Capture, Coding, and Reporting of Health Care and Medicine Information in Australian Workers' Compensation Systems.

OBJECTIVE: This study aims to characterize the approaches to collecting, coding, and reporting health care and medicines data within Australian workers' compensation schemes. METHODS: We conducted a cross-sectional survey of data and information professionals in major Australian workers' compensation jurisdictions. Questionnaires were developed with input from key informants and a review of existing documentation. RESULTS: Twenty-five participants representing regulators (40%) and insurers (60%) with representation from all Australian jurisdictions were included. Health care and medicines data sources, depth, coding standards, and reporting practices exhibited significant variability across the Australian workers' compensation schemes. CONCLUSIONS: Substantial variability exists in the capture, coding, and reporting of health care and medicine data in Australian workers' compensation jurisdictions. There are opportunities to advance understanding of medicines and health service delivery in these schemes through greater harmonization of data collection, data coding, and reporting.

Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review.

PURPOSE: Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes. METHODS: We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible. RESULTS: From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes. CONCLUSION: Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.

Length of hospital stay and associated factors among heart failure patients admitted to the University Hospital in Northwest Ethiopia.

BACKGROUND: A prolonged length of hospital stay during heart failure-related hospitalization results in frequent readmission and high mortality. The study was aimed to determine the length of hospital stays and associated factors among heart failure patients. METHODS: A prospective hospital-based cross-sectional study was carried out to determine the length of hospital stay and associated factors among heart failure patients admitted to the medical ward of the University of Gondar Comprehensive Specialized Hospital from January 2019 to June 2020. Multiple linear regression was used to identify factors associated with length of hospital stay and reported with a 95% Confidence Interval (CI). P-value ≤ 0.05 was considered as statistically significant to declare the association. RESULT: A total of 263 heart failure patients (mean age: 51.08 ± 19.24 years) were included. The mean length of hospital stay was 17.29 ± 7.27 days. Number of comorbidities (B = 1.494, p < 0.001), admission respiratory rate (B = -0.242, p = 0.009), serum potassium (B = -1.525, p = 0.005), third heart sound (B = -4.118, p = 0.005), paroxysmal nocturnal dyspnea (B = 2.494, p = 0.004), causes of acute heart failure; hypertensive heart disease (B = -6.349, p = 0.005), and precipitating factors of acute heart failure; infection (B = 2.867, p = 0.037) were significantly associated with length of hospital stay. Number of comorbidities, paroxysmal nocturnal dyspnea, and precipitating factors of AHF specifically infection were associated with a prolonged length of hospital stay. CONCLUSION: Heart failure patients admitted to the medical ward had prolonged hospital stays. Thus, clinicians would be aware of the clinical features contributing to the longer hospital stay and implementation of interventions or strategies that could reduce the heart failure patient's hospital stay is necessary.

Glycemic control in newly insulin-initiated patients with type 2 diabetes mellitus: A retrospective follow-up study at a university hospital in Ethiopia.

BACKGROUND: Though many trials had examined the effectiveness of taking insulin with or without oral agents, there are limited real-world data, particularly among patients with type 2 diabetes mellitus (T2DM) in the resource limited settings. This study aimed to examine level of glycemic control among patients with T2DM after initiation of insulin and factors associated with poor glycemic control. METHODS: An analysis of retrospective medical records of patients with T2DM who initiated insulin due to uncontrolled hyperglycemia by oral agents was conducted from 2015-2020 in the University of Gondar Comprehensive Specialized Hospital. Difference in median fasting plasma glucose (FPG) before and after insulin initiations was examined by a Wilcoxon signed-rank test. Kruskal Wallis test was performed to explore difference in the median level of FPG among treatment groups. A logistic regression model was also used to identify associated factors of poor glycemic control after insulin initiation. Statistical significance was declared at p < 0.05. RESULTS: Of 424 enrolled patients with T2DM, 54.7% were males and the mean age was 59.3±9.3 years. A Wilcoxon signed-rank test showed that there was significant deference in FPG before and after insulin initiation (P < 0.001). A declining trend of blood glucose was observed during the 1-year follow-up period of post-initiation. However, majority of the participants did not achieve target glucose levels. Participants who had higher FPG and systolic blood pressure (SBP) before insulin initiation were found more likely to have poor glycemic control after insulin initiation. Similarly, patients who received atorvastatin compared with simvastatin were found to have poor glycemic control in the post-period of initiation (P = 0.04). Premixed insulin was associated with a lower likelihood of poor glycemic control than neutral protamine Hagedorn (NPH) insulin (P < 0.001). CONCLUSION: Following insulin initiation, a significant change in glycemic level and declining trend of FPG was observed during a 1-year follow-up period. However, the majority of patients still had a poorly controlled glycemic level. Appropriate management focusing on predictors of glycemic control would be of a great benefit to achieve glycemic control.

Ethiopia's commitment towards achieving sustainable development goal on reduction of maternal mortality: There is a long way to go.

Maternal mortality reduction has been recognized as a key healthcare problem that requires prioritizing in addressing. In 2015, the United Nations has set Sustainable Development Goals to reduce global maternal mortality ratio to 70 per 100,000 live births by 2030. Ethiopia as a member country has been working to achieve this Sustainable Development Goals target for the last decades. In this article, we discussed Ethiopia's commitment towards achieving Sustainable Development Goals in maternal mortality. Furthermore, the trends of maternal mortality rate in Ethiopia during Millennium Development Goals and Sustainable Development Goals are also highlighted. Although maternal mortality has been declining in Ethiopia from 2000 to 2016, the rate of death is still unacceptably high. This requires many efforts now and in future to achieve the Sustainable Development Goals target by 2030.

Medication non-adherence in chronic kidney disease: a mixed-methods review and synthesis using the theoretical domains framework and the behavioural change wheel.

OBJECTIVE: Medication non-adherence is a well-recognised issue in chronic diseases but data in patients with chronic kidney disease (CKD) not receiving kidney replacement therapy (KRT) remains limited. This review summarised the prevalence of medication non-adherence and assessed determinants and outcomes associated with it in adults with CKD, not on KRT. METHOD: We searched PubMed, Embase, PsychInfo, Web of Science, and Cochrane (CENTRAL) for studies published until January 2020. Pooled prevalence of medication non-adherence was reported. Determinants of adherence-identified from quantitative and qualitative studies-were mapped into the theoretical domains framework and interventions proposed using the behavioural change wheel. RESULTS: Twenty-seven studies (22 quantitative and 5 qualitative) were included. The pooled prevalence of medication non-adherence was 39% (95% CI 30-48%). Nine studies reported association between non-adherence and outcomes, including blood pressure, disease progression, adverse events, and mortality. Modifiable determinants of non-adherence were mapped into 11 of the 14 Theoretical Domains Framework-of which, six appeared most relevant. Non-adherence decisions were usually due to lack of knowledge on CKD, comorbidities, and medications; polypharmacy and occurrence of medication side effects; changes in established routines such as frequent medication changes; higher medication cost, poor accessibility to medications, services and facilities; inadequate patient-healthcare professional communication; and forgetfulness. Using the behavioural change wheel, we identified several areas where interventions can be directed to improve medication adherence. CONCLUSION: Medication non-adherence is common in adults with CKD, not on KRT and may lead to poor outcomes. Evidence synthesis using mixed study designs was crucial in identifying determinants of non-adherence, drawing on a parsimonious approach from behaviour science. PROSPERO REGISTRATION: CRD42020149983.

Newborns and Under-5 Mortality in Ethiopia: The Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the SDG Targets.

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia's progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.

Correction: Prevalence and determinants of polypharmacy in cardiovascular patients attending outpatient clinic in Ethiopia University Hospital.

[This corrects the article DOI: 10.1371/journal.pone.0234000.].

Prevalence and determinants of polypharmacy in cardiovascular patients attending outpatient clinic in Ethiopia University Hospital.

BACKGROUND: While there are advances in medicine and pharmaceutical care, the burden of medication use has also grown with polypharmacy. In this regard, cardiovascular patients are subjected to polypharmacy for a longer period. OBJECTIVE: The present study aimed to assess the prevalence and predictors of polypharmacy in cardiovascular outpatients attending the University of Gondar Comprehensive specialized hospital, northwest Ethiopia. METHODS: A hospital-based cross-sectional study was employed at the University of Gondar Comprehensive Specialized Hospital from March 30 -May 30, 2019. The unique medical registration number of 424 patients was selected by using systematic random sampling to trace the medical chart and followed with an interview to explore the factors related to polypharmacy. All the Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Bivariable and multivariable logistic regressions were used to identify the predictors of polypharmacy in cardiovascular patients. RESULT: The mean age of the respondents was 56.83 ± 15.27 years. The mean number of medications per patient was 3.3±1.6. The prevalence of polypharmacy was 24.8% in cardiovascular outpatients while cardiovascular specific polypharmacy was 9.2%. Elderly (aged ≥ 65 years and above) patients were nearly two times more likely to had polypharmacy prescriptions with AOR: 1.97; 95% CI: 1.08-3.61; p = 0.027. Patients with abnormal weight (underweight AOR: 4.51; 95% CI: 1.42-14.30; p = 0.010, overweight AOR: 3.78; 95% CI: 1.83-7.83; p<0.001 and obese AOR: 5.1; 95% CI: 2.04-12.75 p<0.001) are more likely to have polypharmacy. Having a family history of CVD increase the likelihood of polypharmacy more than double; AOR: 2.40; 95% CI: 1.17-4.93; p = 0.017. A unit increase in Charlson comorbidity index score resulted in a nearly threefold likelihood of polypharmacy with AOR: 2.83; 95% CI 1.91-3.89; p<0.001. CONCLUSION: One out of four cardiovascular patients attending the outpatient clinic was on polypharmacy. The elderly age, abnormal body mass index (non-normal weight), family history of cardiovascular diseases and increasing Charlson morbidity index were the predictors of polypharmacy in cardiovascular patients. Clinicians should ensure the relevance of all prescribed medications and pharmaceutical care targeting at the prevention of inappropriate polypharmacy would be pivotal to reduce polypharmacy associated burdens.

Diabetic health literacy and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of a university hospital in Ethiopia.

BACKGROUND: Despite how much effect of low health literacy is on diabetic treatment cannot be accurate, it has an impact on controlling blood glucose level. Less is known about diabetic health literacy in Ethiopian diabetic patients which can affect patient medication adherence, self-care, and glycemic control. OBJECTIVE: This study was aimed to assess the diabetic health literacy level and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH): Northwest Ethiopia. METHODS: A cross-sectional study was employed at the outpatient clinic of the University of Gondar Comprehensive Specialized Hospital from May, 1 -May 30, 2019. The comprehensive 15-items diabetic health literacy questions with a 5-point Likert scale used to measure diabetic health literacy. The mean score calculated and switched to the percentage (5 points as 100%) to determine the level of diabetic health literacy. Morisky Green Levine Scale 4 item adherence assessment tool was used to assess the diabetic patient's level of adherence. Binary and multivariable logistic regression analysis was used to assess the association between sociodemographic, clinical variables, diabetic-related literacy, and glycemic control. Independent samples t-test and One-way ANOVA test was employed to compare the mean literacy score difference in different groups. RESULT: 400 respondents were included in the study. Of all the respondents, 17.3%, 26.3%, and 56.5% had low, medium and high diabetic-related health literacy, respectively. The proportions of patients with low, medium and high adherence to medication were 9.8%, 56.3%, and 34% respectively. Patients with high diabetes literacy are 1.85 times more likely to achieve target glycemic control than lower diabetic literacy patients with 95% CI Adjusted Odds Ratio (AOR). 1.85(1.09-3.40). While patients with good adherence 1.61 times more likely to achieve target glycemic control than patients with low adherence; 95% CI AOR 1.61(1.04-4.79). Diabetic patients with morbidity have 67% less likelihood to achieve the target glycemic control; 95% CI AOR 0.33(0.15-0.73). CONCLUSION: Adequate diabetic health literacy and better glycemic control are highly correlated. Adjusting all variables; younger age, high diabetic health literacy and good adherence are associated with achieving the target glycemic control.

Beliefs and Risk Awareness on Medications Among Pregnant Women Attending the Antenatal Care Unit in Ethiopia University Hospital. Overestimating the Risks Is Another Dread.

Background: Most studies on drug use during pregnancy were generally focused on potential teratogenic effects. However, beliefs and risk awareness of medications can also influence medication use and fetal well-being. Objective: This study aimed at assessing the risk awareness and beliefs on medication use among pregnant women attending antenatal care unit in an Ethiopian university hospital. Method: A cross-sectional study was employed in pregnant women who were attending for antenatal care service at Gondar University Referral Hospital from March 15, to April 15, 2016. A pretested structured interview questionnaire adopted from the Beliefs About Medicines Questionnaire (BMQ) was used for data collection. Chi-square test and binary logistic regression were used to identify possible predictors influencing the outcome variables. Result: Of the 423 women approached, 384 agreed to complete the questionnaire (90.8% response rate), and the mean age of the participants was 27.22 ± 5.5 years. More than two-thirds of the respondents had two to three (46.1%) or greater than three (25.8%) pregnancy histories. A third and nearly half (45.6%) of the respondents were on the first trimester and second trimester of their gestational age, respectively. The majority (70%) of pregnant women thought all drugs are harmful if taken during pregnancy. Only few (4.2%) of the participants did not mind taking drugs without professional advice. Most (90%) of the respondents were not willing to take drugs without professional advice. Pregnant women who came from rural areas had 25% less likelihood to self-medicate, with an adjusted odds ratio of 95% CI, 0.75 (0.37, 0.96). Conclusion: In this study, overestimated and exaggerated beliefs of medication risks during pregnancy are a concern, though cautious drug use is necessary and warranted. Adequate counseling has to be provided by physicians, pharmacists, and other healthcare professionals to change pregnant women's conservative attitudes and misinformed beliefs on medication risk.

Correction: The prognosis of heart failure patients: Does sodium level play a significant role?

[This corrects the article DOI: 10.1371/journal.pone.0207242.].

The characteristics of drug information inquiries in an Ethiopian university hospital: A two-year observational study.

The types of drug-related information request from patients and health professionals, the extent of inquiry and capability of existing drug information centers are seldom studied in Ethiopia. This study aimed to identify the types and potential areas of drug information inquiry at the Drug Information Center (DIC) of Gondar University specialized Hospital (GUSH), Ethiopia. An observational study was employed. The drug information query was collected by distributing the drug information queries in different hospital units through two batches of graduating undergraduate pharmacy students. Descriptive statistics used to describe, characterize and classify drug related queries. Binary logistic regression test was employed to identify predictor variables to type of drug information query. A total of 781 drug related queries were collected and 697 were included in the final analysis. Near to half (45.3%) of queries comes from the pharmacists followed by general practitioners (11.3%) and nurses (10.2%). Slightly greater than half of the queries (51.9%) were focused on therapeutic information. 39.6% of drug related queries related to infectious disease case scenarios, followed by cardiovascular cases in 21.3% of queries. More than half of (53.9%) and nearly one in five (19.4%) of the queries took 5 to 30 minutes and 30 minutes to 1 hour of literature searching to answer, respectively. Pharmacists (with odds ratio of 2.474(95% CI (1.373-4.458)) and patients (with odds ratio of 4.121(1.403-12.105)) ask patient-specific questions in their drug related queries higher than other group of health professionals. Pharmacists are the primary drug information users and frequent drug related information inquirers at the DIC. Most of the queries targeted therapeutic indications, adverse drug events, infectious or cardiovascular disease related requests. This is imperative that drug information services can assist the growing role of pharmacists in addressing the patient specific drug related needs.

Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital.

BACKGROUND: A considerable proportion of cardiovascular events could be attributed to poor adherence to antihypertensive medications. Adverse effects can be severe enough to affect adherence to antihypertensive medications. This study aimed to measure the contribution of adverse effects on antihypertensive medications adherence. METHODS: The study was conducted from May 1 to June 30, 2017, at the ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH) in Gondar town. A binary logistic regression was performed to determine the significance of the association between adverse effects and adherence to antihypertensive medications. An institution-based cross-sectional study was conducted by administering a questionnaire to hypertensive patients who came for follow-up at the ambulatory clinic of UOGCSH. Level of adherence to antihypertensive medications was used as outcome measure. RESULTS: A total of 249 patients were included in the final analysis with a mean age of 56.51 years and a female majority (53%). The following variables were identified as predictors of poor adherence: tiredness [AOR (95% CI): 3.802 (1.723-8.391), p = 0.001], muscle pain [AOR (95% CI): 5.199 (1.407-19.214), p = 0.013], poor sleep [AOR (95% CI): 4.891 (1.578-15.160), p = 0.006] and, believing that the symptoms were caused by antihypertensive medications [AOR (95% CI): 3.249 (1.248-8.456), p = 0.016]. CONCLUSION: Adverse effect significantly contributes to antihypertensive medication non-adherence among hypertensive patients.

Evaluating patients', physicians' and pharmacy professionals' perception and concern regarding generic medicines in Gondar town, northwest Ethiopia: A multi-stakeholder, cross-sectional survey.

BACKGROUND: Generic medicine prescribing has become common practice in many countries. However, data regarding the perceptions of stakeholders (patients, prescribers and dispensers) regarding generic medicines in Ethiopia is scarce. The present survey aimed to investigate the perception of patients, physicians and pharmacy professionals regarding generic medicines in Ethiopia. METHODS: A quantitative cross-sectional survey was conducted in Gondar town, Northwest Ethiopia between January 1 and February 1, 2017. The questionnaire, comprised of 5-point Likert scale items on perception and concerns regarding generic medicine, was administered to patients, physicians and pharmacy professionals working in the community drug retail outlets. Frequencies, percentages, and median were calculated using Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows to describe different variables. RESULTS: The survey was completed by 612 participants. More than half of patients, 56% (n = 219) knew about the term brand and generic medicines and 38.7% (n = 151) of patients agreed/strongly agreed that brand medicines are more effective. Nearly half, 47% (n = 184) of patients agreed that they should have the option of choosing between generic and brand medicines and 61.4% (n = 240) of patients believed that cost should be considered before a medicineis prescribed. The majority of physicians 70.6% (n = 101) indicated a very low generic medicine prescription rate. 56% (n = 130) of physicians and 87.2% (n = 68) of pharmacy professionals agreed that they need a standard guideline to both prescribers and pharmacists on brand substitution process. Furthermore, 39.9% (n = 57) of the physicians and 87.2% (n = 68) of pharmacy professionals agreed that drug advertisements by the manufacturers would influence their prescribing/dispensing practice. CONCLUSIONS: Overall, our findings demonstrate a knowledge gap among patients towards the perception of generics, perceiving generics are less effective and inferior in quality compared to their branded equivalents. The majority of physicians reported a very low generic medicine prescribing rate and the majority pharmacy professionals' dispensing practice was influenced by drug advertisements. Hence, a customized educational program should be developed and implemented to patients, prescribers and dispensers so as to boost the acceptability of generic medicines and increase generic prescribing and/or substitution.

The prognosis of heart failure patients: Does sodium level play a significant role?

INTRODUCTION: Heart failure (HF), a major cardiovascular disorder, remains a grievous clinical condition regardless of advances in medical care. Hyponatremia is classified as a serum sodium concentration of <135 mEq/L, and the prevalence, clinical impact and prognostic factor of hyponatremia in heart failure patients varies widely. The current study was conducted with the aim of assessing the prevalence of hyponatremia in patients hospitalized with a diagnosis of HF and comparing baseline clinical characteristic of HF patients based on their sodium status. Survival difference between patients with hyponatremia and normonatremia was also assessed and the clinical prognostic indicators of overall mortality in HF patients were evaluated. METHOD: A retrospective cohort study was conducted to assess medical records of heart failure patients who were admitted to Gondar University Referral Hospital. Patients were categorized based on their sodium level status at their first admission to the internal medicine department. Each patient was assigned to either of the following groups: hyponatremia if sodium < 135 mmol/L, or normonatremia if sodium ≥ 135 mmol/L. RESULT: Among 388 participants, the prevalence of hyponatremia in the study cohorts was 51.03%. Kaplan-Meier survival curves showed that there was a significant difference in survival status of HF patients among the two cohorts (Log-Rank test, P <0.0001). Hence, patients with normal sodium levels had a higher chance of survival over hyponatremic patients. Multivariate Cox regression has revealed a statistically significant association of mortality with the following variables: advanced age (AHR = 1.035 (1.012-1.058), P = 0.003), hyponatremia (AHR = 4.003 (1.778-9.009), P = 0.001), higher creatinine level (AHR = 1.929 (1.523-2.443), P = <0.0001) and, prescription of angiotensin-converting enzyme inhibitors (AHR = 0.410 (0.199-0.842), P = 0.015) and spironolactone (AHR = 0.511 (0.275-0.949), P = 0.033. CONCLUSION: In conclusion, hyponatremia is one of the crucial factors in the clinical prognosis of heart failure patients. However, as other prognostic factors (i.e. medication, creatine level, and age) also played vital roles in overall survival, well-controlled clinical trials (complete with medication dosing, laboratory outputs and long-term prospective follow up) are required to further study the impact of hyponatremia in HF patient's prognosis in low income nations.

Costs incurred by outpatients at a university hospital in northwestern Ethiopia: a cross-sectional study.

BACKGROUND: Out-of-pocket expenditure constitutes high proportion of healthcare spending in low-income countries. It can affect patients' adherence to treatments leading to serious health consequences. The objective of this study was to document costs incurred by patients visiting Gondar University Referral Hospital, in Gondar, northwestern Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 346 outpatients at the hospital from 2nd to 20th of May 2016. Data collection took place through interviews with patients coming to the outpatient pharmacy after finishing their visits at the different departments in the hospital. Data were collected on socio-demographic information, cost incurred before and during hospital visit as well as ownership of household items. RESULTS: Among the 342 interviews included in the final analysis, a median total cost of 22.25 USD was incurred by patients. This constituted spending on solutions tried before hospital visit, direct medical, nonmedical and indirect costs. Among these, direct nonmedical and indirect costs constituted a large share. Medicine, transportation and waiting time during visit were major components of direct medical, nonmedical and indirect costs respectively. Total median cost was found to be predicted by residence, marital status and payment scheme used to pay for hospital services. CONCLUSIONS: Outpatients visiting the hospital incurred significant costs for illnesses/conditions associated with their visit to the hospital, the main components being nonmedical and indirect costs. Residence, marital status and payment scheme, predicted median total cost. Direct nonmedical costs and indirect costs were found to be significant components associated to the spending and loss of earning by patients and their families in their trip to and from the hospital.

Older patients' perception of deprescribing in resource-limited settings: a cross-sectional study in an Ethiopia university hospital.

OBJECTIVE: To assess older patients' attitude towards deprescribing of inappropriate medications. DESIGN: This was an institutional-based, quantitative, cross-sectional survey. SETTING: Outpatient clinics of the University of Gondar Referral and Teaching Hospital in Ethiopia. PARTICIPANTS: Patients aged 65 or older with at least one medication were enrolled in the study from 1 March to 30 June 2017. Excluded patients were those who had severe physical or psychological problems and who refused to participate. MAIN OUTCOME MEASURES: Older patients' attitude towards deprescribing was measured using a validated instrument, 'the revised Patients' Attitudes towards Deprescribing' (rPATD) tool for older patients. Data were collected on sociodemographic characteristics and clinical data such as comorbidity and polypharmacy, and the main outcome was older patients' willingness to deprescribe inappropriate medications. RESULTS: Of the 351 eligible participants, 316 patients completed the survey. Of the 316 patients, 54.7% were men and were taking a median of 3 (IQR: 2-4) medications daily. Overall, most of the participants (92.1%; 95% CI 89% to 95%) were satisfied with the medications they were taking; however, still a significant number of participants (81.6%; 95% CI 77% to 86%) were willing to stop one or more of their medications if possible and agreed by their doctors. This willingness was correlated with seven items of the rPATD, including a strong correlation with the overall satisfaction of patients with the medications taken. CONCLUSION: Many older patients have shown their willingness to reduce one or more of their medications if their doctors said it was possible. Healthcare providers should be proactive in discussing and evaluating potentially inappropriate medications for better clinical decision making.

The Attitude of Medical and Pharmacy Students towards Research Activities: A Multicenter Approach.

Aim: To assess the attitude of medical and pharmacy students in Asian and African universities towards scholarly research activities. Methods: An anonymous, cross-sectional, self-reported online survey questionnaire was administered to medical and pharmacy students studying in various Asian and African universities through social media between May and July 2016. A 68-item close-ended questionnaire consisting of Likert-scale options assessed the students' research-specific experiences, and their attitudes towards scholarly research publications. Results: A total of 512 questionnaires were completed, with a response rate of 92% from Asia and 94% from Africa. More pharmacy students (70.8%) participated than medical students (29.2%). Overall 52.2% of the pharmacy students and 40% of medical students believed that research activities provided a means of gaining respect from their faculty members. Lack of encouragement, paucity of time, gaps in research activities and practices, and lack of research funding were some of the most common barriers acknowledged by the students. A nonparametric Mann-Whitney test showed that a statistically significant difference was observed, in that more than 80% of the pharmacy students viewed scientific writing and research activities as valuable experiences (p = 0.001) and would like to involve their co-students in scholarly research activities (p = 0.002); whereas the majority of the medical students desired to be involved more in scholarly research publications (p = 0.033). Conclusion: Pharmacy students had good attitudes towards research activities and a higher number of medical students desired to be involved more in research publications. Faculties may consider taking special research initiatives to address the barriers and improve the involvement of medical and pharmacy students in scholarly research activities.

Anemia in severe heart failure patients: does it predict prognosis?

BACKGROUND: Anemia is highly prevalent in heart failure (HF) patients. However, the prevalence, clinical impact and prognostic factor of anemia in heart failure patients is widely varies. The aim of this study was to evaluate the prevalence of anemia in patients with HF, to compare baseline clinical characteristic and outcomes of severe HF patients with and without anemia admitted to Gondar University Referral Hospital (GURH), Gondar, Ethiopia. METHOD: A retrospective cohort study was conducted and we assessed medical records of heart failure patients who were admitted Gondar University Referral Hospital in the period between December 02, 2010 and November 30, 2016. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Multivariate Cox regression was used to analyze independent predictors of mortality in all HF patients. P value less than 0.05 was considered statistically significant. RESULT: Three hundred and seventy patients participated in the study. The prevalence of anemia in the study cohorts was 41.90% and majority of the participants were females (64.59%). There was a significant difference in the level of hemoglobin, creatinine, and sodium among anemic and non-anemic patients. Anemic patients with HF tend to take angiotensin converting enzyme inhibitors (ACEI) less frequently. Kaplan Meier survival curves and Log rank test (P = 0.042) showed a significant difference in the prognosis of HF patients with anemia and non - anemic. More significant difference was observed (Log rank test, P = 0.001) in the study participants based on hemoglobin level. Furthermore, multivariate Cox regression showed: advanced age, levels of lower sodium and higher creatinine, and absences of medications like ACEI and Spironolactone independently predicted overall mortality. CONCLUSION: HF patients with anemia tend to be older age, had lower hemoglobin and sodium level and higher creatinine value. Moreover, there was a significant difference in the prognosis between study cohorts, as anemic pateints tend to have a worse survival status . Even though, anemia is a significant risk marker, it is not an independent predictor of mortality in the current study.