Understanding CB integration into routine practice has positive implications for successful implementation. The generic process map can be used to develop targeted resources, and/or be disseminated to facilitate CB delivery and foster whole team involvement. Similar methods could be utilised within other settings, to allow those developing novel services to distil the key processes and consider their integration within routine workflows to effect maximal, efficient implementation and benefit to patient care.
Dispensing antibiotics without a prescription (DAWRx) is a potential threat to global public health and can lead to antimicrobial abuse and resistance development. Further research is required to examine the characteristics of DAWRx practice in Iraq. This study aimed to investigate the practices of DAWRx in Iraqi community pharmacies. A semi-structured, validated, pilot-tested online questionnaire was used to conduct a descriptive cross-sectional study in March 2020 among the members of the Iraqi Pharmacist Syndicate. The questionnaire contained five sections: demographics, antibiotic dispensing knowledge, and the prevalence, sources, and characteristic features of DAWRx practices. The results are presented using descriptive statistics and significant associations were reported. A total of 403 respondents completed the questionnaire and, of them, 363 were analyzed. Despite having a satisfactory knowledge of dispensing (64.7%), the practice of DAWRx was prevalent (98.3%). DAWRx was reported based on the pharmacies’ recommendation (30.58%) and patients’ request for antibiotics. Adults and pediatric patients received antibiotics from pharmacies for various conditions. Injectable antibiotics were also dispensed without a prescription (mainly ceftriaxone, n = 51/72). Moreover, the prevalence and the daily number of antibiotics dispensed were significantly associated with sex, pharmacy attitude toward DAWRx, and DAWRx upon patients’ request. A significant association was noted between the knowledge of dispensing inquiries and the prevalence of and attitude toward DAWRx (p < 0.05). Impactful intervention strategies based on patterns identified in this study should be developed to improve antibiotic dispensing in community pharmacies and safeguard public health from the adverse effects of antimicrobial resistance.
Objective: To determine the ability of uVDBP to discern SRNS from steroid-sensitive nephrotic syndrome (SSNS) in Iraqi children.
Materials and Methods: This cross-sectional study enrolled children with SRNS (n=31) and SSNS (n=32) from the pediatric nephrology clinic of Babylon Hospital for Maternity and Pediatrics over three months. Patients' characteristics in terms of demographics, clinical data, and urinary investigations were collected. Quantitative analysis of uVDBP levels was undertaken via a commercially available ELISA kit.
Results: The median uVDBP values were significantly higher (p-value<0.001) in the SRNS group (median=10.26, IQR=5.91 μg/mL) than in the SSNS group (median=0.953, IQR=4.12 μg/mL). A negative correlation was noted between uVDBP levels and estimated glomerular filtration rate (eGFR) (Spearman's rho coefficient= − 0.494, p=0.001). Nevertheless, the rise in uVDBP concentrations was still considerable in children with SRNS whose eGFR measurements were above 60 mL/min/1.73 m2. The study revealed a good discriminatory power for uVDBP as a predicting parameter to distinguish SRNS from SSNS (AUC= 0.909, p<0.0001. The optimal uVDBP cut-off value of 5.781 μg/mL was associated with a sensitivity of 0.839 and specificity of 0.844 to differentiate SRNS from SSNS.
Conclusion: Considering its significant discriminatory strength, uVDBP can be considered as a potential marker to noninvasively distinguish children with SRNS from those with SSNS.
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