In the context of Covid-19, personal protective equipment is much needed and often in short supply as a protection against the virus, but nobody until recently was discussing the downside of its prolonged use by its wearers. Increasing numbers of health care workers feel unwell using it and are overheating and some have fainted. Will it impair their professional performance? This article considers this aspect of PPE based upon the personal experience of a Forensic team at AIIMS Bhopal in India who wore it during autopsy work and proposed recommendations to minimise it.
Background: Cancer is a disease that is inevitably treated using chemotherapy, but the cytotoxic drugs used in the treatment have the potency to cause adverse drug reactions (ADRs). Thus, supportive therapy plays an essential role in managing the untoward effects of the cancer drugs in patients. This highlights the importance of medication adherence in managing the disease, mitigating and preventing the occurrence of chemotherapy-induced ADR without compromising the health status of the cancer population. Objective: To assess the adherence to chemotherapy and supportive therapy and to evaluate type and degree of causality of ADRs observed in cancer patients. Methods: On ethics committee approval, a 6-month observational study was conducted among recruited cancer patients undergoing chemotherapy in a tertiary care hospital. Morisky Medication Adherence Measurement Scale–8 was employed to assess the medication adherence, and ADR causality was determined using Naranjo ADR Probability Scale. Results: Ninety cancer patients participated in the study, out of which females were 61.11%. Chemotherapy adherence in comparison to supportive drugs was observed to be more (21.11%). Twelve different combination of ADR were reported in the subjects with variability in the degree of causality assessment. Conclusion and Relevance: The distinction of adherence to the medication used in cancer management with marked level of ADR was well depicted in the study, implicating the necessity of prudent symbiotic practice of an oncology pharmacist, patient, and physician relationship in optimizing the quality of life of cancer patients by imparting vigilant efforts in medication adherence.
Patients with rheumatic diseases are susceptible to various infections throughout the course of the disease. The increased risk of infections can be attributed partly to the aberrant immune system and partly to the effect of immunosuppressive drugs used in the treatment of the disease. Immunization appears to be an excellent strategy to prevent infections in such patients. However, the effect of vaccines in these patients is modified due to disease per se and/or immunosuppressive drugs. Biological agents, that frequently increase the susceptibility to infections, are now being initiated earlier in the course of the disease and also for new indications. Thus, concerns regarding safety, efficacy and potential adverse effects of vaccines in these patients are more complex than in any other immunosuppressive conditions. Different patients show different amount of immunosuppression in response to disease modifying drugs. Besides, there is lack of adequately powered randomised controlled trials investigating the efficacy of a vaccine in terms of actual prevention of the disease. Pneumococcal and influenza vaccines are the most studied vaccines and they are strongly recommended in rheumatic patients. In general, live vaccines should be avoided among patients receiving high doses of immunosuppressive drugs. However, they may be given to patients receiving low dose steroids and methotrexate. Non-live vaccines may be administered as per the recommendations of national guidelines. There is necessity to increase awareness among patients and doctors towards promoting the appropriate and judicious use of vaccines in the patients with rheumatic diseases.
Background Very little is known about the effects of drug wastage costs among cancer patients in terms of “financial toxicity” leading to poor health and nonhealth outcomes. But reducing this drug waste is an attractive strategy for cost-cutting with regard to improving the health-related quality of life of the cancer patients. Thus, the objective of the study was to determine drug wastage and to generate evidence for cytotoxic drug waste and financial burden among cancer patients. Methodology: On Ethics Committee approval, a prospective-observational study was conducted in cancer patients. The data were collected in data collection form. Daily monitoring was done to analyze the quantity of drug wastage which was interpreted using KW-ANOVA and further evidence was developed for corrective mitigation strategies applicable to intent drugs. Results Among 90 patients, 52 patients experienced drug wastage that includes 9 intent drugs which figured out unnecessary monetary units and quantity wastage that range from 80 to 50,000 INR and 10 to 500 mg, respectively. The median price value for cost of drug wastage was 237.30 INR. Conclusion The study generates evidence that concludes the mandatory requirement of implementation of drug wastage mitigation strategies for the drugs expected to cause wastage. Clinical pharmacist extensively contributes in oncology pharmacy practice setting to identify the intent drugs and to abate the drug wastage among medications intending to cause potential increment in drug expenditure among cancer patients on chemotherapy clinical pharmacist.
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