Are pharmacists on the front lines of the opioid epidemic? A cross-sectional study of the practices and competencies of community and hospital pharmacists in Punjab, Pakistan.

INTRODUCTION: Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues. STUDY DESIGN: A cross-sectional study, conducted across Punjab, Pakistan. METHOD: The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists. RESULTS: 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'. CONCLUSION: Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.

Agreement Between 64-Slice Multidetector CT Angiography and Transthoracic Echocardiography in Detection of Extracardiac Findings of Congenital Heart Disease.

OBJECTIVE: To determine the degree of agreement between multi-detector computed tomography angiography and transthoracic echocardiography in diagnostic evaluation of congenital heart disease with extracardiac findings. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Radiology Department, Doctors Hospital and Medical Centre, Lahore, from May to November 2016. METHODOLOGY: Patients with clinical suspicion of cardiovascular malformation were included in the study. All the patients had echocardiography and thoracic computed tomography angiography done to diagnose congenital heart disease. Agreement was labelled in true positive and true negative patients. RESULTS: Computed tomography angiography could detect the extracardiac findings of congenital heart disease in 140 (93.3%) patients, while transthoracic echocardiography in 118 (78.7%) patients. Agreement was detected in 108 (72%) patients. Kappa statistics showed poor agreement (kappa = -0.113). CONCLUSION: Although transthoracic echocardiography is usually the first line of investigation in evaluation of congenital heart disease; it has its limitations for evaluating congenital heart disease with extracardiac findings, due to intrinsic limitation of the imaged field. Computed tomography angiography has better sensitivity in detecting extracardiac findings of congenital heart disease along with better delineation of anatomy.