Community pharmacists-led interventions in tuberculosis care: A systematic review

BackgroundA multidisciplinary approach is required to tackle the tuberculosis (TB) epidemic, which is one of the most pressing public health concerns worldwide. However, community pharmacists are underutilized in TB programs.ObjectiveTo identify community pharmacists-led interventions in TB management with their corresponding impacts in TB case detection and treatment outcomes.MethodsA systematic search was performed in six electronic databases and health organization websites, from database inception to August 2, 2022. Studies which described TB screening, referral and/or treatment monitoring by community pharmacists with their corresponding outcomes were screened and reviewed independently by two reviewers. The studies were checked for the risk of bias using Cochrane risk of bias tools. All data of included studies were analysed qualitatively and presented narratively.ResultsThe search yielded 8,121 studies and five reports for initial screening. Sixteen studies and two case study reports were included in this review. Community pharmacists were involved throughout the TB care cascade, contributing their services in TB screening, referrals and in directly observed treatment-short course (DOTS) program. These interventions showed improvements in the effective control and prevention of further spread of TB, which improves individual, community and population level outcomes.ConclusionsThe inclusion of community pharmacists into TB program can improve the continuity of care, bridging the gaps in TB case detection and treatment monitoring. Adequate training and support are essential, to further empower the role of community pharmacists in TB control and prevention, in building a TB-free world.     

Psychological interventions with families of alcohol misusers: A systematic review

Aims: To review the literature on psychological interventions for families affected by alcohol misuse, with a focus on outcomes for family members.

Methods: A comprehensive and systematic literature review. A detailed search strategy was developed and implemented with no date, language or time restrictions. Two reviewers screened all identified titles and abstracts, and then independently assessed the eligibility and quality of all potential studies. The studies were analysed according to whether or not the alcohol misuser was involved in the primary intervention under investigation and analysed thematically.

Results: Forty-three publications (34 studies) were included in the review. All were in English, covered the period 1979–2009, were mainly published articles in peer review journals and included 2500–3000 family members. Research with female family members (particularly spouses or partners), and ‘white’ family members dominated. The included studies show how the field has moved from primarily focussing on how family members can engage and support the user through treatment to adopting a wider holistic focus which considers the needs of family members in their own right. Studies in both categories demonstrated positive outcomes for family members across a range of domains.

Conclusions: Adopting a broader review methodology has brought a fuller understanding of a field where few such reviews have been conducted, and offers direction for future research. Further work is needed in terms of broadening the reach of such interventions and embedding them more firmly into routine therapeutic practice.     

Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients

Background

Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD.

A systematic review of cost-effectiveness analyses of pharmacogenomic interventions

Cost-effectiveness analysis is a widely used tool to assess the value of healthcare interventions. Our objective was to conduct a systematic review of the literature on the cost effectiveness of pharmacogenomic interventions. We found 11 studies that met our inclusion criteria. The most commonly examined disease was deep vein thrombosis (n=4), followed by cancer (n=3) and viral infections (n=3); the most frequently examined mutation was factor V Leiden (n=5); and the majority of the mutations examined were inherited mutations (n=7), although several studies looked at acquired (tumor or viral) mutations (n=4). The majority of the studies reported a favorable cost-effectiveness ratio for the pharmacogenomic-based strategy (n=7), while two studies reported that the pharmacogenomic-based strategy was not cost effective and two were equivocal. We conclude that there have been few evaluations of the economic costs and benefits of pharmacogenomic interventions and they have covered a limited number of conditions. Further analyses that can be used to guide the use of pharmacogenomics in clinical practice and in developing health policies are urgently needed.     

A systematic review of interventions for homeless alcohol-abusing adults

Aims: To compile and critically analyse published research on interventions with alcohol-abusing homeless adults. Methods: A systematic review was conducted of research published utilising the MEDLINE, EMBASE, PsycInfo, CINAHL and SocIndex databases from inception to March 2015. A meta-analysis was performed on studies that met the inclusion criteria, to determine if there were any significant pre- and post-intervention effects on alcohol-use. Results: Seventeen studies from three continents were included in this systematic review. A meta-analysis of pre- and post-intervention effects on alcohol use across the 17 studies found highly significant effects (p?<?0.001). A smaller subset of studies (n?=?10), where the same specific alcohol use outcome measurement was employed across all studies, also showed highly significant pre–post intervention effects (p?<?0.001). Results indicate that a range of interventions were effective in reducing alcohol use and abuse within samples of homeless participants, although short-term effects are more apparent than longer term ones. Conclusions: There is a relative paucity of research into alcohol abusing homeless adults, which has implications for evidence-based practice. This systematic meta-analytical review demonstrates that a range of alcohol abuse interventions for homeless adults produces improvements in alcohol use (p?<?0.001).     

Neurocognitive correlates of medication-induced addictive behaviours in Parkinson's disease: A systematic review

Dopaminergic medication can induce severe addictive behaviours (e.g., pathological gambling) in susceptible Parkinson's disease (PD) patients. It is still unknown which particular neurocognitive processes become exacerbated or dysfunctional in PD patients with addictive behaviours. We sought to systematically review the relevant literature to identity potential neurocognitive correlates of medication-induced addictive behaviours in PD. We framed our review around neurocognitive processes central to four dominant accounts of substance addiction: ‘aberrant learning’, ‘incentive sensitization’, ‘impulsivity to compulsivity’ and ‘impaired response inhibition and salience attribution’. Searches of the PubMed and Scopus databases were completed on June 23, 2017. To be included, studies were required to involve: (a) medicated PD patients, without a history of deep brain stimulation, with and without addictive behaviours; (b) a reward-related or decision-making task; and (c) statistical comparison of addictive and non-addictive groups’ ‘on’ medication performance on the task(s). Studies were summarised qualitatively with statistically significant (p<.05) group differences and effect sizes (Cohen's d) highlighted. 35 studies were included. Findings showed that the extant literature is highly heterogeneous. The domains of reward and punishment learning, reflection impulsivity and disadvantageous decision-making exemplify this. More homogeneity exists in domains in which (a) neurocognitive dysfunction is not apparent (motor control, cognitive/attentional flexibility and cognitive control) or (b) typical neurocognitive processes appear exacerbated by medication (reward motivation and choice impulsivity). Future large-scale neurocognitive studies are still required to develop our scientific understanding of addictive behaviours in PD and aid their clinical treatment and prediction.     

Evaluations of clinical tobacco cessation interventions in Arab populations: A systematic review

Background and aimsTobacco smoking is prevalent among Arab smokers. Interventions to support smoking cessation may differ in effectiveness in this population from Western populations usually studied. This review assessed evidence of effectiveness of clinical smoking interventions in Arab smokers.MethodsA systematic search for comparative trials evaluating tobacco cessation interventions in Arab populations was conducted in the MEDLINE, EMBASE, PyschINFO, CINHAL and Web of Science databases. Behavioural, pharmacological and combined interventions were included. Reference lists of included studies were hand searched. The outcome measure was self- reported tobacco abstinence at the final follow-up, with biochemical verification where available. Assessment of evidence for effectiveness was undertaken using Bayes Factors.ResultsA total of 659 titles and abstracts were identified. Five studies met the inclusion criteria. Four of these were randomized controlled trials and one was a non-randomized comparative trial. Differences between study features precluded meaningful aggregation for a meta-analysis. The four randomized trials all yielded Bayes Factors <1, suggesting no effect of the intervention compared with the control condition. The non-randomized trial, conducted in tuberculosis clinics in Sudan, yielded an extremely high Bayes Factor (>1000), supporting the hypothesis of effectiveness; however, the study was judged to have a high risk of bias.ConclusionsAs yet, there is no convincing direct evidence that clinical smoking cessation interventions, which are found to be effective in Western populations, are also effective for Arab smokers. There is an urgent need for high quality randomized trials evaluating interventions in this population.     

Community pharmacists' knowledge of Alzheimer disease care in high- and low-income Chicago

Objectives

This pilot study examined community pharmacists' knowledge to provide care and services for persons with Alzheimer disease (AD) and area income-based disparities in knowledge and availability of cognitive enhancers.

过敏性哮喘脱敏治疗效果的系统评价

目的探讨评价变应原脱敏治疗（SIT）对过敏性哮喘的疗效。方法利用计算机查找及筛选出pubmed（1966-2007）、eoehrane图书馆（Issue2，2007、8）、BMBASE（-2007）、VIP（1989-2007）、中国生物医学文献数据库（CBMDISC）（1978-2007）、中国学术期刊全文数据库（CJFD）（1979—2007）等数据库中所需的文献。并手工检索相关资料，检索本领域专家近年来使用脱敏疗法治疗哮喘病的研究成果。并对纳入的研究的方法学质量按Cochrane协作网推荐的方法进行了评价。结果共纳入10篇随机对照试验（298例患者），描述性分析表明：与安慰剂组比较，脱敏疗法显著改善了哮喘患者的临床症状和减少了对药物的需求量，在提高FEV1值方面效果显著。脱敏治疗对哮喘患者生活质量的提高，也有统计学意义。结论脱敏技术在哮喘研究中已趋于完善，脱敏治疗能够改善患者的临床症状和肺部功能，并且能减少对药物的需求量。同时脱敏治疗的不良反应（比如过敏反应）发生率低，推荐用于临床。     

The role of community pharmacists in delivering interventions for osteoporosis: A systematic review

BackgroundOsteoporosis is a major public health concern, given that disease prevalence is expected to substantially increase due to the aging population. Community pharmacists can play a key role in the identification and management of chronic diseases.ObjectivesThe purpose of this systematic review was to present an overview of the literature on the role of community pharmacists in providing osteoporosis interventions to patients. The secondary objective was to assess the impact of these interventions on patient outcomes.MethodsA literature search was conducted in Embase, CINAHL, Scopus, MEDLINE, and Web of Science from database inception to March 2021. The search was limited to human studies in the English language. Primary studies were included if they described or assessed a patient-directed osteoporosis intervention conducted by community pharmacists. The following data were extracted and tabulated: citation, study location, study design, subject, number of participants, nature of intervention, classification of intervention, outcome measures, measurement methods, findings, and effect. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies (ROBINS-I).ResultsTwenty-one studies were included in this review. The main interventions were education, screening, and medication management. Nineteen of these studies reported patient outcomes, all yielding positive outcomes. Outcomes included increased physician follow-up, risk factor reduction, increased osteoporosis knowledge, increased medication adherence, identification of medication-related problems, and positive patient-reported experience measures (PREMs). Three studies were considered to have a moderate risk of bias, whereas the remaining 18 studies had a high risk of bias.ConclusionThere is some evidence that pharmacist-led osteoporosis interventions have a positive impact on patient outcomes. More high-quality studies using objective outcome measures are needed to determine whether this translates into clinical outcomes such as decreased hospitalization and fractures.     

The effectiveness of brief alcohol interventions in primary care settings: A systematic review

Issues. Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials. Approach. A pre‐specified search strategy was used to search all relevant electronic databases up to 2006. We also hand‐searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta‐analyses, subgroup and sensitivity analyses and meta‐regression were conducted. Key Findings. The primary meta‐analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: ?38 g week^?1, 95%CI (confidence interval): ?54 to ?23], although there was substantial heterogeneity between trials (I² = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non‐significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials. Conclusions. Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care. [Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, Burnand B, Heather N. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug Alcohol Rev 2009;28:301–323]     

药师对急诊科问题处方进行实时干预的分析与评价

目的:研究药师对急诊科处方的实时干预是否有助于提高急诊科临床用药的合理性。方法:对北京朝阳医院药师于2014年1—12月干预的急诊科处方数据进行分析。对比2014年与20 13年急诊科不合理处方点评结果,用以评价急诊科处方干预措施的效果。结果:通过实时处方干预,本院急诊科不合理处方发生率由2013年均4.45%降低为2014年均0.12%,与整体不合理处方发生率下降趋势一致。结论:药师针对不合理用药情况及时与医师沟通并进行整改,对提高普通急诊科临床用药合理性有一定作用。     

A systematic review of magnesium sulfate for acute asthma in adults

In order to provide evidence for making clinical decision, the role of intravenous and nebulized MgSO₄ in treatment of adult’s acute asthma was systematically estimated in the present study. Pubmed, Embase, Web of Sciences, the Cochrane Library and two Chinese literature databases (CNKI, WanFang) were systematically searched up to January 2016. Randomized controlled trails (RCTs) that compared the clinical outcomes of MgSO₄ groups and placebo groups were included. The primary outcome was hospital admission. Secondary outcomes included pulmonary function, symptom scores, vital signs and adverse events. The methodological quality of the included studies was evaluated, and the forest plots with meta-analysis were drawn by RevMan 5.2. A total of 24 RCTs derived from 2931 patients were included. Both intravenous MgSO₄ and nebulized MgSO₄ treatments had no effect upon hospital admission (RR 0.91, 95% CI 0.80 to 1.03, P = 0.14; RR 0.78, 95% CI 0.56 to 1.08, P = 0.14). Both intravenous MgSO₄ and nebulized MgSO₄ treatments were associated with significant evidence upon respiratory function (SMD 0.23, 95% CI 0.03 to 0.43, P = 0.02; SMD 0.37, 95% CI 0.11 to 0.64, P = 0.006), but sensitivity analyses showed that outcomes were changed by omitting studies of less than 100 individuals (SMD 0.05, 95% CI -0.05 to 0.15, P = 0.35; SMD 0.05, 95% CI -0.16 to 0.25, P = 0.64). There were no statistically significant differences in clinical symptom scores and vital signs (heart or pulse rate; systolic blood pressure; respiratory rate) in either form of MgSO₄ compared with placebo groups (P>0.05). There were no serious adverse events reported in any literature. Overall, there was no role for intravenous and nebulized MgSO₄ in the management of acute asthma in adults. Considering the low risk of serious adverse effects and easy availability, it seemed reasonable to use intravenous or nebulized MgSO₄ treatment in adults with life threatening asthma in whom any potential benefit would justify the risks of treatment.     

The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis

International Journal of Clinical Pharmacy - Background The clinical pharmacist has been an important partner in clinical treatment team. In China, there is no systematic review to evaluate the...