally low. The effects of HRT in reducing risks associated with menopause appear to be dependent on the duration of treatment. Unfortunately many postmenopausal women do not realize the potential beneficial effects.1
Objectives To delineate the use of HRT among women between 45 – 65yrs, and analyze factors that contribute to acceptance and continuation of HRT.
Design A validated questionnaire was distributed to 661 randomly chosen patients. All participants were asked to complete a questionnaire and return it. Two hundred questionnaires were distributed at 20 randomly chosen pharmacies. Main outcome measures: Compliance with the use of HRT and level of awareness of was determined.
Results Thirty eight percent (329) of questionnaires sent, were completed and eligible for analysis. Sixty nine percent of the respondents never used HRT. Of the 31% (98) HRT users, 94% (92) were offered HRT by the GP or obstetrics and gynecology consultant, 12% (12) started because of age, 18% (18) used HRT because of menstrual problems, 46% (47) started after hysterectomy and 10% (10) used it for other conditions. Of the 69% (222) HRT non-users, 63% (139) were never recommended HRT, 24% (52) had a family history or history of breast cancer, 18% (29) did not want to use HRT. Information about HRT is generally obtained form media (39%), Obstetrics and gynecology consultant (21%), family doctor (19%), friends and relatives (13%), Internet (6%) and pharmacist (3%). Forty seven percent (149) of respondents discussed the use of HRT with their health care professional, but 69% (222) feel they need more information.
Conclusion Education about the long-term benefits and risks of HRT is critical in improving both acceptance and compliance.
Reference 1. B. Karakoc, M. Erenus. Compliance consideration with HRT The Journal of North American Menopause Society, 1998; 5: 102-106.
The diagnosis and treatment of Hepatitis B and C in Malta Louisa Camilleri
Background Hepatitis B and C virus infections account for substantial proportion of liver disease(1). The seropositivity for HBV in Malta has been reported to be <3% while no figures for HCV are available locally.
Objective To assess the local situation of hepatitis B and C providing an updated review on the diagnostic and treatment trends.
Design Study 1: A questionnaire was distributed to 120 clinicians assessing the knowledge on hepatitis. Data was analysed using Excel. Study 2: A booklet was developed for the clinician as a brief guide on hepatitis and validated using the test re-test method with a sample of 40 GPs. Study 3: A semi-structured interview was conducted to the infectious disease specialists on the local diagnostic and treatment trends.
Main outcome measures Knowledge on the topic and local trends were assed through the number of correct answers in the questionnaire and information collected through interviews.
Results Ninety five (79%) out of 120 clinicians answered the questionnaire. Overall 85% of doctors have a statistically very highly significant lack of knowledge and 0% showed statistically insignificant or perfect knowledge. Knowledge was highest for community based doctors (23.3%) and those in the younger age groups (22%). Knowledge assessed by section showed that there was a statistical significance (p<0.0001) with respect to the place of work and the number of years of practice (F=5.359, p=0.0003). The results of the interviews reported adequacy in diagnostic facilities and techniques however inadequate treatment protocols.
Conclusion The results provide a preliminary description of the GPs inadequate present level of knowledge on hepatitis leaving potential areas for improvement in the local management.
References Kao Jia-Horng, Chen Pei-Jer, Lai Ming-Yang, Chen Ding-Shinn. Occult Hepatitis B virus infection and Clinical Outcomes of Patients with Chronic Hepatitis C. JCM 2002 Nov;40(11):4068-4071.
Evaluation of an enzyme extracted from fish for topical use in the treatment of pressure sores Monique Mangion
Background PENZIM500 gel is a skin preparation manufactured by Zymetech of Iceland.1
Objective To assess the clinical efficacy and cost-effectiveness of PENZIM500 gel in the treatment of pressure sores.
Design A clinical study over a maximum of 25 weeks involving 50 wounds was carried out. The wounds were divided into two equal groups, A and B. Group A patients were treated with PENZIM 500 gel while conventional treatment was used for Group B. The clinical efficacy of the products in the two groups was assessed. Statistical analysis was carried out using Excel. The t-test was carried out for the comparative study.
Setting St Vincent de Paule Residence
Main outcome measures Pressure sore colour and volume; treatment cost for Penzim500 gel and for other products.
Results The mean width of the pressure sores in Group A was significantly smaller than that of Group B in the final weeks of the study according to the Mann-Whitney test (p value ranging from 0.0221 to 0.0454). The same trend was seen with regards to mean length but the difference was not significant. The mean depth of the pressure sores in group A was found to be significantly higher than that of Group B (p value ranging from 0.0013 to 0.0386). The wound colour appeared to be significantly better for PENZIM500 gel for various weeks (p value ranging from 0.0180 to 0.0411).
Conclusion PENZIM500 gel was found to be significantly more effective than conventional treatment.
References
1. Gudmundsdóttir A, Gudmundsdóttir E, Óskarsson S, Bjarnason J.B, Eakin A, Craik C.S. Isolation and characterization of cDNAs from Atlantic cod encoding two different forms of trypsinogen. Eur. J. Biochem 1993;217:1091-1097.
Prescription trends in the acute psychiatric setting Christian Tanti
Objectives A one-year cross sectional study was carried out to assess in-patient and out patient psychotropic drug utilization at Mt. Carmel Hospital (MCH). The analysis followed the drug classification and standardized measurements proposed by the World Health Organization.1
Design Measurement units used for psychotropic drug consumption were the number of Defined Daily Doses (DDDs). To estimate the proportion of the population treated daily with psychotropic drugs, number of DDDs/100 inhabitants/day were calculated. Data gathered from patient files aimed at giving a description for patients’ age, gender, occupation, family, social and medical history.
Outcome measures The sampling datasets available at MCH’s Access Accounts software program served as the data source together with patient’s files.
Setting Mixed Admissions Ward, Females Ward 1, Males Ward 1 and MCH’s dispensary at MCH.
Results Major consumers of psychotropic drugs were in the 35-74 age bracket and more women than men were being treated. The number of DDDs/100 inhabitants/day for all kinds of psychotropic drugs was estimated to be 28.52; where Hypnotics and anxiolytics counted 9.12, antipsychotics 8.88 anti depressants 7.12, anti-parkinsonian agents 2.55 and mood stabilizers 0.83. Ordered by DDDs, the top 10 most frequently used chemical substances were; haloperidol, paroxetine, diazepam, benxhexol, promethazine, nitrazepam, clozapine, fluvoxamine, chlorpromazine and amitryptiline. The cost in Maltese Liri for psychotropic drugs from January to September 2003 was estimated to be Lm 159,381.36.
Conclusions The consumption of psychotropic drugs in Malta according to drug class were found to be greatest for hypnotics and anxiolytics followed by antipsychotics, anti-depressants and mood stabilizing drugs, a picture, which reflects the consumption in countries where similar drug utilization studies were, carried out.
References WHO Expert Committee. The Selection of Essential Drugs (Technical report series 615). Geneva: World Health Organization, 1977; 615: 1-36
Antibiotic use in dental care Joann Vassallo
Background Antibiotics are prescribed by general dental practitioners to manage and prevent dental infections, and for the treatment of periodontal disease. Antibiotics are also used prophylactically in certain patient categories.
Objective To determine the local prescribing trends of antibiotics by dental practitioners for treatment and prophylaxis of dental infections, to determine the pharmacists’ awareness of possible complications related to dental problems and to assess the advice given when dispensing such prescriptions.
Design Two questionnaires were developed: one directed towards dental practitioners and another one was directed towards community pharmacists. The questionnaires used were adapted from three previous studies. 1,2,3 The questionnaires were psychometrically evaluated.
Setting St. Luke’s Hospital, School of dentistry, Private Community Pharmacies and Private Dental Clinics
Main outcome measures Prescribing trends by dental practitioners for treatment and prophylaxis of dental infections; pharmacist intervention during dispensing of prescriptions for dental infections.
Results The highest frequency of antibiotic prescription issued were 10 a week (18 %, n = 83). Dentists who have been practising for a longer time were found to issue less antibiotic prescriptions per week. 4 % (n = 83) of the respondents think that enough information about antibiotics is given to the public through the media and by healthcare professionals. 95. % (n = 83) do not think that enough information is given, while 1 % (n =83) did not answer the question.
Conclusions The results of this study confirm the prescribing patterns described in the study by Magri Demajo 3.
References: 1. Caruana S. The management of oral disease in community pharmacy: Dissertation. Malta: Department of Pharmacy, University of Malta; 1998 2. Garcia J. Antibiotic use in Malta: Dissertation. Malta: Department of Pharmacy, University of Malta; 2000. Magri Demajo D. Antibiotics in dental treatment: Dissertation. Malta: Department of Pharmacy, University of Malta; 1998.
Treatment Protocols in Pregnancy Antonella Aquilina
Objective To develop and evaluate protocols to be followed by pharmacists for the treatment of conditions occurring during pregnancy.
Design Four protocols were constructed, namely dyspepsia, headache, urinary tract infections and vaginal candidiasis. A data sheet was developed to interview pregnant patients. A focus group consisting of a gynaecologist, a general practitioner and a pharmacist was constructed in order to review the development of the protocols. The protocols were modified according to the discussion in the focus group. A questionnaire was developed to asses whether pharmacists comply with the protocols. Data was analysed using Microsoft Excel.
Setting Out-Patients Department at Karin Grech Hospital, community pharmacies in Malta and Gozo
Main outcome measures Frequency of the ailments in pregnant women, determination of compliance of pharmacists with the four protocols.
Results Out of a total of 205 pregnant patients interviewed, the most common ailment was dyspepsia (66%), followed by headache (58%), urinary tract infections (25%) and vaginal candidiasis (8%). With respect to medications taken, approximately 74% of patients suffering from dyspepsia or headache preferred not to take any medication, whereas only 42% of patient with vaginal candidiasis and 20% of patient with urinary tract infections did the same. Out of a total of 103 pharmacist questionnaires, the average % compliance for all 4 protocols was 15%. Compliance was highest for the dyspepsia protocol (18%) and lowest for the urinary tract infections protocol (10%). The number of first-time referrals was highest for urinary tract infections (82%) and vaginal candidiasis (71%).
Conclusions The relatively poor average compliance obtained by pharmacists for all four protocols accentuates the need for the establishment of protocols for common conditions occurring during pregnancy. This would support the promotion of pharmacist intervention during pregnancy.
Health Promotion in the Community Pharmacy Romilda Zarb
Diabetes, hypercholesterolaemia and hypertension constitute major health risk factors and are the primary cause of death in Malta (1).
Objectives To assess the public response towards a health promotion scheme being set up in community pharmacies and to evaluate the feasibility and practicality of the scheme
Setting 32 different pharmacies were selected by stratified random sampling.
Design A health promotion scheme directed to the public and related to diabetes, hypertension and hypercholesterolaemia was organized in community pharmacies. Volunteers were selected by convenience sampling and asked whether they would like to have their blood glucose, blood pressure, and body mass index (BMI) determined free of charge. A questionnaire was addressed to the participants to assess knowledge on the conditions and their perception of the health promotion scheme. Another questionnaire was presented to the community pharmacists’ to assess their attitude towards the scheme.
Main Outcome Measures Acceptance response to the scheme by pharmacy patrons and pharmacist perception to offer health promotion schemes
Results Out of the approached 487 patrons, 372 volunteers agreed to participate. 87% (n=322) agree that the pharmacist is capable of providing health related information. All participants agreed that such health schemes should be organized in community pharmacies, with only 72% (n=267) being ready to pay for such a service. 75% (n =30) of the interviewed pharmacists are ready to offer such health promotion schemes, of which 43% (n=17) already offer same services. 98% (n=39) believe that blood pressure, glucose and cholesterol should be monitored on a regular basis.
Conclusion The majority of interviewed volunteers and pharmacists agree that the pharmacist plays a major role in providing patient-centered services directed to improve drug therapy outcomes.
Reference Sammut A. Cholesterol awareness and monitoring in a community pharmacy [dissertation]. Department of Pharmacy, University of Malta 1998; 2 – 3.
Media in Health Promotion Sabrina Farrugia
Background Pharmacists are key players in the health care team. Their contribution to health promotion and disease prevention has been well established. Communication through the mass media is a fundamental component of many health promotion strategies designed to change health risk behaviours. The mass media have the capacity to reach and influence millions of people simultaneously.1
Objective Preparation and evaluation of health education programmes suitable for radio broadcasting in order to provide awareness of heath-related issues.
Design Preparation of radio programmes relevant to thirteen topics was undertaken. The topics were chosen after an extensive literature review in order to identify the common minor illnesses encountered in the pharmacy. The programmes were recorded and aired at Campus FM. A scored questionnaire was administered to each participant twice, one to be completed before, (pre-test) and the other one, after the programmes (post-test). Data was analysed using BMDP software.
Setting Campus FM
Main outcome measures Score indicating knowledge on condition. Evaluation of the impact of health education programmes on knowledge of individuals.
Results One hundred consumers participated in the study. The average score of knowledge during the pre-test was 8.05 (range 5.62 – 11.94) whilst the average score of knowledge in the post-test was 14.03 (range 6.98-19.43). On average the score of the respondents after listening to the radio programme increased by 73% (range 24% - 113%). As determined from the One-way ANOVA test, it was found that the difference in means for the scores before and after the programmes was significant for all programmes (p < 0.05).
Conclusions The study has shown that radio programmes prepared by the pharmacist addressing the management of minor illnesses could be a useful medium to promote health.
References: 1. Arkin EB. Opportunities for improving the nation’s health through collaboration with mass media. Public Health Rep 1990;105:219-23.
Promoting Travel Health in Malta Melania Camilleri
Background Maltese people are now travelling more frequently, therefore becoming even more at risk of travel- related health hazards.
Objective To asses knowledge on travel- related health hazards and evaluate an information booklet.
Design A survey was conducted amongst Maltese literate citizens 16 years of age and over. A self-administered quantitative questionnaire was distributed to participants before and after the distribution of a 64- page bilingual travel health information booklet.
Setting: Shopping localities in Malta.
Main outcome measures Determination of knowledge and evaluation of developed booklet.
Results The questionnaire was completed by 433 participants (response rate of 87%); 55% (239) were females and 45% (194) were males. Of these 96% (414) have traveled at least once in their lifetime. 13 % (56) claimed to have had a health problem during travel of which only 30 % (17) took advice prior to traveling. From all the participants, 68% (293) do not seek advice with 47% (139) claiming it to be unnecessary. The majority of respondents 98 % (425) knew that HIV can be prevented by avoiding unsafe sex. However, the proportion of adequate knowledge about other infectious diseases such as Hepatitis A and Hepatitis B was lower with only 21% (93) and 39% (168) having correct knowledge. 75% (323) of the participants completed the second questionnaire distributed with the booklet.
Conclusion This study indicates that compared to the increase in amount of travel, relatively few people seek advice prior to travel. |