<span lang="EN-US">Pandemi <em>coronavirus disease-19 </em>(COVID-19) menyebabkan perubahan pelayanan kesehatan. Upaya mengurangi penyebaran COVID-19 adalah menjaga jarak dan menghindari kerumunan. Pada layanan kesehatan, telefarmasi memberikan akses cepat dan kenyamanan yang baik. Penelitian ini bertujuan mengeksplorasi peran dan perilaku apoteker dalam penggunaan telefarmasi serta faktor-faktor yang mempengaruhi penerapan telefarmasi selama pandemi COVID-19. Penelitian dilakukan menggunakan metode non-eksperimental kualitatif fenomenologis melalui wawancara mendalam. Informan diambil hingga data jenuh dan diperoleh 5 informan. Wawancara dilakukan langsung maupun <em>online</em>. Keabsahan data melalui uji kredibilitas dengan <em>member checking</em>, uji transferabilitas dengan uraian rinci, uji dependabilitas dan uji konfirmabilitas melalui <em>peer debrifing</em>. Hasil wawancara dianalisis secara deskriptif dengan proses berpikir induktif. Peran apoteker dalam </span><span lang="IN">telefarmasi</span><span lang="EN-US"> selama pandemi COVID-19 adalah memberikan layanan telefarmasi yang profesional, sedangkan perilaku apoteker adalah memanfaatkan telefarmasi untuk memberikan layanan farmasi klinik dan menggunakan media yang bervariasi. Faktor pendukung penerapan telefarmasi selama pandemi adalah kerja sama rekan sejawat dan keluarga pasien, peraturan terkait dukungan telefarmasi, dan pandemi COVID-19; sedangkan faktor penghambatnya adalah teknologi, hambatan finansial pasien, penerimaan pasien terhadap telefarmasi, keterbatasan sumber daya manusia dan waktu.</span>
Pneumonia is one of the major causes of mortality due to infection in hospitalized patients. It was frequently found in patients with renal failure. Clinical outcomes of infected patients with renal failure are worse compared to patients without renal failure. The presence of renal impairment affects the pharmacokinetics of the drug. Ceftazidime is one of the most commonly used antibiotics in patients with pneumonia. Approximately, 80-90% of ceftazidime’s total drug fraction is eliminated by kidneys so that the presence of kidney disorders will affect the concentration of ceftazidime in the blood. This study aimed to determine the estimated concentration of ceftazidime in the blood and clinical outcome of pneumonia patients with renal impairment. This study was a retrospective study with descriptive observational design. Data were obtained from patient’s medical record in a hospital in Yogyakarta between January 2013-June 2017 which fulfilled the inclusion criteria, i.e., ≥18 years old patients with complete medical record data, treated in internal medicine ward with diagnosis of pneumonia (HAP/HCAP) who had chronic renal failure, and received ceftazidime for minimum 72 hours or 3 days. The number of research samples were 40 patients. This study showed that 31 patients (77.5%) had achieved estimated ceftazidime concentration in the blood above the minimum inhibitory concentration of 8 μg/ mL. After ceftazidime therapy, 19 patients (47.5%) had improved clinical outcome and 21 patients (52.5%) had not improved clinical outcome.
The high prevalence of antiepileptic drug use in pediatrics increases the risk of side and toxic effects; therefore, it is necessary to monitor drug levels. Therapeutic drug monitoring is conducted through pharmacokinetics by calculating blood drug levels based on respondents' dose and frequency of therapy. This study aimed to determine the pharmacokinetics of antiepileptic drug levels and the correlation with clinical outcomes using descriptive observational design. Furthermore, the Indonesian Epilepsy Community collected respondents' data from June to July 2020 through online and telephone interviews. Out of the 11 respondents that recieved phenytoin, only 1 (9.09%) was in the therapeutic range (10–20 mg/L), while 10 (90.91%) were outside the therapeutic range (<10mg/L). From the 14 respondents that received phenobarbital, 8 (57.14%) were in the therapeutic range (15–40 mg/L), and 6 (42.86%) were outside the therapeutic range (<15 mg/L and >40 mg/L). From the 47 respondents that received valproic acid, 23 were administered through monotherapy, 7 (30.44%) were in the therapeutic range (50–100 mg/L), and 16 (69.56%) were outside the therapeutic range (<50 mg/L and >100mg/L). Out of the 24 respondents that received valproic acid as monotherapy, 18 (75%) were in the therapeutic range (50–100 mg/L), and 6 (25%) were outside the therapeutic range (<50 mg/L and >100mg/L). The results showed that there was no significant relationship (p>0.05) between drug levels and clinical outcome in respondents treated with either monotherapy or polytherapy of valproic acid. In conclusion, a total of 38 respondents (52.05%) had drugs levels outside the therapeutic range, while 35 (47.95%) had drug levels in the therapeutic range. Furthermore, respondents with drug levels outside the therapeutic range require direct monitoring of antiepileptic drug levels to avoid toxic effects and improve clinical outcomes.
The coronavirus disease 2019 (COVID-19) pandemic had a tremendous effect on essential healthcare services, including public health centers (PHCs). Pharmacists had the responsibility of maintaining high-quality pharmacy services during this pandemic. The objective of this study was to explore pharmacists’ roles and barriers in PHCs while providing pharmacy services during the COVID-19 pandemic. This study used a qualitative design with a phenomenological approach. Ten pharmacists from PHCs in Indonesia were recruited using a non-probability sampling method and interviewed individually using an online platform (Zoom and Google Meet) or via telephone. Informants were purposefully recruited through recommendations by registered pharmacists in Indonesia. Two interviews were conducted for each informant with an interval of 1 month. Each interview was recorded, transcribed verbatim, and analyzed using an inductive thematic method. Member-checking and peer-debriefing were conducted to increase the credibility of the study. This study revealed changes in the managerial and clinical pharmacy aspects of pharmacists’ roles. Additional roles related to COVID-19 were also described. In performing these services, pharmacists faced some barriers, including the limited provision of direct services to patients, a decrease in the number of patients, dishonesty among patients, a lack of human resources in PHCs, difficulty in procuring medical products related to COVID-19, and a lack of information regarding COVID-19 vaccination. The COVID-19 pandemic forced pharmacists in PHCs to adapt to various changes in pharmacy services, and support from stakeholders, including the government, patients, the pharmacists’ professional organization, and other health workers, is required to overcome the associated barriers.
Anti-epileptic drug (AED) has a narrow therapeutic index of drugs that a slight increase in dosage showed toxic effects. The therapeutic response is difficult to predict in malnutrition status because the patient with nutritional deficiency have more complicated problems likes hypoalbuminemia, macronutrient and micronutrients deficiency that affected the levels of AEDs. The nutritional deficiency could be a direct and indirect cause of ineffective AEDs therapy and also recurrent epilepsy. This study aims to describe the use of antiepileptic drugs in Indonesian children with poor nutritional status. The research design was observational studies with cross sectional random sampling to evaluate the AED doses of malnutrition status in children. All information was collected by spreading electronic forms and interviewing the parents by phone. The data were analyzed descriptively. Total of 8 malnourished children mostly included in the range of ages from >2 to 12 years (n=5; 62.50%) with means 3,9±2,7 years. The study showed valproic acid was bigger used in monotherapy (n=5; 62,50%) than polytherapy with carbamazepine or sodium phenytoin and phenobarbital. The means estimation of valproic acid monotherapy concentration in females’ group (n=2; 33,33%) showed sub-therapeutics level were Cssmin 26,09±0,57 mg/L and Cssmax 64,17±1,39 mg/L, also the means in males’ group (n=2; 33,33%) of valproic acid monotherapy were Cssmin 22.07±2,71 mg/L and Cssmax 54.27±6.66 mg/L. All of them included in good clinical outcome of free seizure > 6 months.
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