Impact of pharmacist care in the management of autoimmune disorders: A systematic review of randomized control trials and non-randomized studies.

INTRODUCTION: Autoimmune disorders are chronic, self-mediated, misdirected immune responses against their own immune system. It required intensive, complex and costly drug treatment regimen increased the risk of pharmacotherapy error and adversely affects patients. Hence, pharmacist care will have vital roles in autoimmune disorders to achieve health related outcomes. OBJECTIVES: This review aimed to gather evidence on the impact of pharmacist care on clinical, humanistic and economic outcomes, adherence to medications, and drug related problems in the management of autoimmune disorders among the usual care group. METHODOLOGY: A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMed Central, Web of Sciences, Scopus, Cochrane Library andgoogle scholar from inception until August 2020. This research included full-text articles of randomized and non-randomized studies that evaluated impact of pharmacist care in autoimmune disorders. RESULTS: A total of nine studies were included (seven RCTs and two non-RCTs), including 829 patients with autoimmune disorders. A total of four studies (80%) show an enhancement in at least one clinical parameter due to pharmacist care. A substantial improvement in at least one humanistic parameter observed in all five studies (100%). While four out of five studies (80%) clearly displayed a remarkable improvement in medication adherence in the pharmacist care group from baseline to the completion of follow-ups. One study quantified a 99.08% resolution of DRPs in the pharmacist care group. Another study estimated the cost of medical resources uses per patient and found no difference in cost-effectiveness over six months between groups. CONCLUSION: This review reinforces the vital contribution of pharmacists to achieve clinical outcomes, humanistic outcomes, adherence to medications and DRPs in the efficient management of autoimmune disorders. However, no notable changes in economic outcomes were observed in this review.

Bioavailable dissolved organic matter and its spatio-temporal variation in a river dominated tropical brackish water Lagoon, India.

Bioavailable dissolved organic carbon (BDOC), nitrogen (BDON) and their degradation rate constants were measured for the Chilika Lagoon, India. Long-term laboratory incubation experiments (90 days) were conducted at a constant temperature (25 °C) to quantify the bioavailable dissolved organic matter (DOM) and the possible degradation rate coefficients. The results showed that 41 ±â€¯12% of dissolved organic carbon (DOC) and 47 ±â€¯17% of dissolved organic nitrogen (DON) were BDOC and BDON respectively, with their stoichiometry found to be higher than the Redfield ratio. A first order exponential non-linear fitting routine was used to estimate pool sizes. The degradation rate constant (k) for the BDOC varied from 0.127-0.329 d-1 and BDON from 0.043-0.306 d-1 during the study period. Half-lives of the BDOC and BDON ranged from 2.1-5.4 and 2.2-15.9 days, respectively. Overall, the results showed that a fraction of the labile DON was transported from the lagoon to the adjacent coastal sea.