Objectives: This study was designed to explore the awareness and attitude of the pharmacists work... more Objectives: This study was designed to explore the awareness and attitude of the pharmacists working in the retail pharmacies toward the national adverse drug reactions (ADRs) system activities in Iraq. Methods: A cross-sectional survey using a validated self-administered questionnaire was used in this study. The questionnaire was delivered to retail pharmacists (RPs) practicing in Baghdad during the study period (4 months). Results: Of the 200, only 176 pharmacists responded to the survey (response rate of 88%). The total number of usable responses was 123 (61.5%). The survey findings revealed that 79 pharmacists (64.2%) were not aware of the Iraqi spontaneous reporting system (SRS). The restriction factors which dropping the ADRs reporting among RPs were identified. These include lack of knowledge in the way of reporting (n = 41; 33.3%), the unavailability of reporting forms (n = 88; 71.6%), and unawareness of where these reports should be sent to (n = 88; 71.6%). Conclusions: The study showed that the RPs in Baghdad have a very positive attitude toward ADRs but unfortunately; they are not familiar with the Iraqi SRS. The study findings emphasize the serious need for special education programs to promote ADRs reporting among RPs.
integrated chronic care approach in patients with atrial fibrillation compared to usual care. The... more integrated chronic care approach in patients with atrial fibrillation compared to usual care. The objective of the present study is to assess cost-effectiveness of this nurse-led care program versus usual care. METHODS: A cost effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, Maastricht, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline adherent management, steered by dedicated software and supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per lifeyear as well as a cost per QALY analysis was performed, both from a hospital perspective. QALYs were based on scores of the Short Form 36 questionnaire (SF-36), converted to utility scores by extracting the Short Form 6D (SF-6D). All unit prices were supplied by the hospital's financial department, except for prices for medication, which were taken from the Dutch Pharmacotherapeutic Compass. Results represented the costs and effects for a 12 months follow-up period. RESULTS: The nurse-led care program was associated with slightly more lifeyears and QALYs at a lower cost. Specifically, the nurse-led program contributed to 0.086 QALY gains with a reduced cost of € 1102.77 per patient and a gain of 0.02 life years with a reduced cost of € 731.62 per patient. Therefore, the nurse-led program would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led program is considered to be more likely cost effective than the care as usual. CONCLUSIONS: The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach is very likely a costeffective management strategy for patients with atrial fibrillation.
Deficiencies in knowledge about immunization among parents often leads to poor uptake or errors i... more Deficiencies in knowledge about immunization among parents often leads to poor uptake or errors in immunization dosage and timing. The aims of this study were to determine Iraqi parents' views of barriers to immunization and beliefs about ways to promote immunization. A questionnaire survey was carried out among 528 Iraqi parents with children who had incomplete immunization status. The main barriers to immunization agreed by the parents were lack of vaccine availability (51.5% of parents) and parents' lack of education (42.4%), while 88.4% of parents thought that lack of funding was not an important barrier. More than 60% of the parents suggested promoting childhood immunization via the media, and 77.5% thought that an increase in funding would not remove barriers to childhood immunization. Better vaccine availability in public health clinics and improving parents' literacy might enhance immunization uptake in Iraq.
Background: Pharmacovigilance plays an essential role in the reduction of adverse drugs reaction ... more Background: Pharmacovigilance plays an essential role in the reduction of adverse drugs reaction (ADRs), thus the evolution and growth of this science are critical for effective and safe clinical practice. Aim: This study will evaluate doctors’ attitudes, barriers and factors encouraging toward ADRs reporting. Methods: A cross-sectional prospective study has been conducted. It was a psychometric evaluation assessment using a previously modified questionnaire. Results: The majority of the surveyed doctors (78%) believed that reporting adverse drug reactions (ADRs) is part of their duty, and monitoring drug safety is also important (96%). The study findings revealed that about 68% of the doctors felt that they did not have sufficient clinical knowledge to detect ADRs. Nearly two-third of the doctor’s agreed that they are not convinced that the ADRs are caused by the drug. This study show that an association between doctors knowledge about ADRs detection and the number of patient seen by day, as the number of patient increased the doctors knowledge about ADRs improved. Recommendations: Special and direct educational programs, along with continued promotion, could help to enhance the involvement of physicians in ADR reporting and pharmacovigilance activities and help to reduce misconceptions and other logistic barriers to ADR reporting. Further studies with large populations are needed for a better understanding of the actual deterrents which prevent private clinic doctors from reporting ADRs
OBJECTIVES: To conduct a systematic review for the evidence supporting or disproving the reality ... more OBJECTIVES: To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug.METHODS: The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan.RESULTS: There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics.CONCLUSIONS: There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).
Objectives: This study was designed to explore the awareness and attitude of the pharmacists work... more Objectives: This study was designed to explore the awareness and attitude of the pharmacists working in the retail pharmacies toward the national adverse drug reactions (ADRs) system activities in Iraq. Methods: A cross-sectional survey using a validated self-administered questionnaire was used in this study. The questionnaire was delivered to retail pharmacists (RPs) practicing in Baghdad during the study period (4 months). Results: Of the 200, only 176 pharmacists responded to the survey (response rate of 88%). The total number of usable responses was 123 (61.5%). The survey findings revealed that 79 pharmacists (64.2%) were not aware of the Iraqi spontaneous reporting system (SRS). The restriction factors which dropping the ADRs reporting among RPs were identified. These include lack of knowledge in the way of reporting (n = 41; 33.3%), the unavailability of reporting forms (n = 88; 71.6%), and unawareness of where these reports should be sent to (n = 88; 71.6%). Conclusions: The study showed that the RPs in Baghdad have a very positive attitude toward ADRs but unfortunately; they are not familiar with the Iraqi SRS. The study findings emphasize the serious need for special education programs to promote ADRs reporting among RPs.
integrated chronic care approach in patients with atrial fibrillation compared to usual care. The... more integrated chronic care approach in patients with atrial fibrillation compared to usual care. The objective of the present study is to assess cost-effectiveness of this nurse-led care program versus usual care. METHODS: A cost effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, Maastricht, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline adherent management, steered by dedicated software and supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per lifeyear as well as a cost per QALY analysis was performed, both from a hospital perspective. QALYs were based on scores of the Short Form 36 questionnaire (SF-36), converted to utility scores by extracting the Short Form 6D (SF-6D). All unit prices were supplied by the hospital's financial department, except for prices for medication, which were taken from the Dutch Pharmacotherapeutic Compass. Results represented the costs and effects for a 12 months follow-up period. RESULTS: The nurse-led care program was associated with slightly more lifeyears and QALYs at a lower cost. Specifically, the nurse-led program contributed to 0.086 QALY gains with a reduced cost of € 1102.77 per patient and a gain of 0.02 life years with a reduced cost of € 731.62 per patient. Therefore, the nurse-led program would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led program is considered to be more likely cost effective than the care as usual. CONCLUSIONS: The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach is very likely a costeffective management strategy for patients with atrial fibrillation.
Deficiencies in knowledge about immunization among parents often leads to poor uptake or errors i... more Deficiencies in knowledge about immunization among parents often leads to poor uptake or errors in immunization dosage and timing. The aims of this study were to determine Iraqi parents' views of barriers to immunization and beliefs about ways to promote immunization. A questionnaire survey was carried out among 528 Iraqi parents with children who had incomplete immunization status. The main barriers to immunization agreed by the parents were lack of vaccine availability (51.5% of parents) and parents' lack of education (42.4%), while 88.4% of parents thought that lack of funding was not an important barrier. More than 60% of the parents suggested promoting childhood immunization via the media, and 77.5% thought that an increase in funding would not remove barriers to childhood immunization. Better vaccine availability in public health clinics and improving parents' literacy might enhance immunization uptake in Iraq.
Background: Pharmacovigilance plays an essential role in the reduction of adverse drugs reaction ... more Background: Pharmacovigilance plays an essential role in the reduction of adverse drugs reaction (ADRs), thus the evolution and growth of this science are critical for effective and safe clinical practice. Aim: This study will evaluate doctors’ attitudes, barriers and factors encouraging toward ADRs reporting. Methods: A cross-sectional prospective study has been conducted. It was a psychometric evaluation assessment using a previously modified questionnaire. Results: The majority of the surveyed doctors (78%) believed that reporting adverse drug reactions (ADRs) is part of their duty, and monitoring drug safety is also important (96%). The study findings revealed that about 68% of the doctors felt that they did not have sufficient clinical knowledge to detect ADRs. Nearly two-third of the doctor’s agreed that they are not convinced that the ADRs are caused by the drug. This study show that an association between doctors knowledge about ADRs detection and the number of patient seen by day, as the number of patient increased the doctors knowledge about ADRs improved. Recommendations: Special and direct educational programs, along with continued promotion, could help to enhance the involvement of physicians in ADR reporting and pharmacovigilance activities and help to reduce misconceptions and other logistic barriers to ADR reporting. Further studies with large populations are needed for a better understanding of the actual deterrents which prevent private clinic doctors from reporting ADRs
OBJECTIVES: To conduct a systematic review for the evidence supporting or disproving the reality ... more OBJECTIVES: To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug.METHODS: The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan.RESULTS: There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics.CONCLUSIONS: There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).
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Papers by Muhannad Salih
the evolution and growth of this science are critical for effective and safe clinical practice.
Aim: This study will evaluate doctors’ attitudes, barriers and factors encouraging toward ADRs reporting.
Methods: A cross-sectional prospective study has been conducted. It was a psychometric evaluation assessment
using a previously modified questionnaire.
Results: The majority of the surveyed doctors (78%) believed that reporting adverse drug reactions (ADRs) is
part of their duty, and monitoring drug safety is also important (96%). The study findings revealed that about 68% of
the doctors felt that they did not have sufficient clinical knowledge to detect ADRs. Nearly two-third of the doctor’s
agreed that they are not convinced that the ADRs are caused by the drug. This study show that an association
between doctors knowledge about ADRs detection and the number of patient seen by day, as the number of patient
increased the doctors knowledge about ADRs improved.
Recommendations: Special and direct educational programs, along with continued promotion, could help
to enhance the involvement of physicians in ADR reporting and pharmacovigilance activities and help to reduce
misconceptions and other logistic barriers to ADR reporting. Further studies with large populations are needed for a
better understanding of the actual deterrents which prevent private clinic doctors from reporting ADRs
the evolution and growth of this science are critical for effective and safe clinical practice.
Aim: This study will evaluate doctors’ attitudes, barriers and factors encouraging toward ADRs reporting.
Methods: A cross-sectional prospective study has been conducted. It was a psychometric evaluation assessment
using a previously modified questionnaire.
Results: The majority of the surveyed doctors (78%) believed that reporting adverse drug reactions (ADRs) is
part of their duty, and monitoring drug safety is also important (96%). The study findings revealed that about 68% of
the doctors felt that they did not have sufficient clinical knowledge to detect ADRs. Nearly two-third of the doctor’s
agreed that they are not convinced that the ADRs are caused by the drug. This study show that an association
between doctors knowledge about ADRs detection and the number of patient seen by day, as the number of patient
increased the doctors knowledge about ADRs improved.
Recommendations: Special and direct educational programs, along with continued promotion, could help
to enhance the involvement of physicians in ADR reporting and pharmacovigilance activities and help to reduce
misconceptions and other logistic barriers to ADR reporting. Further studies with large populations are needed for a
better understanding of the actual deterrents which prevent private clinic doctors from reporting ADRs