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Pharmacy Ethics: Evaluation Pharmacists’ Ethical Attitude
Pooneh Salari Sharif,Mohammadreza Javadi,Fariba Asghari
Journal of Medical Ethics and History of Medicine , 2011,
Abstract: Alterations in pharmacy practice from prescription dispensing to more patient-centered relationship intensifies the necessity of clinical decision-making. Pharmacists' knowledge as well as ethical reasoning affects their clinical decision-making. Unfortunately in Iran pharmacy ethics did not develop along with medical ethics and special considerations are of major importance. The study was designed to evaluate pharmacists' attitude toward some principles of bioethics.A cross-sectional survey was performed on a sample of Iranian pharmacists attended in continuous education programs in 2010. Based on the pharmacists' attitude toward common ethical problems, 9 Likert-type scale scenarios were designed. A thousand pharmacists were surveyed and 505 questionnaires were filled. For the whole questionnaire the strongly disagree answer was the most ethical answer. On a scale from 1-5 on which 5=strongly disagree, the total score of pharmacists ethical attitude was 17.69 ± 3.57. For easier analysis we considered the score of 1 for agree and strongly agree answers, score of 2 for neutral answers and score of 3 for disagree and strongly disagree answers. The total score in confidentiality for all participants was 4.15 ± 1.45 out of 9, in autonomy 6.25 ± 1.85 out of 9, in non-maleficence 5.14 ± 1.17 out of 6 and in justice was 2.27 ± 0.89 out of 3, however there was no significant difference between men and women in the total score and the score of each theme. The older participants (> 40 years) significantly had lower total score (P< 0.05) as well as the score of each theme (P< 0.05), except for non-maleficence. The work experience showed impact on the pharmacists' attitude toward autonomy and the participants with more than 5 years work experience significantly obtained lower score in this theme.Compiling ethical guidelines and improving pharmacy ethics curriculum is highly critical to provide the best pharmaceutical care and to make clinical decisions in critical situations. Therefore further quantitative and qualitative investigations into finding pitfalls and challenges in this issue are highly recommended.
Assessment of Professionalism in Iranian Pharmacists
Mohammadreza Javadi,Fariba Asghari,Pooneh Salari
Journal of Medical Ethics and History of Medicine , 2011,
Abstract: In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist's role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority.The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists' attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants, in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17-25) of the total score. Women obtained significantly higher scores in altruism (P<0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants' response to the whole questionnaire nor any of subscales.Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists' professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists.
Drug Utilization Review of Vancomycin in Febrile Neutropenic Patients Hospitalized at a Bone Marrow Transplantation Center
Alireza Hayatshahi,Mohammadreza Javadi,Hassan Torkamandi,Molouk Hadjibabaie
International Journal of Hematology-Oncology and Stem Cell Research , 2010,
Abstract: "nIntroduction: Infections in neutropenic patients are considered as major causes of mortality and emergence of drug resistant Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including methicillin resistant Staphylococcus aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent. "nMethods: We conducted a prospective observational study at bone marrow transplantation research center, Shariati teaching hospital in Tehran to evaluate the appropriateness of vancomycin utilization for our adult bone marrow transplantation (BMT) patients for a period of six months. "nResults: The charts of a total of 117 patients were prospectively reviewed in 3 adult BMT wards. Seventy four patients (63.2%) received vancomycin treatment during their hospital stay. Most patients received allogienic versus autologous transplantation (62.2%, 18.9%). Majority of patients were under 50 years of age (91.9%). About 58% of cases were febrile neutropenic at the time of vancomycin initiation. Based on the criteria of appropriate indications, vancomycin utilization was justified in 59.5% of cases which 43.2% of those cases received appropriate initial doses. "nConclusion: Based on the results of this study, in the majority of our BMT patients vancomycin was utilized appropriately as a part of their empiric treatment. More attention in the time of initiation and also dose adjustment seems to be necessary to minimize treatment failure and the emergence of drug resistance.
Drug Utilization Review of Conventional Amphotericin B in Febrile Neutropenic Patients Hospitalized at a Bone Marrow Transplant Center
Alireza Hayatshahi,Mohammadreza Javadi,Hassan Torkamandi,Molouk Hadjibabaie
International Journal of Hematology-Oncology and Stem Cell Research , 2010,
Abstract: "nIntroduction: Conventional amphotericin B is one of the antifungal choices as prophylactic and empiric treatment against fungal infections in febrile neutropenic patients. However the time of initiation, dosing and monitoring of drug adverse effects must be justified to maximize the efficacy and minimize the toxicities of this antifungal agent. "nMethods: We conducted a prospective observational study at Shariati teaching hospital, Hematology – Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences to evaluate the appropriateness of amphotericin B utilization for our adult bone marrow transplant (BMT) patients for a period of six months. "nResults: The charts of a total of 54 patients in 3 adult BMT wards were prospectively evaluated. Most patients underwent allogienic transplantation (61.1%). The mean duration of treatment with amphotericin was 9.3 days with 50% as prophylactic and 42.6% as empiric treatments. Appropriate dose was initiated in 70.4% of patients versus 22.2% unjustified initial doses. The use of amphotericin was appropriate in 92.6% of cases versus 7.4% unjustified uses. "nConclusion: Based on the results of this study, in the majority of our BMT patients amphotericin B was utilized appropriately either as prophylactic or empiric treatment. More attention in dose adjustment seems to be necessary to minimize nephrotoxicity and other adverse effects of this agent.
Evaluation of Human Albumin Use in Bone Marrow Transplantation Patients in a University Hospital in Iran: A Retrospective Study
Maryam Mousavi Nejad,Alireza Hayatshahi,Mohammadreza Javadi,Molouk Hadjibabaie
International Journal of Hematology-Oncology and Stem Cell Research , 2010,
Abstract: "nIntroduction: The aim of this study was to evaluate the use of albumin in bone marrow transplanted patients and its possible economic repercussions from its inappropriate use. "nMethods and materials: This was a retrospective study in which all patients receiving albumin ) from start to end of treatment( at three bone marrow transplantation wards were assessed in two consecutive years .The clinical indications for albumin were evaluated on the basis of guidelines. The concomitant drugs that affected albumin levels were assessed. Characteristic data including age, gender, weight, body surface area(BSA), diagnosis, blood group, type of transplantation were recorded .All lab data which included serum creatinine , alanine aminotransferase , aspartate aminotransferase, alkaline phosphatase, total protein, albumin, hematocrite, calcium before and after albumin use were also recorded . Postconsumption data was in-hospital stay and mortality. "nResults: During the study period, 104 patients received albumin at 3 wards (BMT1:36 patients, BMT2:11 patients, BMT3:57 patients). Patients received a mean number of 24.52 ± 20.86 vials. The mean treatment duration was 13.96 ± 9.14 days. Drugs decreasing albumin level did not significantly affect the use of albumin. Weight, total protein and calcium have been significantly altered after albumin use. "nConclusion: Drug Use Evaluation is an opportunity for clinical pharmacist to help improve therapy by designing strategies to reduce the medication error and cost or changing prescriber manners.
A review of the causes, indicators, diagnosis and treatment of dental fluorosis
Farnaz Moshref-Javadi,Parastoo Afghari,Mojgan Rafizadeh,Mohammadreza Moharreri
Journal of Isfahan Dental School , 2012,
Abstract: Introduction: Fluorosis is defined as a special form of injury to tooth structures, which is caused by excessive intake of fluoride during tooth development. The last fifty years have witnessed an increase in the incidence of fluorosis, necessitating special attention to the esthetic issues, diagnosis and treatment of these defects. The aim of this study was to investigate the causes, indicators, diagnosis and treatment of dental fluorosis.Review report: In this review article, the related articles were evaluated by running a Pubmed search from 1985 up to the present. After classification of the papers the most important relevant papers were selected and evaluated with an emphasis on practical therapeutic procedures.Results: Fluorosis appears when the fluoride content of drinking water is more than 1 ppm. Severity of fluorosis depends on the duration of exposure to fluoride. The host specific body response, weight, the extent of physical activity, nutritional factors, and bone growth and development result in different severities in individuals who have been exposed to the same fluoride level. Fluorosis is classified as very mild, mild, moderate and severe. There are three special indicators for dental fluorosis: Thylstrup and Fejerskov, Dean, and TSIF. Depending on the severity of fluorosis, different treatment modalities are recommended, including bleaching, microabrasion, macroabrasion, veneers and crowns. Conclusion: There are different classifications for fluorosis. In addition, there are specific indicators for fluorosis, each with some advantages and disadvantages. Treatment of fluorosis is different depending on the severity of the problem and treatment outcomes are usually satisfactory. Key words: Dental, Fluorosis, Therapy
Penicillin Allergy and Cross-reactivity with other Beta-lactams
Mohammadreza Javadi,Kheirollah Gholami,Hassan Torkamandi,Alireza Hayatshahi
Journal of Pharmaceutical Care , 2013,
Abstract: Beta-lactams are a group of antibiotics with a broad spectrum of both Gram-negative and Gram-positive coverage. The goal of this study is to evaluate the results from studies regarding Ig-E mediated hypersensitivity to Penicillin and cross-reactivity with other beta-lactams. Review was conducted of both retrospective and prospective studies by searching in PubMed and Medline for the original and systematic review articles by using the keywords: penicillin allergy, beta-lactams and cross-reactivity. The rate of true Penicillin allergy is about 10% of reported cases by the patients. The rate of Ig-E mediated cross-reactivity between Penicillin and Cephalosporins is less than 10% for the first and second generations and less than 5% for the third and fourth generations. According to the reviewed studies, Imipenem has between 9.2% to 25.6% cross-reactivity with Penicillin. Recent studies have shown safe use of Meropenem in patients with penicillin allergy even with positive skin test. The only member of Monobactam family, Aztreonam, has no cross-reactivity with any of Penicillins, Cephalosporins (with the exception of Ceftazidime) and Carbapenems. Due to the low rate of true Penicillin allergy, the patient’s self report of this adverse reaction must be justified carefully before avoiding beta-lactams. Even in the cases of true penicillin allergy, Meropenem appears to be safe, if indicated. There are also a few case reports regarding hypersensitivities to Clavulanate itself and also its cross-reactivity with Penicillin. Keywords: Penicillins, Cephalosporins, Carbapenems, Monobactams, Review, Hypersensitivity
Evaluation of the Sensitivity and Specificity C- reactive protein, and leukocyte count in the diagnosis of acute appendicitis and its types
Mohammadreza Javadi,Younes Moradi,Sepideh Behnoud,Hazhir Seifpanahi-sha’bani
Pajouhan Scientific Journal , 2013,
Abstract: Introduction: Appendicitis is a common urgent surgical operation. Since early diagnosis and treatment of appendicitis is necessary and also some disease mimic its clinical manifestation and rate of negative appendectomy was high (15-30%), so surgeons were trying to increase the accuracy of diagnosis of appendicitis by using laboratory facilities. The main aim of this study were to investigation of Sensitivity and Specificity CRP in the diagnosis of acute appendicitis and compare it with routine laboratory tests such as leukocyte count and neutrophil count.Material and Methods: In this descriptive - analytical study, blood samples of 191 patients with diagnosis of acute appendicitis that underwent appendectomy at the Besat hospital, were used to measuring of CRP. The surgical specimens were reviewed by pathologists and pathologic findings were considered as gold standard. Then by using of the results of pathology tests, sensitivity, specificity and positive and negative predictive value of CRP, WBC and neutrophils were measured. Data were analysed by SPSS-14 software and t test and chi square test.Results: 74/3% of patients were male and 25/7% female and the mean age was 26 ± 3/4 years. The most common symptom, sign and pathologic stage of patients were loss of appetite (95/2%), local tenderness (95/8%) and Acute suppurative (64/9%). 08/13% of patients had normal appendectomies that consist of 35% of women and 6% of men appendectomy. The sensitivity and specificity of CRP, WBC and neutrophils respectively were: 98/1%, 61/5%, 84/8%, 50%, 93/3% and 19.2%.Conclusion: According to the results, the CRP test at diagnosis and in finding of negative appendectomy has high value. But wasn't reliable as an exclusive test. Therefore, the use of CRP as a paraclinical criterion along with other criteria of Alvarado scoring system can be very useful in diagnosis of appendicitis.
Side effects of herbal drugs used in dermatologic disorders  [PDF]
Gita Faghihi, Mohammadreza Radan
Journal of Cosmetics, Dermatological Sciences and Applications (JCDSA) , 2011, DOI: 10.4236/jcdsa.2011.11001
Abstract: Because of the awareness of the environmental damage caused by industrialization, a trend has developed to use products with natural ingredients. Herbal products have been used for the treatment of disease, most commonly in the last century. As herbal supplements become more popular, several adverse side effects have been reported in users who also take other medications. In dermatology ,many botanicals are used especially with regard to cosmetic benefits of natural topical products on skin aging process,so dermatologists should face with higher side effects of these types of drugs.The most common presentation of topical aromatherapy side effects are contact dermatitis and the second in order will be contact urticarial reactions.
Modified FILTERSIM Algorithm for Unconditional Simulation of Complex Spatial Geological Structures  [PDF]
Peyman Mohammadmoradi, Mohammadreza Rasaei
Geomaterials (GM) , 2012, DOI: 10.4236/gm.2012.23008
Abstract: Facies and fracture network modeling need robust, realistic and multi scale methods that can extract and reproduce complex relations in geological structures. Multi Point Statistic (MPS) algorithms can be used to model these high order relations from a visually and statistically explicit model, a training image. FILTERSIM as a pattern based MPS method attracts much attention. It decreases the complexity of computation, accelerates search process and increases CPU per-formance compare to other MPS methods by transferring training image patterns to a lower dimensional space. The results quality is not however as satisfactory. This work presents an improved version of FILTERSIM in which pattern extraction, persisting and pasting steps are modified to enhance visual quality and structures continuity in the realiza-tions. Examples shown in this paper give visual appealing results for the reconstruction of stationary complex struc-tures.
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