Improving antiepileptic drug tolerability among patients living with epilepsy: the impact of pharmaceutical care services.

Therapeutic management of epilepsy is usually long term; thus, patient tolerability of prescribed antiepileptic drugs should be a major consideration as it affects compliance to therapy. The aim of this study was to determine the impact of pharmaceutical care services on antiepileptic drug tolerability among patients living with epilepsy. This study was an open, randomized, controlled, longitudinal and two-arm parallel prospective study with a 6-month patient follow-up period. Patients were recruited from the neurology and medical out-patient clinics of two selected epilepsy referral centres. Recruited patients were randomized into one of the two study groups: pharmaceutical care (PC) or usual care (UC) groups. Patients in the UC group received the usual care provided in the hospitals, while patients in the PC group received PC services in addition to the usual care provided in the hospitals. The impact of PC on patient tolerability of antiepileptic drugs was evaluated using a patient judged antiepileptic drug tolerabiltity scale. The evaluation was done at baseline (pre-intervention), 3 months and 6 months post-intervention. Patients in the PC group had a significantly lower antiepileptic drug tolerability score than those of the UC group at 3 months and 6 months - (Pre-intervention: 0.97 versus 1.13; t = -1.081; p = 0.281), (3 months: 1.13 versus 0.71; t = 3.084; p = 0.001), (6 months: 1.00 versus 0.60; t = 3.083; p = 0.001), indicating a significant improvement in the tolerability of antiepileptic drugs among those in the PC group over time. Pharmaceutical care interventions that included education and counseling services significantly improved tolerability of antiepileptic drugs among patients living with epilepsy.

Effectiveness of a pharmacist-led educational intervention on health outcomes in hypertension management at community pharmacies in Nigeria: A two-arm parallel single-blind randomized controlled trial.

AIMS: This study determined the impact of a pharmacist-led educational intervention on the health outcomes of hypertensive patients in community pharmacies. METHODS: A 2-arm parallel single-blind randomized trial design was adopted among hypertensive patients in 4 pharmacies in Abuja and Lokoja, Nigeria. A pharmacist-led educational intervention was provided to the patients in the intervention group. The study outcomes, namely changes in adherence to medication, quality of life and cost of medication were measured using MARS-10, SF-12 and official price list, respectively. Independent and paired-sample t-tests were conducted on the data. RESULTS: A total of 128 patients participated in the study. All of them completed the study and were included in the analysis: 70 in the control arm and 58 in the intervention arm. There was a significant improvement in components of Behaviour (2.57 vs. 2.98), Attitude (2.59 vs. 3.14) and Negative attitude (1.62 vs. 1.92). There was a better improvement in adherence in the intervention arm: 8.05 ± 1.32 vs. 6.55 ± 2.24; t = -4.65, P = .0001. There were no changes in the respondents' health status after intervention in both groups (P < .05). There was a weak inverse association between the physical health component and mental health component: R = -0.2, P = .04 and a positive association with overall adherence (R = 0.26, P = .004) in the intervention group, in whom the monthly cost of treatment decreased from N2233.1 to N2068.4. CONCLUSION: Community pharmacy educational intervention improves health outcomes, particularly with adherence among patients with hypertension. Health-related quality of life of the patients improved, but the physical health component was better than that of the mental health component.

Factors associated with the timely completion of doctoral research studies in clinical pharmacy: A mixed-methods study.

INTRODUCTION: There is growing scientific evidence of mental and well-being issues that doctoral research students face as a result of not finishing their program on time. This study aims to explore the factors associated with the timely completion of doctoral research studies in the clinical pharmacy speciality. METHODS: This was a mixed-method study that combined surveys with in-depth interviews. Current doctoral research students and pharmacists who have recently completed their doctoral research program participated in the study. A validated questionnaire and an interview topic guide developed from the literature and pretesting were used to collect data. Data for this study were collected between February 2021 and September 2021. Quantitative data were analysed with the Statistical Package for Social Sciences (SPSS) V.25 while interview data were subjected to reflexive thematic analysis. RESULTS: 47 students who are currently pursuing their doctoral research program in clinical pharmacy participated in the survey, while 8 pharmacists who had recently completed their doctoral research program in clinical pharmacy participated in the in-depth interviews. Five themes were identified: factors contributing to delay in the program, factors contributing to the timely completion of the program, ways to improve the program, advice to current students and advice to prospective students. Having more than one supervisor, supervisors' commitment to the research work and support from the department were identified as facilitators of timely completion of doctoral research programs in clinical pharmacy. CONCLUSION: Our study provides an understanding of the barriers and facilitators of timely completion of doctoral research programs in the clinical pharmacy specialist, and how these can be used to improve the postgraduate study programs in Nigeria.

Community acceptance and willingness to pay for hypothetical COVID-19 vaccines in a developing country: a web-based nationwide study in Nigeria.

INTRODUCTION: some promising COVID-19 vaccines are soon to be available but getting the African community to accept them may be challenging. This study assessed the acceptability and willingness to pay (WTP) for hypothetical COVID-19 vaccines among Nigerians. METHODS: a cross-sectional, web-based study was conducted among the Nigerian populace. A 20-item questionnaire was used to collect responses through Google form which was shared to consenting participants through two social media platforms. Multivariate logistic regression was used to determine the sociodemographic factors that were predictive of respondents´ willingness to accept the COVID-19 vaccines. Statistical significance was set at p<0.05. RESULTS: six hundred and eighty-nine respondents completed the survey, with 50.5% being females. Exactly 43.3% of respondents reported that they would accept a hypothetical vaccine if it is currently available, 62.1% said they would accept it in the future while 71.1% agreed to accept it if recommended by healthcare providers. A third (31.9%) of respondents accepted the vaccine for their self-protection and half of those not accepting it (51.3%) said they did not want to "be used as an experiment". Respondents who were of oldest ages (aOR=0.330, 95% CI: 0.141-0.767, p=0.010), of Christian religion (aOR=3.251, 95% CI: 1.301-8.093, p=0.011), and aware of a possible vaccine being made available (aOR=0.636, 95% CI: 0.440-0.920) were significantly more unwilling to accept the vaccine. The median range of WTP was US$1.2-2.5. CONCLUSION: there is a low acceptance in Nigeria for a COVID-19 vaccine if it was available now, but much higher if it is recommended by a healthcare provider. A high proportion of willing respondents indicated a positive WTP for the vaccine.

Pharmacists' Readiness to Receive, Recommend and Administer COVID-19 Vaccines in an African Country: An Online Multiple-Practice Settings Survey in Nigeria.

Background: Without a cure, vaccination is the most reliable means of combating COVID-19 pandemic, since non-pharmacological measures could not prevent its spread, as evidenced in the emergence of a second wave. This study assessed the readiness of pharmacists to receive, recommend and administer COVID-19 vaccines to clients in Nigeria. Methods: This was a cross-sectional study in which responses were collected from pharmacists in Nigeria through Google Form link. A 21-item questionnaire was developed and validated for the study. The link was shared on the WhatsApp groups of eligible respondents. The response was downloaded into Microsoft Excel (2019) and cleared of errors. This was uploaded into KwikTables (Beta Version 2021) for data analysis. Descriptive statistics such as frequencies and percentages were used to describe the data. Chi-squared test was used to determine the relationship between all the responses and the practice areas of the pharmacists. Results: A total of 509 pharmacists responded to the study, but 507 indicated their areas of practice. The highest response of 247(48.7%) was obtained from hospital pharmacists, then community pharmacists; 157(31.0%). Hospital and community pharmacists accounted for 96 and 66 of the 191(37.7%) pharmacists that would probably accept the vaccine (p=0.126). The Pfizer-bioNTech vaccine was the preferred brand for 275(54.2%) respondents. Healthcare Professionals>Elderly>General Populace>Children was the order of roll-out recommended by 317(62.5%). Adverse-effect-following-immunization was the concern of 330(65.1%) pharmacists. Age was a factor in their likelihood of recommending the COVID-19 vaccine to clients (p=0.001). Conclusion: This study established that most pharmacists are willing to accept to be vaccinated against COVID-19, recommend and administer it to other citizens. They were impressed by the effectiveness and cost of some of the vaccines, but were concerned about their possible adverse effects. The pharmacists would want the authorities to consider strategies that will make the vaccines accessible to all citizens.

Global contributions of pharmacists during the COVID-19 pandemic.

Throughout the SARS-CoV-2 (COVID-19) global pandemic, pharmacists were rarely mentioned as essential frontline health care providers by the news media, the public, or politicians. Around the world, pharmacists are working on the frontlines of health care every day providing essential health care services during the pandemic. Pharmacists are medication experts providing patient care in a variety of settings including hospitals, clinics, community pharmacies, long-term care, physician offices, and national and public health. In this paper, we describe how pharmacists from high and low-middle income countries contributed to essential patient care and well-being of the public during the COVID-19 pandemic. While the news media, the public, and politicians often overlooked pharmacists as essential frontline health care providers, we hope that this list of contributions by pharmacists from nine countries in this article can help to change this perspective.

Infrequent Monitoring of the Effects of Valproate and Carbamazepine Therapy in Patients With Epilepsy in Nigeria.

BACKGROUND: Carbamazepine and valproate are widely used in the treatment of epileptic seizures. However, these agents exhibit certain adverse effects including hematopoietic disorders (carbamazepine) and severe hepatotoxicity (valproate). PURPOSE: To determine the extent of monitoring of the hematologic effects of carbamazepine as well as the extent of monitoring of the hepatic effects of valproate in patients with epilepsy receiving treatment with these agents. METHOD: A cross-sectional antiepileptic drug use study using case notes of patients with epilepsy managed at the neurologic clinics of 2 tertiary medical facilities in Nigeria between January and December 2017. RESULTS: Carbamazepine was the most frequently prescribed antiepileptic drug (48.24%), followed by valproate (29.34%) and levetiracetam (9.24%). Pretreatment monitoring of hematologic effect was carried out in only 61.11% of patients placed on carbamazepine therapy while follow-up monitoring was done in 3.7% of these patients. Also, in patients placed on valproate therapy, pretreatment and follow-up monitoring of the hepatic effect was done in only 33.71% and 19.0% of the patients, respectively. CONCLUSIONS: The extent of monitoring of the hematologic effects of carbamazepine, as well as the hepatic effects of valproate in the cohort studied, is poor.

Health Professionals' Stigma towards the Psychiatric Ill in Nigeria.

BACKGROUND: Stigma affects the quality of life of the mentally ill, and health professionals are considered to be involved in possessing negative attitudes towards them. We evaluated the prevalence of stigmatization among different health professionals in Nigerian hospitals. METHODS: This study was a descriptive, cross-sectional and comparative survey assessing attitudinal views of health professionals (doctors, pharmacists, and nurses) regarding mental illness in two hospitals in Eastern Nigeria. The survey utilized the 40-item Community Attitude to Mental Illness, CAMI-2 questionnaire. The prevalence and the factors that contribute to negative attitudes among this cohort were assessed. Statistical analysis using T-tests, ANOVA and Pearson Correlation were conducted. RESULTS: Attitudes to all the four constructs of the CAMI-2 were non-stigmatizing. Stigmatizing attitudes were significantly higher among pharmacists, doctors and then nurses (p<0.006). Health professionals who did not have contact with the mentally ill (p<0.0001), who were males (p=0.008) and had lower years of working experience (p=0.031) expressed significantly higher stigmatizing attitudes towards the mentally ill. Conclusions: Nigerian health professionals were largely non-stigmatizing towards the mentally ill. However, being a pharmacist, of male gender, and working in a non-psychiatric hospital were associated with stigmatizing attitudes when they exist.

International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice.

Health-system and community pharmacy practice in the United States is experiencing transformational change; however, this transformation is lagging in the international arena. As a result, efforts are being made to provide support and education to the international pharmacy leaders and practitioners. This article describes one effort, the Mandela Washington Fellows Program, and suggests areas where pharmacy leaders can be involved to help advance the practice of pharmacy on an international level. The Mandela Washington Fellows Program for young Africa leaders consists of a US-Africa pharmacy-mentoring program identified ranging from educational opportunities to collaboration for implementation of patient care programs. The specifics of the mentoring program include daily meetings, clinic and ward rounds, round table discussions with mentors, and visits to various hospital care systems. Lessons were learned and strategies for sustaining the program are discussed. These types of programs represent leadership opportunities that may not be apparent to most pharmacy directors, but expanding their view to helping international pharmacists expand their practice only strengthens the professional goal of providing patient-centered pharmacy services.

Cognitive Determinants of Academic Performance in Nigerian Pharmacy Schools.

Objective. To evaluate cognitive factors that might influence academic performance of students in Nigerian pharmacy schools. Methods. A cross-sectional, multi-center survey of Nigerian pharmacy students from 7 schools of pharmacy was conducted using 2 validated questionnaires measuring cognitive constructs such as test anxiety, academic competence, test competence, time management, and strategic study habits. Results. Female students and older students scored significantly better on time management skills and study habits, respectively. Test anxiety was negatively associated with academic performance while test competence, academic competence, and time management were positively associated with academic performance. These 4 constructs significantly discriminated between the lower and higher performing students, with the first 2 contributing to the most differences. Conclusion. Test and academic competence, test anxiety, and time management were significant factors associated with low and high academic performance among Nigerian pharmacy students. The study also demonstrated the significant effects of age, gender, and marital status on these constructs.

Student pharmacists' career choices: a survey of three Nigerian schools of pharmacy.

BACKGROUND: There is little data on the preferences of pharmacy students as regards their future pharmacy job choices in Africa and this has created concerns amongst licensing bodies, employers and also the institutions they graduate from. OBJECTIVE: Career choices and factors that influence these choices of pre-registration pharmacists were assessed. METHODS: Final and fourth year students from three schools of pharmacy were approached with a previously validated and employed questionnaire comprising questions on future job choices and reasons for that job choice. Data collected were subjected to descriptive and inferential analysis. RESULTS: Four hundred and eighty eight students took part in the study (response rate 71.5%). Majority (78.8%) was younger than 26 years and had a work experience (68.2%). Job flexibility was significantly more important to females, while younger students considered salary most important (p<0.05). Hospital and community practice were most preferred career choices. Other demographic factors (especially gender, marital status, previous degree and previous work experience) significantly affected career choices. CONCLUSIONS: Age, gender, and previous work experience affect career choices of graduating pharmacy students. Patient-oriented practices (e.g. hospital and community) remain the most preferred careers.

Student pharmacists’ career choices: a survey of three Nigerian schools of pharmacy / Opciones de carrera de los estudiantes de farmacia: encuesta en tres escuelas de farmacia nigerianas

Background: There is little data on the preferences of pharmacy students as regards their future pharmacy job choices in Africa and this has created concerns amongst licensing bodies, employers and also the institutions they graduate from. Objectives: Career choices and factors that influence these choices of pre-registration pharmacists were assessed. Methods: Final and fourth year students from three schools of pharmacy were approached with a previously validated and employed questionnaire comprising questions on future job choices and reasons for that job choice. Data collected were subjected to descriptive and inferential analysis. Results: Four hundred and eighty eight students took part in the study (response rate 71.5%). Majority (78.8%) was younger than 26 years and had a work experience (68.2%). Job flexibility was significantly more important to females, while younger students considered salary most important (p<0.05). Hospital and community practice were most preferred career choices. Other demographic factors (especially gender, marital status, previous degree and previous work experience) significantly affected career choices. Conclusion: Age, gender, and previous work experience affect career choices of graduating pharmacy students. Patient-oriented practices (e.g. hospital and community) remain the most preferred careers (AU)

Antecedentes: Existen pocos datos sobre las preferencias de los estudiantes de farmacia sobre su futuro laboral en África y esto ha producido preocupación entre los organizamos acreditadores, patronos y las instituciones en las que se gradúan. Objetivos: Se evaluaron las elecciones de carrera y los factores que influencian esta selección entre los farmacéuticos pre-registro. Métodos: Se abordó a estudiantes de último y cuarto año de las tres escuelas de farmacia con un cuestionario previamente validado y utilizado que contenía preguntas sobre elección de futuro laboral y motivos de esa elección. Los datos recogidos fueron sujetos a análisis descriptivo e inferencial. Resultados: Unos 488 estudiantes tomaron parte en el estudio (tasa de respuesta 71,5%). La mayoría (78,8%) era menor de 26 años y tenía experiencia laboral (68,2%). La flexibilidad laboral era significativamente más importante para las mujeres, mientras que los estudiantes más jóvenes consideraba el salario como lo más importante (p<0,05). Las opciones de carrera profesional preferidas eran hospital y comunidad. Algunos otros factores demográficos (especialmente género, estado civil, titulaciones previas, y experiencia laboral previa) afectaban significativamente las opciones de carrera. Conclusión: La edad, género, y experiencia laboral previa afectan las opciones de carrera de los estudiantes graduados en farmacia. Los ejercicios orientados al paciente (e.g. hospital y comunidad son las carreras preferidas (AU)

Concurrent use of complementary and alternative medicine with antiretroviral therapy reduces adherence to HIV medications.

OBJECTIVE: Antiretroviral therapy requires strict adherence to ensure therapeutic success. Concurrent use of complementary and alternative medicine (CAM) could alter the adherence to and thereby effectiveness of antiretroviral drugs. This study examined the association of CAM use with adherence to antiretroviral therapy (ART) and CD4 count. METHODS: The study was conducted in two HIV clinics: one in a semi-urban, the other in a rural area. Adherence to ART was assessed using the Morisky Medication Adherence Scale (MMAS). Data on type of CAM used and MMAS adherence were collected by patient interview and demographic; clinical data were collected from hospital records. RESULTS: Altogether 212 HIV patients participated in the exit study conducted over 3 months. Almost half (47.9%) used CAM concurrently with antiretroviral drugs. Dietary supplements (40.3%), healing systems (36.5%) and exercise (23.2%) were mainly used. The use of CAM significantly lowered adherence to ART (89.4% in non-CAM users versus 82.5% in CAM users, P = 0.01). Improvement in CD4 count was less in patients using CAM compared to non-CAM users although the difference was not statistically significant (310.5 ± 294.0 cells/L in CAM users versus 224.5 ± 220.0 cells/L in non-CAM users, P = 0.13). Patients attending the rural HIV clinic were more likely to use CAM compared to patients attending semi-urban hospital (χ(2) test = 7.0; P < 0.01). CONCLUSION: Use of CAM could lower adherence to antiretroviral therapy. There is need to develop protocol which could help in monitoring CAM use in HIV patients especially those from rural settings.

Does the clinical clerkship course improve students' attitudes towards pharmaceutical care?

OBJECTIVE: The clinical clerkship course undertaken by final year pharmacy students to improve their pharmacotherapeutic knowledge and professional competence was tested in this study to see its effect on students' attitudes towards pharmaceutical care. METHODS: A 13-item Pharmaceutical Care Attitude Survey (PCAS) questionnaire was administered to final year pharmacy students at the University of Nigeria, before and after the 8-week-long clinical clerkship course. Statistical analyses were conducted on retrieved data. RESULTS: One hundred and five students (95% of the sample) completed the pre-clerkship phase and 97 students (92% of pre-clerkship students) completed the post-clerkship phase. Of the 13 items, three increased significantly (P < 0.05)--that is, improved--and there were indications that a further six improved, with two having no change and two items getting worse after the clerkship course. CONCLUSION: This study showed that the clerkship course improved students' attitudes towards areas concerning professional duty but not those relating to benefit and responsibility. The importance of professional benefit needs to be emphasized by preceptors.

Antiulcer activity of methanolic extract and fractions of Picralima nitida seeds(Apocynacaea) in rats.

OBJECTIVE: To investigated the antisecrectory activities of the methanol extract, chloroform fraction and methanol fraction of Picralima nitida seeds. METHODS: The methanol extract of Picralima nitida seeds was fractionated into chloroform fraction and methanol fraction. They were evaluated for antiulcer activity and gastric emptying time in rats using aspirin-pylorus-ligation model. RESULTS: Oral administration of the methanol extract, chloroform fraction and methanol fraction at 1 000 mg/kg reduced gastric ulcer by 56.4%, 40.0% and 56.3%, respectively; and the fractions of the extract significantly (P<0.05) reduced gastric emptying time when compared to the control. Gastric acidity was significantly decreased when compared with saline group, 40.25 mEq/L in methanol extract, 50.0 mEq/L in chloroform fraction 51.25 mEq/L in methanol fraction but had no significant effect on the gastric secretion volume. CONCLUSIONS: These findings showed that methanol extract, chloroform fraction and methanol fraction of the seeds of Picralima possessed potent antiulcer properties and some antisecretory properties.

Antiulcer activity of methanolic extract and fractions of Picralima nitida seeds(Apocynacaea) in rats

OBJECTIVE@#To investigated the antisecrectory activities of the methanol extract, chloroform fraction and methanol fraction of Picralima nitida seeds.@*METHODS@#The methanol extract of Picralima nitida seeds was fractionated into chloroform fraction and methanol fraction. They were evaluated for antiulcer activity and gastric emptying time in rats using aspirin-pylorus-ligation model.@*RESULTS@#Oral administration of the methanol extract, chloroform fraction and methanol fraction at 1 000 mg/kg reduced gastric ulcer by 56.4%, 40.0% and 56.3%, respectively; and the fractions of the extract significantly (P<0.05) reduced gastric emptying time when compared to the control. Gastric acidity was significantly decreased when compared with saline group, 40.25 mEq/L in methanol extract, 50.0 mEq/L in chloroform fraction 51.25 mEq/L in methanol fraction but had no significant effect on the gastric secretion volume.@*CONCLUSIONS@#These findings showed that methanol extract, chloroform fraction and methanol fraction of the seeds of Picralima possessed potent antiulcer properties and some antisecretory properties.

Does the African garden egg offer protection against experimentally induced ulcers?

OBJECTIVE@#To evaluate the possible antiulcer effect of the African garden egg, Solanum aethiopicum (S. aethiopicum) (a domestic vegetable) experimentally in rats.@*METHODS@#A methanol extract of the plant fruit was prepared by maceration. Twenty five overnight fasted rats for each model were divided randomly into five groups of five rats. Groups 1, 2, 3, 4 and 5 received normal saline, extract dose levels of 100, 200 and 400 mg/kg and 100 mg/kg of ranitidine respectively. All administrations were given orally. For the indomethacin and aspirin models, ulcerogenic agents (indomethacin, 50 mg/kg and aspirin 200 mg/kg) were given thirty minutes after extract treatments and animals sacrificed 8 h later. The acidified ethanol model (ethanol 60% + 0.1 mol/L HCl) was given 1 hr after extract treatment and animals sacrificed 1 h later. Ulcer index was checked and analysed with appropriate statistical tools.@*RESULTS@#Extract of S. aethiopicum showed positive effect on all the models used. It produced higher ulcer inhibition than ranitidine in the indomethacin and acid-ethanol models. All the anti-ulcer effects of the extract at different doses were dose dependent but only in indomethacin model did it produce statistically significant (P<0.05) ulcer reduction in all doses compared to control.@*CONCLUSIONS@#Garden egg, a readily cultivated crop vegetable possesses ulcer protective properties against ulcers induced experimentally making it a cheap source of natural anti-ulcer remedy.