Development of Community Pharmacy Competencies.

Objective: This study aimed to develop a consensus statement of competencies for community pharmacists in Thailand. Methods: A 2-round modified Delphi process was used to develop consensus among a panel of community pharmacy experts. A total of 18 experts from 6 stakeholders represented a panel of each pharmacy organization in Thailand. In the first experts were asked to rate their degree of agreement on whether a competency was essential using a 7-point Likert scale (1 = "not essential competency" to 7 = "the most essential competency"). Also, in the second round, they were asked to rate the competencies from a scale of "must be included" to "must be excluded." Competencies considered "must be excluded" by a consensus of 80% or more of experts were removed from the community pharmacy competency list. Results: Nearly half the experts had experience in their position for more than 10 years. The expert panels were typically committee members of the Community Pharmacy Association (Thailand) and community pharmacy clerkship preceptors (29.4% and 23.5%, respectively). The number of community pharmacy competencies on the initial list was 55 competencies. None of them was eliminated after the first round. Of 55 competencies, 11 were eliminated after the second round. The final list of competency statements was 44 competencies divided into 4 domains: personal competencies, pharmacy professional competencies, patient care competencies, and management competencies. Conclusion: Community pharmacy competencies include having a positive attitude and being accountable for individual patient care, providing disease prevention and health promotion, and addressing morality and ethics in business.

Clinical burden associated with postsurgical complications in major cardiac surgeries in Asia-Oceania countries: A systematic review and meta-analysis.

BACKGROUND: Evidence on the burden of postsurgical complications is mainly from studies in western countries, and little is highlighted in the Asia-Oceania region. This study aimed to identify and compare the burden of postsurgical complications in major cardiac surgeries in Asia-Oceania countries. METHODS: A systematic search was performed in PubMed, Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria were: (a) observational studies or randomized control trials; (b) studied in coronary artery bypass graft (CABG) and/or heart valve procedures; (c) measured postsurgical clinical outcomes; and (d) conducted in Asia-Oceania countries. Pooled effects were calculated using a random-effects model. RESULTS: Of the 6032 articles screened, 472 studies with a total of 614 161 patients met the inclusion criteria. The pooled incidences (95% confidence interval) of hospital mortality and 30-day mortality were similar at 2.38% (2.16%-2.59%) and 2.33% (2.16%-2.50%), respectively. Length of stay (LOS) was 14.07 days (13.44-14.71 days). The incidence for atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was 17.49% (15.99%-18.99%) and 1.64% (1.51%-1.78%), respectively. Below outcomes tended to be better in studies on CABG compared to heart valve procedures, including the incidence of hospital mortality (1.97%[1.75%-2.18%] vs 3.97% [3.29%-4.65%]), AF (16.47% [14.85%-18.10%] vs 21.98% [17.41%-26.54%]), stoke/CVA (1.51% [1n 37%-1.65%] vs 2.55% [2.07%-3.04%]), and mean LOS (days) (13.08 [12.51-13.65] vs 19.58 [16.72-22.45]). Similarly, all postsurgical complications tended to be higher in studies involving high-risk patients vs non-high-risk patients. CONCLUSIONS: There are opportunities to improve clinical outcomes of patients with high surgical risks and those undertaking heart valve procedures, as they tend to have poorer survival and higher risk in developing postsurgical complications.

An overview of the evidences of herbals for smoking cessation.

BACKGROUND: Despite availability of several therapeutic options for smoking cessation, their usages are limited due to high cost and adverse effect profiles. Recently, more attention has been paid to investigating herbals for smoking cessation. OBJECTIVES: To review relevant evidences on the efficacy and safety of herbals for smoking cessation. METHODS: We searched clinical studies evaluating herbals use for smoking cessation from Medline, EMBASE, CINAHL, Cochrane CENTRAL, PsychINFO, AMED, WHO Trial registry, Thai dissertation database, and other databases from its inception to October 2012. Studies are restricted to only English or Thai. RESULTS: A total of 7 studies met inclusion criteria; 6 studies were randomized trial (RCT) evaluating variety of herbals. Three RCTs evaluated oral St. John's wort (SJW) extract (N=289), 2 RCTs evaluated oral mix-herbal tea (N=164), and 1 RCT evaluated inhaled aromatic black pepper (N=48). The other study was a non-randomized controlled trial evaluating oral SJW extract among 24 smokers. All interventions were given in a range of 1 week before starting the study and continued up to 14 weeks. Smoking cessation was measured with various methods including the number of cigarettes per day, abstinence rate, expired CO level, and urine cotinine level. Follow-up duration ranged from 3-h session to 6-months period. Evidences of SJW indicated low percentage in abstinence rate for smoking and its effectiveness was not significantly different from placebo. Studies of mix herbal tea showed a statistically significant effectiveness, compared to placebo, in reducing the number of cigarettes per day, craving scale, and total withdrawal scale but not urinary cotinine excretion. Essential oil of black pepper with a hollow plastic tube significantly reduced craving at 3-h session. CONCLUSION: Evidence supporting the role of complementary medicines as an anti-smoking is limited. Further research in this field would benefit from the standardization of herbals products to implement on standard interventions and outcome measurement for smoking cessation.

Searching for health information on the Internet by undergraduate students in Phitsanulok, Thailand.

UNLABELLED: Searching the Internet has become an important and rapidly-expanding tool for users with health concerns. OBJECTIVES: This study was designed to describe the accessibility, searching pattern, and implication for obtained health information on the Internet of Thai undergraduate students. METHOD: Questionnaires composed of personal data and accessibility to drug information, were provided to convenience samples of undergraduate students in Phitsanulok. RESULTS: Four-hundred questionnaires were completed, 66% females, mean age (SD) 21.58 (2.26) years old (range 17-29). Ninety percent of respondents accessed the Internet; 75% percent had access to the Internet at school in range of 1-3 times per week and 1-3 hours per time. Half the Internet users had access to health information. The most sought health information included general health (65.7%), disease and treatment (49.5%), and nutrition (41.9%). The main reasons for searching on the Internet were easy access (38.5%) and updated information (34.6%). Seventy percent of the Internet-based information seekers used the obtained information in their daily life. CONCLUSION: This study summarizes current Internet searching patterns of undergraduate students in Thailand. The results have implications for constructing realistic simulations of searching behavior and improving the value of websites on health information relevant to youth.

The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis.

OBJECTIVE: The aim of this study was to specifically determine the impact of a fixed dose of ginger administration, compared with placebo, on the 24-hour postoperative nausea and vomiting. STUDY DESIGN: The design was a systematic review and metaanalysis of trials revealed by searches. Randomized controlled trials comparing ginger with placebo to prevent postoperative nausea and vomiting and postoperative vomiting from Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles, contact of authors, and experts in the field. Two reviewers selected studies for inclusion and independently extracted data. RESULTS: Five randomized trials including a total of 363 patients were pooled for analysis of preventing postoperative nausea and vomiting and postoperative vomiting. The summary relative risks of ginger for postoperative nausea and vomiting and postoperative vomiting were 0.69 (95% confidence interval 0.54 to 0.89) and 0.61 (95% confidence interval 0.45 to 0.84), respectively. Only one side effect, abdominal discomfort, was reported. CONCLUSIONS: This meta-analysis demonstrates that a fixed dose at least 1 g of ginger is more effective than placebo for the prevention of postoperative nausea and vomiting and postoperative vomiting. Use of ginger is an effective means for reducing postoperative nausea and vomiting.