Do pharmacists counsel customers on the disposal of unused or expired household medications? A national survey among 1,596 pharmacists in Indonesia.

Introduction: Pharmacists play a vital role in counseling customers on proper medication disposal, yet their consistency in providing such information is often lacking. This study aimed to assess pharmacists' awareness of appropriate disposal practices for unused and expired household medications. Additional objectives included evaluating whether pharmacists offer disposal information during counseling, measuring their willingness to receive medication waste from the public, and identifying associated factors. Methods: A national cross-sectional online survey employing convenience sampling was conducted among pharmacists working in hospitals, pharmacies, clinics, or community health centers (CHCs) in Indonesia, using a validated questionnaire to assess awareness, information provision, and willingness to receive medications for disposal. Binary logistic regression, with 95% confidence intervals (CI) and odds ratios (OR), explored potential associations between factors and outcomes. Results: This study involved 1,596 pharmacists across 37 Indonesian provinces. Most pharmacists were women (80.4 %), aged 31-40 years (49.3 %), with a pharmacist professional background (93.8 %), working in CHCs (41.2 %), and practicing for 1-5 years (51.0 %). More than half were unaware of guidelines for returning medications to health facilities. While 69.9 % never counseled customers on disposal practices, 64.9 % expressed willingness to receive unused and expired medication from the public. Pharmacists practicing for at least six years were more likely to provide disposal information during counseling (OR: 2.54; 95 % CI: 1.44-4.47). Conversely, those in clinics (OR: 2.16; 95 % CI: 1.29-3.62), CHCs (OR: 2.07; 95 % CI: 1.45-2.95), or hospitals (OR: 2.00; 95 % CI: 1.27-3.14) were more likely to be unwilling to receive expired and unused household medication. Conclusions: The study reveals that most pharmacists, particularly those with limited practice duration, lacked awareness regarding the importance of proper medication disposal and did not provide counseling on appropriate medication disposal to patients. To address this issue, there is a pressing need for intensified education intensified education at the undergraduate level, continuous training for pharmacists, and a clear policy and practical guidelines, particularly targeting pharmacists in clinics, CHCs, and hospitals, to facilitate the acceptance of unused and expired household medications.

Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review.

Background: Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients. Methods: The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations. Results: The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results. Conclusion: There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.

Assessment of Rare Case on Patient with Filariasis-Associated Bilateral Pleural Effusion

@#Bilateral pleural effusion is fluid accumulation in both lungs of pleural spaces. The clinical manifestations of bilateral pleural effusion (chylothorax) caused by filariasis are so rare that they are often challenging to diagnose. This case study described a 21-year-old woman, domiciled in Sumatra, with complaints of shortness of breath and swollen legs. Radiological examination results found bilateral pleural effusion. Initially, it was suspected that the effusion was caused by tuberculosis, Systemic Lupus Erythematosus (SLE), and malignancy; however, treatments for these did not improve the patient’s condition. A Water Seal Drainage (WSD) was inserted and a chylous or chylothorax pleural effusion was obtained, and microfilaria was founded in the nocturnal blood examinations. Oxygen and nursing interventions were administered using lung expansion and postural drainage techniques, supported by education on effective coughing and deep breathing, along with the fulfillment of nutritional needs and dietary adjustments

Topical Effects of Aloe Vera in Healing Diabetic Foot Ulcers: A Protocol of Systematic Review

@#Introduction: Wound care is a very important part of managing diabetic foot ulcers. The importance of choosing the right topical therapy for managing diabetic foot ulcers aims to help speed up the wound healing process. Aloe vera is one of the traditional natural ingredients that is often used in wound care and can maintain a moist atmosphere in wound care. So it is necessary to have a systematic review to provide comprehensive evidence regarding the topical effects of aloe vera in increasing wound healing in diabetic foot ulcers. This study aims to determine the topical effect of aloe vera in healing diabetic foot ulcers. Methods: This research is a systematic completion that will use six databases (CINAHL, Academic, PubMed, ProQuest, ScienceDirect, SpringerLink, and google scholar) to search for randomized controlled trial and Quasi-Experimental articles randomly in 2007-2022. The Systematic Review protocol used follows PRISMA as a guide in preparing insights and The Joanna Briggs Institute (JBI) Critical Appraisal Tools to assess research quality. This study will determine the effect of topical aloe vera on wound healing in diabetic foot ulcers. Discussion: The results of this study can be useful for knowing the topical effects of aloe vera for wound healing in diabetic foot ulcers. Trial Registration: This protocol has been registered on the protocol registration site for systematic review namely PROSPERO with registration number CRD42022318695.

Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers' and Nurses' Assessments: A Comparative Study.

Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers' and nurses' assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers' and nurses' assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient's discharge together with family caregivers.

Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals.

PURPOSE: This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors. METHODS: The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach's α and Cohen's kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results. RESULTS: An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency. The reliability analysis yielded the same Cronbach's α coefficient of 0.98 for both the inpatient and outpatient data. A significant, moderate correlation was observed between the CDS and Barthel Index results. CONCLUSION: The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.

Change in Care Dependency of Stroke Patients: A Longitudinal and Multicenter Study.

PURPOSE: The study was conducted to investigate the change of care dependency in stroke patients from inpatient wards and outpatient units in Indonesia. METHODS: This study is longitudinal and multicentered. One hundred and nine patients were included from four hospitals on the island of Java. Care dependency was assessed using the Indonesian version of the 15-item Care Dependency Scale (CDS) at five points in time: at inpatient wards for admission and discharge and at outpatient units after discharge in the 1st week, the 5th week, and the 13th week. RESULTS: Most of the patients were male (65.1%), and diagnosed with ischemic stroke (71.5%). The results showed that care dependency in stroke patients decreased significantly from admission to discharge, as well as from the 5th to the 13th week as measured by the CDS. At admission, 23.0% of the patients were completely dependent on care, and at the 13th week about 1.0% were. Patients' care dependency decreased significantly in all care dependency items of the CDS in the inpatient ward, but five care dependency items of the CDS did not significantly decrease in the outpatient unit. CONCLUSIONS: Based on the findings of this study, we recommend that hospital-based and community-based services should include continual care dependence monitoring using this comprehensive instrument. Care dependency is subject to change over time, therefore nurses have to plan and tailor adequate nursing care measures to patient needs in the different stages, especially with respect to the aspect of mobility.

Change in Care Dependency of Stroke Patients: A Longitudinal and Multicenter Study

PURPOSE: The study was conducted to investigate the change of care dependency in stroke patients from inpatient wards and outpatient units in Indonesia. METHODS: This study is longitudinal and multicentered. One hundred and nine patients were included from four hospitals on the island of Java. Care dependency was assessed using the Indonesian version of the 15-item Care Dependency Scale (CDS) at five points in time: at inpatient wards for admission and discharge and at outpatient units after discharge in the 1st week, the 5th week, and the 13th week. RESULTS: Most of the patients were male (65.1%), and diagnosed with ischemic stroke (71.5%). The results showed that care dependency in stroke patients decreased significantly from admission to discharge, as well as from the 5th to the 13th week as measured by the CDS. At admission, 23.0% of the patients were completely dependent on care, and at the 13th week about 1.0% were. Patients' care dependency decreased significantly in all care dependency items of the CDS in the inpatient ward, but five care dependency items of the CDS did not significantly decrease in the outpatient unit. CONCLUSIONS: Based on the findings of this study,we recommend that hospital-based andcommunity-based services should include continual care dependence monitoring using this comprehensive instrument. Care dependency is subject to change over time, therefore nurses have to plan and tailor adequate nursing care measures to patient needs in the different stages, especially with respect to the aspect of mobility.