Disparities in patients' understanding of cardiovascular disease management.

Non-communicable diseases, including cardiovascular disease (CVD), are some of the leading causes of mortality worldwide. Despite the effectiveness of early diagnostic and treatment options, patient screening, disease detection and disease progression remain a challenge, resulting in suboptimal outcomes. Consequently, cardiovascular diseases remain underdiagnosed and undertreated, particularly in developing countries. Several barriers, including paucity of recommended cardiovascular health information and low literacy levels, lead to a poor understanding of the importance of intervention in terms of modifiable risk factors as well as treatment adherence. This narrative review focuses on cardiovascular patients' understanding of their disease, and the need for compliance with their medication and lifestyle modifications. Low levels of perception and insufficient knowledge of CVDs among patients continue to be indispensably important factors in health behaviour. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary cardiovascular team and ultimately improve the care provided to these patients.

A scoping review on natural cholesterol lowering supplements sold in South African pharmacies.

Background: Dyslipidaemia is defined as elevated total or low-density lipoprotein (LDL) levels or low levels of high-density lipoprotein (HDL). Patients may often make use of natural cholesterol lowering supplements (NCLSs) available at the pharmacy; however, limited information on these supplements is readily available. Pharmacists should be knowledgeable about NCLSs to ensure that the use of these supplements is supported by evidence and to provide appropriate advice to patients for desirable therapeutic outcomes. Aim: This study aimed to identify the NCLSs being sold in South African pharmacies and review the scientific evidence for each of the ingredients in these NCLSs. Methods: Seventeen NCLS products were identified, and the Joanna Briggs Institute (JBI) scoping review methodology was used to conduct a literature review of NCLSs. Results: From the ingredients reviewed it is evident that co-enzyme Q10, probiotics and sterols have sufficient evidence supporting their use. However, there is still limited scientific evidence available to validate the remaining ingredients. Conclusion: Further research on NCLSs will provide practising pharmacists and practitioners with a guide of the evidence available on the various ingredients in NCLSs. Contribution: This study provides a review of the available literature on the NCLSs being sold in the pharmacies across South Africa to provide pharmacists with a collated document of the evidence behind these popular supplements to assist them in making evidence based informed decision regarding natural products for cholesterol.

A guide for the management of post vaccination allergy and anaphylaxis in a pharmacy clinic.

Background: Vaccination falls within the scope of practice of a pharmacist and the coronavirus disease 2019 pandemic has seen an increase in pharmacies providing vaccination services. These vaccines are not without risk of allergic reactions and anaphylaxis. The available guidelines for the management of anaphylaxis include the administration of intravenous (IV) fluids. However, IV administration does not fall within the scope of practice of a pharmacist. A gap was identified in the availability of guidelines for the management of anaphylaxis without the use of IV fluid administration. Aim: This review aimed to address this gap by describing the mechanisms of allergic reactions and anaphylaxis and developing an algorithm to assist pharmacy personnel to manage these within the scope of practice. Methods: The authors used the recommendations for developing guidelines. Results: The availability of anaphylaxis guidelines and clinical studies catering for anaphylaxis and allergy management by pharmacists was deficient, thus the review modified the available management guidelines to align the management of allergy and anaphylaxis within the scope of a pharmacist. The items required for the management were also identified and listed as items that form part of the emergency tray in the pharmacy. Conclusion: The review designed algorithms based on the available literature to assist pharmacy personnel to manage allergy and anaphylaxis within the relevant scope of practice. The review also lists the equipment needed for an emergency tray. Contribution: This review serves to offer guidance for the management of allergy and anaphylaxis in a pharmacy setting.

Pharmacy students' perceptions of an oncology pharmacy simulation.

BACKGROUND AND PURPOSE: Cancer is on the rise both globally and in South Africa, with an estimated 70% increase in incidence in Sub-Saharan Africa by 2030. While oncology pharmacy is a highly specialized field of practice, there is currently no formal certification for oncology pharmacists in South Africa. EDUCATIONAL ACTIVITY AND SETTING: To standardise the way in which oncology pharmacy is practiced within the country, the first-ever simulation-based oncology admixing training for pharmacy students in South Africa was developed at the University of the Witwatersrand. Following the simulation, a survey was conducted to determine the participants' perceptions of the simulation. Current and past pharmacy students were invited to complete a questionnaire. Data were collected through a self-administered cross-sectional REDCap (Research Electronic Data Capture) questionnaire using a Likert-like scale to determine the agreed with statements related to the simulation. FINDINGS: A total of 81 participants completed the questionnaire. Participants provided favorable feedback related to the simulation's benefit, quality, and learning experience. SUMMARY: Based on the perceptions of the participants, the purpose of the simulation exercise was achieved.

May Measurement Month 2018: an analysis of blood pressure screening results in South Africa.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 revealed that 24.5% of adults (mean age = 31 years) have hypertension and only half of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations and university campuses in preference to hospitals and clinics, aiming to raise awareness and allow access to screening to those less likely to be aware of their BP. In total, 2965 individuals (age 40.5 ± 18.2 years) were screened. After multiple imputation for missing BP readings, 34.6% had hypertension, only 56.7% of those with hypertension were aware, 21.2% of those not receiving treatment for hypertension were hypertensive, and a large proportion (42.5%) of individuals receiving antihypertensive medication had uncontrolled BP. These results suggest that opportunistic screening campaigns can identify significant numbers with undiagnosed and uncontrolled hypertension. The high proportions of individuals with undiagnosed and treated uncontrolled hypertension highlight the need for hypertension awareness campaigns and more rigorous management of hypertension.

May Measurement Month 2017: an analysis of blood pressure screening results in South Africa-Sub-Saharan Africa.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. A surveillance study in 2016 in South Africa revealed that 45% of adults have hypertension and only 6-9% of men and women respectively had controlled BP on medication, highlighting the need for regular screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension, and statistical analyses followed the MMM protocol. The sites screened were primarily university campuses and general populations in preference to hospitals and clinics, aiming to raise awareness and allow access to screening in those less likely to be aware of their BP. In total, 3250 individuals (mean age 31.0 ± 13.3 years) were screened. After multiple imputation for missing BP readings, 795 (24.5%) had hypertension. Of individuals not receiving antihypertensive medication, 459 (15.7%) were hypertensive, and 157 (46.9%) of individuals receiving antihypertensive medication had uncontrolled BP. These results suggest that opportunistic screening campaigns can identify significant numbers with undiagnosed and uncontrolled hypertension, even amongst the fairly young. The high proportions of individuals with undiagnosed and treated uncontrolled hypertension, highlight the need for campaigns to increase hypertension awareness and control.

An update on the measurement and management of cholesterol with specific reference to secondary prevention of cardiovascular disease (CVD)

Cardiovascular disease remains the largest contributor to non-communicable adverse disease outcomes. Treatment and prevention of cardiovascular disease have evolved at a dramatic pace in the last 40 years. Serum-cholesterol has emerged as the dominant risk factor for coronary artery disease and events. The link between serum-cholesterol and arterial atherosclerosis is well documented. The attainment of cholesterol goals has historically concentrated on low-density lipoprotein cholesterol (LDL-C) levels. Current evidence and guidelines have shifted to the attainment of non-HDL-C target levels which represent a more thorough inclusion of small dense atherogenic particles. Methods to reduce serum-cholesterol mainly centre around the use of the HMG CoA-reductase inhibitors also known as the statins. High intensity statins like atorvastatin (80 mg) and rosuvastatin (40 mg) are now the preferred starting therapies to lower cholesterol by at least 40­50% in patients with established cardiovascular disease as secondary prevention. In the event of failure of these medications, evidence suggests that the addition of ezetimibe may enhance the total serum-lowering levels to 50­60%. New therapies aimed at inhibiting PCSK9 revealed exciting new targets for LDL-C lowering, but the high cost of these antibodies could preclude access to this therapeutic intervention. Aggressive pursuit of lower LDL-C or non-high-density lipoprotein cholesterol (non-HDL-C) levels may reduce the incidence of secondary myocardial infarctions, strokes and death from cardiovascular disease