Patients with asthma, hypertension, and diabetes and lack of statin, antithrombotic agent, and/or proton pump inhibitor use were associated with higher risks for DRPs.

AimTo determine the general population willingness to pay for cognitive pharmacist service in community pharmacy, describe the behavior of participants regarding health care issues, and evaluate correlation between participants’ sociodemographic characteristics or attitudes and their willingness to pay.MethodsA questionnaire-based survey was conducted among general population visiting community pharmacies. The participants were asked about receiving cognitive pharmacist services to identify and resolve potential medication therapy problems after the initiation of a new medicine to optimize health outcomes of the patients. A univariate and multivariate analysis were used to analyze associations between different variables and willingness to pay for pharmacy service.ResultsOf 444 respondents, 167 (38%) reported that they were willing to pay for a medication management service provided in the community pharmacy. Univariate analysis showed significant association between the willingness to pay for pharmacist-provided service and respondents’ socio-demographic factors, health-related characteristics, and behavior, dilemmas, or need for certain pharmacist-provided service. The logistic regression model was statistically significant (χ2 = 4.599, P < 0.001).ConclusionsThe respondents expressed their willingness to pay for cognitive pharmacist services, which has not been fully recognized within the health care system. In future, pharmacists should focus on practical implementation of the service and models of funding.

Summary Background The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with NASH. Setting: Outpatient hepatology clinic. Methods A prospective trial was conducted. The first cohort included patients with biopsy-proven NASH, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in NASH group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications. Results All 33 NASH patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 micromol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA – IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gammaglutamyltransferase by 24.0 IU/L, 9.1 IU/L, 10.8 IU/L respectively, was noted. Conclusions Pentoxifylline and Metformin may provide possible treatment option in NASH. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived.

Background and Aim: Adverse effects are common in children treated with antiepileptic medications and may affect parental beliefs about treatment. The aim of the study was to investigate the relationship between adverse effects and parental beliefs about antiepileptic drugs used for the treatment of their children. Methods: The study was performed at the University Children’s Hospital, Belgrade, Serbia from 2013–2015. Parents of children treated with valproic acid, carbamazepine or lamotrigine, were eligible. They were asked to fill in the Beliefs about Medications Questionnaire (BMQ) and The Liverpool Adverse Events Profile (LAEP). Results: Parents of 127 children (average age 9.88 ± 4.16 years) of whom 111 had epilepsy (67 generalized, 44 focal) and 16 with febrile seizures participated in the study. Nervousness and/or agitation, weight gain, restlessness, headache, difficulty in concentrating, feeling of aggression and upset stomach were most frequent adverse effects, reported in 37% of the population. BMQ-specific necessity scores significantly correlated with parental education; parents with elementary school showed lower scores than those with higher education. The presence of difficulty in concentrating of their child was associated with higher BMQ concern scores (20.73 ± 4.25 vs. 18.99 ± 3.60, p = 0.043) as well as necessity scores (18.42 ± 3.31 vs. 16.40 ± 2.73, p = 0.017). Higher scores of BMQ-general overuse were reported in the presence of a headache (8.79 ± 2.81 vs. 7.64 ± 2.72, p = 0.027). Conclusions: The main finding of our study is that parental beliefs about antiepileptic drugs were associated with the presence of adverse effects. Understanding this relationship could allow physicians and pharmacists to structure better educational programs for parents of children treated with antiepileptic drugs. Education should be more focused towards understanding the adverse effects of antiepileptics which could alleviate parental concerns and strengthen their beliefs about the necessity of medication use in their children.

Background In the last 30 years, activities of hospital pharmacists have gone through significant changes. Pharmacists are increasingly involved in patient care. Objectives To explore drug-related and logistic problems, interventions, and their outcomes during routine everyday work of hospital pharmacists. Setting Institute for physical medicine and rehabilitation, Banja Luka, Bosnia and Herzegovina. Methods In the period of January 2013-October 2015 a prospective observational study was performed. Medical doctors, nurses, therapists, and patients addressed pharmacists, face-to-face or by telephone, with drug-related problems (DRPs) and/or logistic issues. Main outcome measure Type of DRP or logistic issue, intervention, outcome, initiator and time spent for solving the problem were documented for each consultation. Results Out of 1515 interventions, 48.8% were aimed at solving DRPs. The most common DRPs were the recommendation of a drug or dose and need for additional information about drugs. Drug price and supply were the most prevalent logistic issues. DRPs were more frequently initiated by medical doctors and required more time to solve the problem compared to logistic issues (Mann-Whitney U test, p ≤ 0.001, respectively). The acceptance rate of interventions to solve DRPs (83.7%) was lower compared to logistic issues (95.2%; p ≤ 0.001). Conclusions Hospital pharmacists were faced with an approximately equal number of DRPs and logistic issues during their routine everyday work. The overall acceptance rate of pharmacists' interventions was high, and the results of our study indicate that there is a need for more involvement of hospital pharmacists in Bosnia and Herzegovina in clinical activities. Impact on practice.

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive memory and cognitive function impairment as well as behavioural and psychiatric disturbances. Pharmaceutical care involves the process of identifying, resolving, and preventing drug-related problems, and it is aimed at improving the patient's quality of life. AD is usually diagnosed in elderly patients with comorbidities and, consequently, a variety of drug-related problems may occur. Pharmacists should focus on adverse reactions, drug-drug interactions, and adherence in patients with AD. The introduction of acetylcholinesterase inhibitors in treatment may be associated with adverse effects, such as diarrhoea, muscle cramps, fatigue, nausea, vomiting, insomnia, anorexia, headache, and dizziness, which may be transient or require an alternative medication. Use of anticholinergic medications, bradycardia causing medications, antipsychotics and other medications should be assessed carefully because of potential drug-drug interactions with acetylcholinesterase inhibitors, especially rivastigmine. Adherence may be a major drugrelated problem in patients with AD because of the nature of illness and appropriate communication between pharmacists and patients or carers requiring adequate skills and knowledge. Although AD is increasing in prevalence there is a lack of evidence about the impact of pharmaceutical care on the treatment outcomes and quality of life of patients and more research is needed in this area.

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Radioaktivni jod predstavlja značajnu terapijsku opciju u liječenju benignih oboljenja štitaste žlijezde. Uprkos višedecenijskom iskustvu i velikom broju liječenih pacijenata, mnoga pitanja vezana za terapiju radioaktivnim jodom još su uvijek predmet diskusija, uključujući način određivanja terapijske doze, kao i faktore koji utiču na ishod terapije. Klinička praksa, kao i preporuke odgovarajućih vodiča u pogledu doziranja radioaktivnog joda široko variraju u svijetu, od primjene fiksnih doza do kompleksnih dozimetrijskih protokola. Veća zastupljenost dozimetrijskog pristupa olakšala bi uspostavljanje korelacije doza-efekat i proučavanje uticaja raznih faktora na ishod terapije. Razvoj novih protokola za izračunavanje terapijske doze aktivnosti, kao i nova saznanja o faktorima koji utiču na ishod terapije omogućavaju dalje unaprijeđenje kako efikasnosti, tako i bezbjednosti terapije radioaktivnim jodom za individualnog pacijenta.