Evaluating smokers' opinions on smoking and customized cessation in a Thailand University context: A qualitative study.

INTRODUCTION: In Thailand, smoking cessation services have been developed to reach smokers who want to quit. However, in universities, smoking cessation services are still limited. This study aimed to identify smokers' opinions on smoking and customized cessation, and to synthesize a cessation model in the university context using the Health Belief Model. METHODS: A qualitative research method was designed. In-depth interviews with semi-structured questions following the Health Belief Model framework were conducted with students, teachers, and supporting staff who were current smokers. The study was conducted from January to March 2022 at a Thai public university comprising schools of health sciences. Purposive sampling and a snowball technique were applied until data saturation was reached. Interview questions were constructed and validated for content. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation. RESULTS: Forty-three participants were included in this study. Of six main themes and 19 subthemes, most subthemes were consistent between groups except in economic-related themes and customized cessation services. Perceptions of harm showed positive awareness of self-harm and harm to others. Barriers included addiction, being around smokers, social norms, not trusting the counseling services, and having no information about the services. Self-efficacy to quit smoking was found in a few participants. Customized cessation services varied among groups and included convenient services with 24/7 services, services units, generous counselors, communication with an application, online counseling, and medications for cessation. Moreover, the cessation services in a university were mentioned including a quit-smoking community, more activity areas, fewer smoking areas, alliance counselors from schools, and more public relations for cessation units. CONCLUSIONS: The perception and self-awareness of harm ranged from relaxed to being serious. Because of barriers, smoking cessation was hard to achieve, and it was hard to reach smokers. Strategies to support cessation were suggested by providing health education programs, promoting facilities and activities on campus, and designing easily accessible and customized cessation services.

Trends in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties: a three-year retrospective study in a tertiary hospital in Thailand.

OBJECTIVES: The study determined a comparative three-year trend in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties of a tertiary hospital. METHODS: Prescription data for three consecutive fiscal years (2016-2018) were extracted from a tertiary hospital electronic database, for the gastrointestinal, cardiovascular and orthopaedic outpatient specialties. The data collected were individual proton pump inhibitors, overall and individual prescribing volumes (capsule/tablet) and costs, stratified by specialty and fiscal year. KEY FINDINGS: Of the three specialties, the largest volume of proton pump inhibitor prescriptions, mostly for omeprazole, comes from the orthopaedic specialty (46%). In terms of prescribing costs, at the top is the cardiovascular specialty (45.75%). Lansoprazole, which is one of the proton pump inhibitors on in the national list of essential medicines, contributed most to the cost. Prescribing proton pump inhibitors that are not included in the national list of essential medicines were responsible for over 90% of the costs in the cardiovascular and gastrointestinal specialties. An escalating trend in prescribing varied proton pump inhibitors, that is, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole and rabeprazole, all of which were not on the list of essential medicines, was evident in the latter. CONCLUSIONS: The highest volume of proton pump inhibitor prescribing-mostly of omeprazole, was issued by the orthopaedic specialty. The cardiovascular specialty was responsible for the largest amount of cost. The increases in the uses and costs of varying proton pump inhibitors which were outside the national list of essential medicines were notable in the gastrointestinal specialty.

Smoking characteristics and lung functions among university athletes.

Cigarette smoking has negative effects on the respiratory system, particularly pulmonary functions. This study aimed to determine smoking prevalence and characteristics among university athletes. We conducted a cross-sectional study of Thammasat University athletes in Thailand from July to October 2018. Demographic and smoking data were recorded. Exhaled carbon monoxide (CO) levels and lung function data were analysed. A total of 433 subjects (56% men) were included. Mean age was 19.8 ± 1.3 years. Asthma was reported in 5.5%. The prevalence of current cigarette smoking was 23.8%. Tobacco use was 3.0 ± 3.2 cigarettes per day. The Fagerstrom score for nicotine dependence was 0.76 ± 1.47. Compared to non-smokers, smokers were predominately males (70.6% vs 29.4%, P < 0.001), had higher exhaled CO levels (3.75 ± 3.08 ppm vs 2.18 ± 0.73 ppm, P < 0.001), higher FVC (89.65 ± 17.61% vs 83.22 ± 15.72%, P = 0.001), higher FEV1 (92.60 ± 15.36% vs 87.77 ± 11.23%, P = 0.002), but lower FEV1/FVC (78.21 ± 5.38% vs 79.70 ± 5.60%, P = 0.015). Moreover, athletes who smoke, were more likely to: drink alcohol, have a family member who smokes, have a friend who smokes or have a university instructor who smokes. In conclusion, smoking prevalence among university athletes was relatively high, although low nicotine addiction level and good lung functions were found. Home and institute environments had important influences on cigarette use in students.Trial registration: TCTR20180917001.

Clinical equivalence of budesonide dry powder inhaler and pressurized metered dose inhaler.

INTRODUCTION: A delivery device is the most important factor that determines the local/systemic bioavailability of inhaled corticosteroids. Dry powder inhalers (DPIs) and pressurized metered dose inhalers (pMDIs) are the most commonly used delivery devices for localized drug delivery to the airways. OBJECTIVE: This study was to compare the clinical equivalence of budesonide delivered by the Pulmicort Turbuhaler (DPI) and the Aeronide inhaler (pMDI). MATERIALS AND METHODS: The two inhalers were compared for their pharmaceutical equivalence and clinical equivalence. The in vitro test included the uniformity of the delivered dose and determination of the aerodynamic particle size of budesonide. The in vivo test was carried out in 36 patients with mild to moderate asthma. This was a randomized, single-blinded study conducted for a period of 3 months. This included assessment of the spirometric parameters [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), forced expiratory flow 25-75% (FEF25-75)], the severity of asthma symptoms, adverse events, frequency of short-acting inhaled bronchodilator usage and measurement of urinary cortisol levels. RESULTS: The aerodynamic particle size was slightly different between the two inhalers (2.3 ± 0.2 µm for Pulmicort Turbuhaler and 2.2 ± 0.2 µm for Aeronide inhaler). Both inhalers passed the uniformity of delivered dose (95.4% and 97.4%) specified in the British Pharmacopoeia. There was no statistically significant difference observed between the two inhalers in terms of the spirometric parameters, symptom-free days, frequency of bronchodilator usage and the level of urinary cortisol. CONCLUSION: In addition to pharmaceutical equivalence, no clinical difference observed between the two budesonide inhalers.

Effects of the pharmacist's input on glycaemic control and cardiovascular risks in Muslim diabetes.

AIMS: To determine whether an extended pharmacy service would improve glycaemic control and cardiovascular risks in diabetic Muslims. METHODS: Ambulatory literate adult diabetic Muslims with A1C >7% were randomly assigned to either a study group (usual care plus added pharmacist input, N=63) or a control group (usual care only, N=67). On four consecutive visits, at 2-month intervals, the study group met a pharmacist who educated and discussed with each patient regarding medication uses and diabetic treatment. This was accompanied by providing a diabetic pamphlet. Changes in A1C (mg/dL), lipid parameters (mg/dL), medication adherence (% pill count) and diabetic knowledge scores were measured. RESULTS: There was no difference in A1C reduction between the study and the control groups (-0.8 vs. -0.6, p=0.56). Total cholesterol and LDL-C improvements were greater in the study group than in the control group (-31.6 vs. -1.2, p=0.000; -15.0 vs. +9.1, p=0.002, respectively). The percent pill count (+6.8 vs. -2.8, p=0.004) and diabetic knowledge scores (+2.1 vs. +0.6, p=0.002) were increased in the study group but not in the control group. CONCLUSION: The pharmacist' s one-on-one education on diabetes accompanied by its pamphlet, in Muslim patients with diabetes did not affect glycaemic outcome but reduction in cardiovascular risks through lowering total cholesterol and LDL-C was found. The strategies may also improve diabetic knowledge and medication adherence.

Safety and efficacy of oral nifedipine versus terbutaline injection in preterm labor.

OBJECTIVE: To compare the safety and tocolytic efficacy of oral nifedipine with intravenous terbutaline for the management of threatened preterm labor. MATERIAL AND METHOD: Pregnant women between 24 and 36 completed weeks of single gestation with preterm labor were randomized to either oral nifedipine (n=20) or intravenous terbutaline (n=20) treatment. Nifedipine (immediate released capsule) 10 mg was crushed and swallowed, 10 mg every 20 minutes was allowed if necessary with a maximum 40 mg in the first hour. After that 20 mg nifedipine every 4 hours was given, up to 72 hours. Terbutaline was initially infused with the rate 10 g/min with an increment 5 microg/min every 10 minutes if required, until 25 microg/min was reached. Once the contractions had stopped for 2-6 hours, the patients were switched to subcutaneous injection with 0.25 mg terbutaline every 4 hours for 24 hours. The main safety outcome was the changes in maternal diastolic blood pressure from baseline and 1 hour after starting the treatment (deltaDBP(1hr)). Secondary outcomes were the efficacy to delay delivery > or =48 hours and 7 days, the adverse events and the birth outcomes. RESULTS: deltaDBP(1hr) was greater in the terbutaline group than that in the nifedipine group with no statistically significant difference. Hypotension (defined as BP < or = 90/60 mmHg) was found in one patient of the nifedipine group and two patients of the terbutaline group. Seventeen and 14 patients in the nifedipine group and 15 and 12 patients in the terbutaline group had delayed delivery > or =48 hours and 7 days, respectively. Mothers in the nifedipine group experienced fewer side effects than those in the terbutaline group. Maternal heart rate, at I hour after starting the treatment, increased significantly higher in the terbutaline group than in the nifedipine group. Birth outcomes were measured in all nifedipine group patients, but in only 16 of the terbutaline group patients. Six mothers in each group delivered after 37 weeks. Intraventricular hemorrhage (IVH) occurred in three babies (gestational aged 25, 29 and 37 weeks) born to mothers treated with terbutaline. In one baby, IVH related to trauma resulted from the delivery procedure. CONCLUSION: The safety and efficacy of nifedipine compares with that of terbutaline for treatment of preterm labor.

Appropriateness of therapeutic drug monitoring for lithium.

OBJECTIVE: Evaluate the appropriateness of therapeutic drug monitoring (TDM) for lithium. MATERIAL AND METHOD: A retrospective chart review of all patients who received lithium for treatment of psychiatric disorders between January 2004 and October 2005 was done. The present study was investigated in a psychiatric hospital in Thailand Based on detailed chart review, the appropriateness of TDM utilization comprised of three aspects, i.e., the indication of TDM request, the time of blood sample taking in relation to the medication process, and the clinical applications of the reported serum lithium levels, were evaluated. The Morecambe Bay Shared Care Guideline 2003 was modified and used as criteria for evaluation. Altogether 91 serum lithium samples were measured among 60 patients. RESULT: In 66 (72.5%) of requests, clear indications for lithium TDM were recorded i.e., initiation therapy 41.8%, suspected toxicity 15.4%, patient compliance assessment 5.5%, after regimen changes 5.5%, and therapeutic failure 4.4%. Routine tests without specified indications were found in the remainder (27.5%), all were in-patients, which pointed to potentially redundant use. The time of sample taking was recorded in 37 (40.6%) of blood samples, all were taken from in-patients, after steady state had been reached. These data for out-patients were not recorded, except one noted that blood sample was drawn after the patient had not received lithium for four days. Serum lithium levels were reported in 83 (91.2%) samples. Of these, 37 (44.6%) were out of therapeutic range, and only 12 required dosage alterations. The evaluation demonstrated somewhat inappropriate use of reported lithium levels. Dose changes were done in some patients who required dosage adjustment. Among 14 toxicity-suspected patients, nine actually had serum lithium levels exceeding the therapeutic range. Of these, only one patient was subsequently switched to a reduced dose, three patients were discontinued while five patients were prescribed the pre-TDM doses. Similarly, in five toxicity-suspected patients whose serum lithium levels were below therapeutic range, lithium was discontinued in three patients and no dosage alteration, which was considerably acceptable, in two patients. The doses were increased in three out offour inadequately controlled patients whose serum lithium was lower than the therapeutic range. Overall, in only 33 (36.3%) requests was TDM performed appropriately according to the indication, sampling time and subsequent dose adjustment. CONCLUSION: The findings indicate the need to improve the utilization of TDM for lithium. Education for hospital personnel on appropriateness of serum sample collection, interpretation, and proper use of serum drug levels is encouraged. Development of a request form containing essential data, such as indication for TDM, current drug dosing regimen, time of last dose, patient compliance, test results and interpretations and clinical decision made, can help optimize TDM use and reduce unnecessary costs.