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This systematic scoping review aimed to examine the literature on expanding role of telepharmacy services during the ongoing COVID-19 pandemic. Four electronic databases, PubMed, Scopus, ProQuest, and Cochrane, were searched to identify published studies that reported implementation of telepharmacy services since the start of pandemic (31st December 2019 to 31st May 2022). Twenty-eight studies met the inclusion criteria comprising 15 cross-sectional studies, 12 studies sharing experience and practice related to telepharmacy services, and one pre-post intervention study. Studies reported establishment and implementation of various novel telepharmacy models in different settings;primary, secondary, tertiary, and quaternary care hospitals, hospital and community pharmacies, and specialized care centers. Telepharmacy provided pharmaceutical care to patients with COVID-19, chronic diseases, HIV infection, cancer, cystic fibrosis, and patients on anticoagulants. Pharmaceutical care services like patient counseling services (19 studies), medication order review and medication reconciliation (15 studies), drug therapy optimization (11 studies), adverse drug reaction monitoring and management (7 studies), medication adherence assessment (5 studies), and drug-related problem monitoring (4 studies) were delivered using telepharmacy. Based on the identified evidence, telepharmacy proved beneficial in delivering a range of pharmaceutical care services to the patients during the current pandemic. However, there is a need for more rigorous evidence on the reliability, safety, and effectiveness of telepharmacy in comparison to the traditional face-to-face healthcare delivery model © 2023 Syed Arman Rabbani et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/)
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The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context. Copyright © RJPT All right reserved.
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Background: One hundred and thirty (130) pharmacy students from the University of Copenhagen were doing their pharmacy internship in community pharmacy. Here they are to acquire knowledge of, as well as skills and competencies in, areas such as organisation, leadership, ethics, economy, patient counselling, patient safety, cooperation etc. The COVID-19 pandemic hit the entire world and created an extra steep learning curve for the interns. And why not try and combine the two: the pharmacy internship learning and the COVID-19 crisis? It is important to explore how pharmacies manage their customary and newly emerging roles during the COVID-19 outbreak. Purpose(s): The purpose of the study is to reveal how the COVID-19 pandemic influences pharmacy organisation, leadership, ethics, economy, patient counselling, patient safety, and cooperation seen through the eyes of the pharmacy interns. Method(s): A two-page long questionnaire on how COVID-19 influences the above mentioned areas was uploaded to the internship webpage, hopefully inspiring the interns, who were tasked with handing in a nine-page long report as part of their exam. A content analysis of the reports will be done. Result(s): Since the interns hand in their reports by June 19 2020, no results are available yet. If all interns write about COVID-19 in their report, though, more than 1,000 pages on their COVID-19 experiences will exist. Answers with the most insightful learning potential for pharmacy practice globally will be presented and discussed. Conclusion(s): Having successfully carried out pharmacy internship-based research for more than 20 years in Denmark, we are convinced that the study will reveal useful results.
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Introduction: Objective Structured Clinical Examination (OSCE) allows simulation of the interaction between the pharmacist (or the pharmacy student) and the patient in a community pharmacy or at a hospital setting. Hence, OSCE is nowadays considered the gold-standard for competency-based assessments in clinical disciplines such as Pharmacy. As a result of the pandemic situation, conventional face to face OSCE presents with challenges related to health and safety. Accordingly, alternative clinical competence assessments with similar objectives and standards for pharmacy students were designed. Method(s): OSCE was conducted during the academic year 2020-21 for fifth-year students after the completion of six months of practical rotations. Students completed an exam with five stations consisting of two face-to-face stations with simulated standardised patients and three online stations developed through the online learning platform Blackboard, each one with a duration of five minutes. The stations tested student knowledge, patient counselling and communication and acquisition of technical and/or clinical skills. Result(s): A total of 49 fifth-year students and ten examiners were involved in this OSCE hybrid format. The analysis of results showed that the best average grade was obtained at live stations. Comparing the results with previous conventional OSCEs (before pandemic) shows higher average grades for the hybrid OSCE celebrated in 2020-21. Amongst the participants in the hybrid OSCE, 33% of them preferred the online stations. Conclusion(s): During the COVID-19 pandemic, online stations have been implemented in OSCE as an opportunity to assess clinical skills in pharmacy students. The online version was effective for evaluating knowledge. However, there were limitations in the assessment of some specific skills such as communication.
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Introduction: Due to reduction in cardiovascular risk, healthy, plant-based foods, as opposed to animal-derived products should be promoted to patients. We created a hospital initiative on the cardiac floors to educate the multidisciplinary staff to serve as advocates for healthy eating. Method(s): Housestaff participated in education sessions on the benefits of plant-predominant meals and patient counseling. More plant-predominant options were added to the menu and several unhealthy items were eliminated. Food orders were assessed pre-intervention (February 2020) and post-staged interventions (October 2020 and April 2022). Food choices were assessed using the healthful and unhealthful diet index. Press Ganey scores were obtained and housestaff comfort with diet counseling was also assessed. Result(s): Resident perception of their own knowledge went from "poor" to "good" post-intervention. Confidence in talking to patients about plant-based diets went from "not confident at all" to "fairly confident'. After analysis of diet orders, a 52% decrease was noted in animal-based products (chicken, beef, pork and turkey), 35% decrease in unhealthful food items (refined grains, processed foods, potatoes and sweetened beverages), and 25% decrease in plant-predominant food items (whole grains, fruits, vegetables, nuts, salads, legumes and fish), but this time period occurred in the setting of high COVID-19 rates. A subsequent analysis of a single cardiac unit after the COVID-19 surges and after select unhealthy items were removed from the menu showed notable improvements in each parameter when adjusted for discharges;a 2% increase in plant-based, 37% decrease in animal based and 4% decrease in unhealthy items. Press Ganey ratings for the quality of food increased post-initiative by at least 27%. Conclusion(s): This quality initiative was a local pilot to increase our understanding of interventions that may have a meaningful impact on healthy eating for patients. Interpretation of results is limited due to the COVID-19 pandemic, which may have impacted food choices of admitted patients. Although further research is needed, housestaff engagement may be a promising mechanism to educate patients and encourage food and nutrition changes in a health system.
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In all countries, where electronic health services such as e-prescriptions have been introduced, patient safety has improved and the standard of medical and pharmaceutical care has increased. ePrescription (eRecept) - launched in Hungary as well - has become the most used eHealth module of the EE SZT (National eHealth Infrastructure) by all healthcare providers in the past near 3 years. During the COVID epidemic emergency e-prescription system has been a huge help to patients, relatives and caregivers too. In this period the proportion of electronic issued prescriptions exceeded 90% of all prescriptions written. The e-prescription system contributes to the better and faster information of healthcare professionals, supports the well-based therapy decisions, helps preventing and eliminating medication errors. Adverse drug reactions (allergies, interactions, polypharmacy etc.) can be more easily identified with the daily use of this service. Less paper administration can increase the time and quality of patient counseling both at the doctor's and in the pharmacies. Medication adherence can also be simply monitored by pharmacist as well. After patient registration - using social security number (SSN / TAJ) -, written maximum 1 year earlier and/ or by other pharmacy dispensed prescriptions will be also downloadable soon from the central database. These functions and real time data contribute to the implementation of high-quality pharmacotherapy advising services in pharmacies as healthcare institutions, made in accordance with the specific standards and protocols. The new functions of the Patient Portal (e.g. Legal Representation) and mobile surfaces provide patients and their relatives access to follow their care process, prescriptions, labs, etc., already on their smartphone too. From the beginning of May 2020, serial-produced medical aids mostly sold in pharmacies, can be electronically issued. The full integration of all the medical aids may be completed next year in a separated module. A simple web-based prescriber (socalled miniHIS) has been developed for connected private doctors, who do not consult in institutions. Measured values of the (smart) medical devices can be uploaded into the personal data repository of the Patient Portal on a voluntary basis. Good measurement results of the blood pressure, sugar, body weight, etc. recorded here demonstrate therapy fidelity, providing feedback to the patient and professionals. Telemonitoring services can be build on this module, so the software can send alerts to the assigned doctor, pharmacist or family member. Keeping data protection rules strict, depersonalized pharmacotherapy data uploaded to the central eHealth database will be searchable soon for professional and scientific purposes.
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GPs can play a pivotal role in the identification and management of alcohol problems at any time, and their role is even more important during the COVID-19 pandemic as more and more patients are resorting to alcohol to manage the stress and anxiety created by the pandemic. © 2021 Medicine Today Pty Ltd. All rights reserved.
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The sense of smell, one of the five basic senses that humans have, helps us detect different types of odors. It also plays an important role in the detection of pollutants, toxic gases, or rotten and hazardous foods. Although olfaction is considered less important than the other senses, smell disorders could cause a variety of problems, including reduced taste detection due to the relationship between taste and smell, depression, and overall loss of quality of life. Olfactory dysfunction is one of the first clinical signs of neurological diseases such as Alzheimer's and Parkinson's disease. The olfactory disorder has many etiologies, some of which are more obvious. Most people with olfactory disorders have experienced a recent illness or trauma. Common causes of olfactory disorders include aging, rhinosinusitis, upper respiratory infections, and cerebral lesion;the rest of the cases are less relevant. Since there are limited evidence-based treatments for olfactory disorders, it is necessary to share information about the risks associated with these disorders. This information includes practical and useful screening measures for olfactory dysfunction, appropriate clinical evaluation, patient counseling to prevent injury, health and quality of life management, and the introduction of treatments with higher recovery rates. This review study focuses on the etiology, prevalence, and short-term and long-term consequences of olfactory disorders. Also, diagnostic strategies and new treatment options have been developed and discussed.
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Diagnosis of a genetic kidney disease can enhance treatment/management, allow patient/family counseling, and enable patient referral to specialists or clinical trials. Here we present a case study describing the use of a >380 gene panel associated with kidney diseases (The RenasightTM test, Natera, Inc.) to diagnose Dent disease 2 in a patient and their family members. A 41-year-old male was referred to Nephrology for evaluation of elevated SCr (4.6 mg/dL) and proteinuria. The patient’s medical history was unremarkable except for glaucoma in infancy. A renal biopsy identified glomerulomegaly. Genetic testing identified a likely pathogenic, hemizygous, frame-shift variant (c.311del;p.Cys104Phefs*2) in exon 5 of OCRL, an X-linked gene, which is associated with Dent disease 2. This genetic diagnosis prompted changes to the patient’s treatment plan, including patient counseling and preparation for renal replacement therapy (RRT). The patient’s 46-year-old brother was hospitalized due to COVID-19 symptoms with a SCr of 19.1 mg/dL. Due to limited medical history, it was unclear if he was presenting with acute kidney injury or chronic kidney disease. Although there was no evidence of nephrolithiasis or renal tubular acidosis typically associated with Dent disease 2, the family history prompted genetic testing that confirmed the presence of the familial variant in this patient. These genetic findings prevented delay in treatment, namely, initiation of RRT. Given the X-linked inheritance of Dent disease 2, the patients’ mother is an obligate carrier of the p.Cys104Phefs*2 variant in OCRL. Therefore, the third brother is an appropriate candidate for genetic testing due to his 50% chance of inheriting the familial variant. In this family, identification of an OCRL variant via broad panel renal genetic testing impacted patient counseling, management, and family testing. Notably, without genetic testing for the proband, his brother’s condition may have gone undiagnosed due to the atypical presentation, demonstrating the variability of OCRL-related conditions. Genetic testing can enable accurate disease diagnosis in individuals with an atypical presentation, syndromic kidney disease and/or a family history.
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Introduction & Objectives: Double J ureteric stents are commonly used in acute and elective urology practice. Ureteric stents with external strings offer an alternative solution to extraction compared to the standard of requiring cystoscopy and stent removal at an additional cost. Our aim was to review the usage of double J stents on extraction strings in our institution and whether this was increasing over time and the potential cost savings. Methods: All ureteric stent insertions in Auckland Hospital between 2015 and 2019 (5 years) were reviewed from the hospital stent register. Results: A total of 4016 ureteric stents were inserted over 5 years. Of the total number of stents inserted 33.2% were stents on strings, with a significant increase in the trend towards stent on strings per year (Cochran-Armitage test p<0.0001). Procedures for stone disease were the most common indication for stent insertion making up 66% of all cases. 45% of stents inserted in management of stone disease were stents on strings. The number of stents on strings and total number of stents inserted for ureteric calculi increased each year. If a Covid test cost and subsequent flexible cystoscopy removal of ureteric stent was applied to stent on strings in our study period, a cost saving of $1.15 million would be seen, and is an important consideration for future practice worldwide. Conclusions: The use of stents on strings appears to be higher in our centre than previously reported in the literature. This is likely to be associated with reduced patient discomfort from stent removal and significantly reduced stent removal costs with implications for future planning and resource distribution in our centre. Potential risks associated with stents on strings - in particular stent dislodgement - need to be considered, and consideration given to case selection and patient counselling.
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Objective: Identify patients who had breakthrough seizures following COVID-19 vaccine administration. Background: Neurologic complications occur following vaccinations. The coronavirus (COVID-19) vaccines are also associated with neurological side effects. For example, 100 cases of Guillian Barre Syndrome were reported following 12.5 million doses of the Johnson & Johnson vaccine. Five case reports of thrombosis and thrombocytopenia, with corresponding cerebral venous sinus thrombosis (CVST) were reported with the Johnson & Johnson vaccine. Lastly, a recent study noted that out of 54 patients with epilepsy, one patient had increased seizure frequency following vaccination and another patient had a new seizure semiology. The impact of the COVID-19 vaccines on primary brain tumor patients is unknown. Design/Methods: We analyzed the 866 patients at the Alvord Brain Tumor Center from January 2021 to April 2021. We describe here 15 patients with primary brain tumors who experienced breakthrough seizures within a week of receiving the first or second dose of the Moderna or Pfizer vaccines. Results: Sixty percent of patients had glioblastoma, the median age of 60 years, with males and females relatively equally affected (47% vs. 53%). Approximately 70% were not on active treatment at the time of seizure breakthrough. The last episode of seizure was at least six months prior to the seizure breakthrough in 33% of patients. Seizures occurred a median of one day after the most recent vaccine. Seizure breakthrough reports were similar between first and second vaccine doses (47% vs. 53%). In two patients, seizure following their COVID-19 vaccine was the first manifestation of their primary brain tumor. Conclusions: COVID-19 vaccines may lower seizure threshold by systemic inflammation or sleep disruption. Given the likely increased risks of COVID-19 infection among patients with brain tumors, vaccination is still recommended. Patient counseling on sleep hygiene, fever, and strict adherence to seizure medication is crucial to mitigate the risk of seizure post-vaccination.