Pharmacological interventions to improve sleep in people with Alzheimer's disease: a meta-analysis of randomized controlled trials.

INTRODUCTION: This systematic review and meta-analysis evaluates the evidence from randomized controlled trials (RCTs) involving pharmacological interventions for improving sleep in people with Alzheimer's disease (AD). METHODS: A systematic literature search in eight databases from January 2000 to July 2023 focusing on RCTs that compared a pharmacological intervention with a placebo for enhancing sleep in people with AD. The authors registered the study protocol at Prospero, followed the PRISMA guidelines, and produced the pooled estimates using random-effect or IVhet models. RESULTS: Eight different interventions and 29 different sleep outcomes were examined in 14 RCTs included in this review. Eszopiclone positively affected sleep efficiency, as did orexin antagonists. However, there was no difference when melatonin was used. The interventions demonstrated low discontinuation rates and a few adverse drug reactions. CONCLUSION: Although melatonin was the most investigated intervention, the evidence for its efficacy is inconclusive. On the other hand, trazodone and orexin receptor antagonists showed promising results; however, more RCTs are needed for definite answers.

Lived experiences of Turkish community pharmacists toward person-centric care: a qualitative analysis.

Background: In Turkey, the SMART pharmacist program was launched to enable community pharmacists to deliver patient-centric care services. However, how far this programme has achieved success and what are the challenges faced by the programme need to be evaluated. Objective: This study aimed to explore the experiences of community pharmacists in providing person-centric care services in pharmacies and provide recommendations for improved care effectiveness. Methods: A phenomenological approach was adopted in this study. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study. A total of 14 pharmacists engaged in semi-structured interviews conducted between May and August 2023. Results: Two main themes emerged from the data: challenges in person-centric care and recommendations to improve person-centric care. Barriers were subdivided into patient-related challenges and personal challenges. Recommendations consisted of pharmacists' professional tasks and recommendations. Conclusion: The findings of this study, suggest that the concerned healthcare authorities should re-evaluate the 'SMART pharmacist' program in Turkey and address professional and personal challenges faced by community pharmacists in delivering effective person-centric care. Pharmacists recommend patient follow-up (follow-ups), providing a counselling environment, collaboration with physicians, expansion of pharmacy services.

Raising awareness among pharmacists can be achieved through initiatives like the 'SMART Pharmacist Program', aimed at enhancing the provision of person-centric pharmaceutical care to patients.Government policies may be required revision to community pharmacists greater authority.Academic institutions could contemplate revising the existing pharmacy education curriculum to emphasise person-centric pharmacy education.Likewise, professional organisations may need to reevaluate the continuing professional development prerequisites for community pharmacists.

Impact of an educational program on community pharmacist's preparedness to conduct pharmacist-led diabetes clinic in Saudi Arabia.

BACKGROUND: Demand for diabetes care and prevention has increased due to Saudi Arabia's high prevalence of diabetes mellitus and its insufficient treatment. This raised awareness of the significance of community pharmacists in Saudi Arabia, who may significantly improve diabetes treatment by setting up pharmacist-led diabetic clinics. Thus, to assess community pharmacists' readiness to lead diabetes clinics in Saudi Arabia, this study evaluated the usefulness of an educational session on diabetes care. METHOD: The preparation of community pharmacists for diabetes treatment and management was assessed using a validated diabetes-specific questionnaire. An engaging and thorough diabetes education class was presented by two licensed diabetes educators. One-way ANOVA, chi-square, and the Mann-Whitney U-test were used to statistically assess the pre- and post-knowledge and attitude scores of community pharmacists. RESULTS: Following a learning session, the community pharmacists had a significant increase in understanding oral hypoglycemic medicines, monitoring the disease's course, and dosing of insulin for diabetics (p = 0.01). Additionally, the community pharmacist's perspective and attitude score on managing diabetes increased from 49.74 to 52.74 (p = 0.01). CONCLUSION: The study's findings demonstrated a marked improvement in community pharmacist's knowledge of and attitude toward running pharmacist-led diabetic clinics following a session on diabetes education in collaboration with the Pharmacy College. The study's findings also emphasized the significance of developing a structured programme for diabetes education in Saudi Arabia to address the demands of community pharmacists in terms of professional development.

Prevalence, types and disclosure of complementary and alternative medicine (CAM) use among chronic kidney disease (CKD) patients in Saudi Arabia.

INTRODUCTION: Despite the paucity of scientific evidence, CAM is widely used for the prevention and treatment of illness among patients with chronic kidney disease, including end-stage renal disease and kidney transplant recipients. It is evident that the irrational use of CAM among CKD patients and its non-disclosure to healthcare providers could lead to adverse drug events. Hence, the current study was conducted to evaluate the prevalence, types, and non-disclosure of CAM use among CKD patients and kidney transplant recipients in Saudi Arabia. METHODS: A cross-sectional study was conducted on 170 CKD patients (121 with stages 3 and 4, two with stage 5 and on hemodialysis, and 47 kidney transplant recipients). Face-to-face questionnaire-based interviews were conducted employing a convenience sampling technique. The study outcomes were the prevalence of CAM, types of CAM use, monthly expenditure on CAM, the source of information about CAM, and CAM disclosure to healthcare providers. A p-value of < 0.05 was considered significant. RESULTS: The study found that out of 170, 60 (35.3%) CKD patients use CAM. The most used CAM was Acacia gum (49, 81.6%) followed by spiritual therapies (34, 56.6%). Female CKD patients had higher use of CAM compared to the male gender (p = 0.015). The monthly expenditures that most users (47, 78.3%) spent on CAM were less than 50 Saudi Riyals (SR). The study results also showed that 55% of CKD patients did not report their CAM use to their physicians. Furthermore, 46.6% of CAM users discontinue their use of CAM after observing no benefit. CONCLUSION: This study reported relatively high use of CAM among CKD patients in Saudi Arabia. The study found that most CKD patients use Acacia gum and spiritual therapies and do not disclose the use of CAM to healthcare professionals, which could lead to adverse drug events. Therefore, the study recommends that healthcare providers should inquire and provide evidence-based counselling about the use of CAM to CKD patients to prevent any adverse drug event or unwanted effect on the renal function of the patients.

Community pharmacist's preparedness to provide patient-centred care in Saudi Arabia.

Background: Community pharmacy practice in Saudi Arabia is evolving and needs to be at par with the developed world. Community pharmacists can play a vital role in bridging gaps in the delivery of healthcare services by providing patient-centred care to patients and contributing toward the healthcare transformation plan of vision 2030 of Saudi Arabia. The present study is aimed at evaluating the knowledge, attitude, and practices of community pharmacists in delivering patient-centred care services. Method: A nationwide cross-sectional survey using a validated and pre-tested 27-item self-reported questionnaire was conducted amongst 301 (86.4% male, 13/6% female) community pharmacists from all regions of Saudi Arabia. Both descriptive and inferential analysis was employed using the SPSS version, with 0.05 as the level of significance. Results: Community pharmacists from chain pharmacy groups, female gender and staff community pharmacists had statistically better overall practice standards, knowledge, and attitude to conduct patient-centred care services (p less than 0.01). The majority of community pharmacists would expect extra remuneration and participation in structured professional skills development programs to provide patient-centred care efficiently. Inaccessibility of patient data from healthcare facilities, the unavailability of informative literature, and administrative workload were among the barriers cited in delivering patient-centred care. Conclusion: The study findings show that community pharmacists could play a significant role in providing patient-centred care and contribute to the achievement of the healthcare reform agenda of Saudi Arabia. However, some obstacles must be overcome before this practice can be shifted, including the introduction of a formalized continuing professional development program, financial incentives, and a decrease in the administrative burden on pharmacists. The results of this study may help policymakers in Saudi Arabia better comprehend the country's existing approach to community pharmacy practice.

Use of potentially inappropriate medications among older outpatients and inpatients in a tertiary care hospital in Malaysia.

BACKGROUND: Older individuals are seemingly having more medical conditions, which predispose them to a greater risk of polypharmacy. Potentially inappropriate medications (PIMs), including those having anticholinergic and sedative properties, are common in their prescriptions, often associated with functional decline and negative health outcomes. Thus, this study reports proportions of inappropriate drugs and drug burden exposures and its correlation with patient-reported outcomes (PROs) among cognitively intact older adults admitted to a ward or visiting the outpatient clinic at a tertiary care hospital in Malaysia. METHODS: This cross-sectional study included data from 344 older (173 inpatients and 171 outpatients) patients, aged 60 years and above, through validated questionnaires. Medication appropriateness was assessed via Medication Appropriateness Index (MAI) tool, whereas Beers and Screening Tool of Older Person's Potentially Inappropriate Prescribing (STOPP) criteria were used to evaluate PIMs and potentially inappropriate prescribing (PIP), respectively. The Drug Burden Index (DBI) and polypharmacy, as well as PROs, included Groningen Frailty Indicator (GFI), Katz Index of Independence in Activities of Daily Living (Katz ADL) and Older People's Quality of Life (OPQOL) were also evaluated. RESULTS: Overall, inpatients received significantly higher medications (6.90 ± 2.70 vs 4.49 ± 3.20) than outpatients. A significantly higher proportion of inpatients received at least one PIM (65% vs 57%) or PIP (57.4% vs 17.0%) and higher mean MAI score (1.76 ± 1.08 and 1.10 ± 0.34) and DBI score (2.67 ± 1.28 vs 1.49 ± 1.17) than outpatients. Inpatients had significantly higher total OPQOL (118.53 vs 79.95) and GFI score (5.44 vs 3.78) than outpatients. We only found significant correlations between GFI and DBI and total OPQOL and the number of PIMs. CONCLUSIONS: Proportions of PIMs and DBI exposure were significantly higher in an inpatient setting. No significant correlations between exposures to inappropriate medications or drug burden and PROs were observed.