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Background: Albumin is generally used in hypovolemic conditions and due to its high cost and complicated manufacturing process, its appropriate use is a vital issue to be considered. The aim of this study was to evaluate the pattern of Albumin prescription in Imam Khomeini teaching hospital in Urmia, Iran.   Methods: This study was carried out between December 2014 to December 2015 in the Imam Khomeini hospital, affiliated to Urmia University of Medical Sciences, using pre-designed forms covering demographic data and clinical and laboratory information that was completed by the educated pharmacist on a daily observational basis.   Results: A total of 202 patients were selected with the mean age of 55.9±20.5 years, including 53% male patients. The highest prescription percentages were for patients with the diagnosis of Gastrointestinal Cancers (10.9%) while most of the patients were admitted in burn ward (16.3%). Overall 2755 Albumin 20% vials equal to almost 3030 million Rials were used while only 79 (39.1%) of the prescriptions were appropriate. Hypoalbuminemia was responsible for the highest number of inappropriate indications.   Conclusion: Our results showed a low percentage of acceptable prescriptions which highlights the necessity for reviewing and supervising the utilization of Albumin in this hospital.   J Pharm Care 2019; 7(3): 44-51. Methods: This study was carried out between December 2014 to December 2015 in the Imam Khomeini hospital, affiliated to Urmia University of Medical Sciences, using pre-designed forms covering demographic data and clinical and laboratory information that was completed by the educated pharmacist on a daily observational basis.   Results: A total of 202 patients were selected with the mean age of 55.9±20.5 years, including 53% male patients. The highest prescription percentages were for patients with the diagnosis of Gastrointestinal Cancers (10.9%) while most of the patients were admitted in burn ward (16.3%). Overall 2755 Albumin 20% vials equal to almost 3030 million Rials were used while only 79 (39.1%) of the prescriptions were appropriate. Hypoalbuminemia was responsible for the highest number of inappropriate indications.   Conclusion: Our results showed a low percentage of acceptable prescriptions which highlights the necessity for reviewing and supervising the utilization of Albumin in this hospital.   J Pharm Care 2019; 7(3): 44-51.

Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

Background: Nutrition is considered an important part of treatment in patients with chronic kidney disease (CKD). Therefore, poor nutrition leads to decreased life quality and increased complications of hemodialysis as well as mortality in these patients. This study aimed at investigating the effect of nutrition education program (NEP) on biochemical parameters among patients undergoing hemodialysis. Methods: This quasi-experimental study was conducted on 30 patients who referred to hemodialysis unit at Ayatollah Taleghani hospital in Urmia province, Iran. The sampling method was purposive. Data were collected through interviews and data collection instruments consisted of demographic questionnaires and checklist. In the pre-education stage, the demographic questionnaire was completed and a 2-month average of biochemical parameters (sodium, potassium, calcium, phosphor, blood urea nitrogen, and creatinine) were measured and recorded in the checklist by the researcher. Then, the patients received four 30-minute educational sessions on nutrition using learning assistant tools. Two months after the education program, the laboratory results were measured and recorded again by the researcher. Data analysis was performed using SPSS 14 and paired t test, and significance level was set at 0.05 (P < 0.5). Results:The findings revealed a significant decrease in sodium, potassium, calcium, blood urea nitrogen (P < 0.05), but no significant difference was found in the laboratory results of phosphor and creatinine (P < 0.05). Conclusions: The implementation of nutrition education program (NEP) for patients under hemodialysis can improve biochemical parameters as well as complications resulting from their imbalance. Therefore, this program is recommended for this group of patients.

Intelligent information systems can create an excellent opportunity to nephrologists for appropriate prescriptions, hemodialysis adequacy monitoring, drug prescription, anemia management, blood pressure control and patient education. Indeed, these technologies make sure patient safety and reduce medical errors through identifying high-risk patients and timely interventions to improve health care processes

Introduction: Hemodialysis (HD) patients encounter several challenges. They require strong attention to behavioral and lifestyle changes. Objectives: The purpose of this study was identifying factors that influence the improvement of self-management behavior in a group of HD patients. Patients and Methods: This is a cross-sectional survey conducted with participation of 420 patients in HD centers in Urmia University of Medical Sciences in 2017. For data collection, a self-designed questionnaire was designed. Results: The most important factors which are effective to improve self-management behavior were related to psychosocial support (4.66), patient education and empowerment programs (4.58), religious beliefs (4.50), active participation of family members (4.43), expanding role providers for self-management patient (4.36), and patient literacy and readiness (4.30) respectively. Conclusion: For the promotion of self-management behavior, healthcare providers should increase the abilities of patients for disease management. Therefore, it seems that selfmanagement training for HD patients is a crucial element of the care process.

Background Drug-laboratory (lab) interactions (DLIs) are a common source of preventable medication errors. Clinical decision support systems (CDSSs) are promising tools to decrease such errors by improving prescription quality in terms of lab values. However, alert fatigue counteracts their impact. We aimed to develop a novel user-friendly, evidence-based, clinical context-aware CDSS to alert nephrologists about DLIs clinically important lab values in prescriptions of kidney recipients . Methods For the most frequently prescribed medications identified by a prospective cross-sectional study in a kidney transplant clinic, DLI-rules were extracted using main pharmacology references and clinical inputs from clinicians. A CDSS was then developed linking a computerized prescription system and lab records. The system performance was tested using data of both fictitious and real patients. The “Questionnaire for User Interface Satisfaction” was used to measure user satisfaction of the human-computer interface. Results Among 27 study medications, 17 needed adjustments regarding renal function, 15 required considerations based on hepatic function, 8 had drug-pregnancy interactions, and 13 required baselines or follow-up lab monitoring. Using IF & THEN rules and the contents of associated alert, a DLI-alerting CDSS was designed. To avoid alert fatigue, the alert appearance was considered as interruptive only when medications with serious risks were contraindicated or needed to be discontinued or adjusted. Other alerts appeared in a non-interruptive mode with visual clues on the prescription window for easy, intuitive notice. When the system was used for real 100 patients, it correctly detected 260 DLIs and displayed 249 monitoring, seven hepatic, four pregnancy, and none renal alerts. The system delivered patient-specific recommendations based on individual lab values in real-time. Clinicians were highly satisfied with the usability of the system. Conclusions To our knowledge, this is the first study of a comprehensive DLI-CDSS for kidney transplant care. By alerting on considerations in renal and hepatic dysfunctions, maternal and fetal toxicity, or required lab monitoring, this system can potentially improve medication safety in kidney recipients. Our experience provides a strong foundation for designing specialized systems to promote individualized transplant follow-up care.

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