[Show abstract][Hide abstract] ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) are the most frequently used antidepressants during pregnancy. There are conflicting results about their influence on pregnancy outcomes. The goal of this study was to update our previous meta-analysis about pregnancy outcomes following exposure to SSRIs. For this purpose, all relevant databases were searched from 1990 to March 2012 for studies investigating the pregnancy outcomes following exposure to any therapeutic dosage of any SSRI (fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine) during pregnancy. Types of outcome investigated were spontaneous abortion, major malformations, cardiovascular malformations, and minor malformations. A total of 25 studies met our criteria and were included in the meta-analysis. The odds ratio (OD) values are 1.87 (95% CI: 1.5 to 2.33, P< 0.0001) for spontaneous abortion, 1.272 (95% CI: 1.098 to 1.474, P = 0.0014) for major malformations, 1.192 (95% CI: 0.39 to 3.644, P= 0.7578) for cardiovascular malformations, and 1.36 (95% CI: 0.61 to 3.04, P= 0.4498) for minor malformations. The results demonstrated that SSRIs increase the risk of spontaneous abortion and major malformations during pregnancy while they don't increase the risk of cardiovascular malformations and minor malformations. Our previous meta-analysis only showed an increase in the risk of spontaneous abortion following the use of SSRIs during pregnancy. This might be due to increase in the number of studies included or addition of two new SSRIs (citalopram and escitalopram). The message to researchers is to try considering SSRIs individually during pregnancy to reduce heterogeneity, although all are aware of inevitable limitations to study on pregnant mothers.
Full-text · Article · Nov 2012 · DARU-JOURNAL OF FACULTY OF PHARMACY
[Show abstract][Hide abstract] ABSTRACT: Purpose Healthcare workers have a main role in detection, assessment and spontaneous reporting of adverse drug reactions (ADRs), and improvement of their related knowledge, attitude and perception is essential. The goal of this study was evaluation of clinical pharmacists' interventions in improvement of knowledge, attitude and perception of healthcare workers about ADRs in a teaching referral hospital, Tehran, Iran.
Method Changes in knowledge, attitude and perception of healthcare workers of Imam teaching hospital about ADRs were evaluated before and after clinical pharmacists' interventions including workshops, meetings and presentations.
Results From the 100 participated subjects, 82 of them completed the study. 51% of the health workers have been aware of the Iranian Pharmacovigilance Center at the ministry of health before intervention and after that all the participants knew this centre. About awareness and detection of ADRs in patients, 69 (84.1%) healthcare workers recognised at least one, and following interventions, it was improved to 73 (89%). Only seven (8.5%) subjects have reported ADRs in before intervention phase that were increased significantly to 18 (22%) after intervention.
Conclusion Clinical pharmacists' interventions were successful in improvement of healthcare workers' knowledge, attitude and perception about ADRs and spontaneous reporting in our hospital.
[Show abstract][Hide abstract] ABSTRACT: Stress ulcers are acute superficial inflammatory lesions of the gastric mucosa induced when an individual is subjected to unusually high physiologic demands. In recent years, use of acid suppression therapy (AST) for stress ulcer prophylaxis (SUP) in inpatient settings other than intensive care has become increasingly common, leading to increased drug cost and an avoidable increased risk of adverse events such as hospitalacquired pneumonia.
To assess the effects of a clinical pharmacist intervention including AST prescribing and adherence to a SUP guideline that was developed by clinical pharmacists for use in the infectious disease ward of a teaching hospital based on the 1999 American Society of Health-System Pharmacists (ASHP) guidelines for use of SUP.
This was an exploratory, prospective pre- and post-intervention study of all patients admitted to the infectious disease ward of Imam Khomeini Hospital, the major referral hospital for infectious disease patients in Iran, which is affiliated with Tehran University of Medical Sciences. The study intervention consisted of the use of an internal guideline for SUP that was prepared by clinical pharmacists in accordance with ASHP guidelines, followed by education provided to the physicians who monitored and visited the hospitalized patients in the infectious disease ward. For the 4-month pre-intervention (August 1, 2008, to December 1, 2008) and post-intervention (February 1, 2009, to June 1, 2009) periods, the following data were collected: admitting diagnoses, number and type of SUP risk factors for AST, and type of AST medication used (omeprazole or ranitidine). Exclusions included (a) patients using AST for appropriate gastrointestinal diagnoses at admission (n = 4 in each period), and (b) patients who died during the hospital stay because of a cause other than a gastrointestinal disorder (n = 3 pre-intervention and n = 1 post-intervention). Rates of AST use were measured for the sample overall, and for patients with and without an indication for SUP. Appropriate use was defined as 1 primary (absolute) risk factor (i.e., coagulopathy, mechanical ventilation, or history of gastrointestinal bleed in the last 12 months) or 2 or more secondary (relative) risk factors (e.g., use of heparin). Pre- and post-intervention results were compared using the Pearson chi-square test.
AST use declined from 80.9% (212 of 262) infectious disease ward patients in the pre-intervention period to 47.1% (113 of 240) patients in the post-intervention period (P < 0.001). Of 23 patients in the preintervention period with an indication for SUP according to our ASHP-based guideline, 78.3% (n = 18) received AST versus 85.7% (n = 12 of 14) in the post-intervention period (P = 0.575). Of the patients without an indication for SUP, 194 of 239 (81.2%) received AST in the pre-intervention period versus 101 of 226 (44.7%) in the post-intervention period (P < 0.001). Of the patients who received AST, 194 of 212 (91.5%) did not have an indication for SUP in the pre-intervention period versus 101 of 113 (89.4%) in the post-intervention period (P = 0.528).
In this pre- and post-intervention study without a comparison group, the introduction by pharmacists of a treatment guideline for SUP in the infectious disease ward of Imam Khomeini Hospital was associated with reduction in use of AST overall and in patients without an absolute indication for SUP. However, there was no significant change in either the proportion of patients with an indication for SUP who received AST or in the proportion who received AST without an indication for SUP.
Full-text · Article · Mar 2010 · Journal of managed care pharmacy: JMCP