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      Evaluation of Medication Package Inserts in Iran

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          Abstract

          Objective:

          Package inserts (PIs) provide information for the safe and effective use of medication. There is no study on the evaluation of PIs in Iran. The purpose of this study was to evaluate the completeness of PIs supplied with the 100 top-selling medications in Iran.

          Methods:

          This cross-sectional observational study was conducted during 3 weeks in January 2017. One hundred medications were chosen from a list supplied by the Iran Food and Drug Administration (IFDA). The PIs were assessed for the presentation and completeness of quality criteria, which was consisted of two parts. The first part was the criteria required by the IFDA, mentioned in Chapter 16 of the Pharmaceutical Regulations and Instructions provided by the IFDA. The second part of the criteria was defined according to the critical comments of clinical and industrial pharmacists.

          Findings:

          Thirty-seven out of 100 medications included no PIs. None of the PIs met all the criteria required by the IFDA. The highest score for completeness was 18 out of 21 (85.7%). Medication name, description, and adverse reaction were mentioned in all PIs. Other items such as patient counseling information (98%), warnings (95.2%), precautions (95.2%), pregnancy/lactation (95%), and storage condition (90.5%) have been mentioned in a high percentage of PIs.

          Conclusion:

          PIs have improved in recent years in Iran, but there is an absolute need for more accurate and up-to-date information. The IFDA should supervise pharmaceutical companies more strictly in this regard and should revise its regulations requiring PIs to conform to the FDA regulations.

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          Most cited references24

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          Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit.

          Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA1c) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA1c), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day, 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 (68; range 9-246] insulin days/annum). There was a significant inverse association between HbA1c and the adherence index (R2 = 0.39; p 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.
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            Patient compliance with antibiotic treatment for respiratory tract infections.

            Despite doctors' expectations, non-compliance is common in short-term antibiotic therapy of respiratory tract infections (RTIs). This phenomenon has profound practical implications. It leads to ineffective management, the deterioration of patients' health, hospital admissions, additional costs and the emergence of antibiotic-resistant microorganisms. This article reviews methods of measuring compliance with antibiotics in the outpatient-based management of RTIs and research results. Causes of non-compliance are also discussed. Factors influencing compliance are analysed, as well as practical strategies for addressing non-compliance with antibiotic therapies for RTIs. The influence of the frequency of doses on compliance is particularly stressed, as it has been observed that once daily dosing has almost a 100% compliance rate. As a number of once-daily antibiotic preparations are available now, the possibility of using once-daily schedules for improving compliance in RTI cases is stressed.
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              The Most Important Causes of Death in Iranian Population; a Retrospective Cohort Study

              Introduction: Health care providers and health policy managers need updated and valid information regarding causes of death (COD) for development the health care facilities, directing primary prevention, assigning funds, and promoting public health. The major causes of death and its burden have not been yet appropriately identified in Iran. Although several studies had been carried out in this area, most of them were local or performed in the past years and need to be update. Thus, the present study aimed to address the major causes of death and its burden in Iran. Methods: The present cross-sectional study was performed on graduate students and their families from February to March 2014. Through a two-stage random sampling procedure, data on 11315 subjects were obtained. The corresponding age of death, gender, and calendar year of death were inquired. All causes of death were categorized in nine groups including major cardiovascular disease, cancers, motor vehicle accidents, unintentional injuries, intentional injuries, stroke, lower respiratory infections, diabetes, and other reasons. Years of life lost (YLL) and person years of life lost were computed as the burden of diseases. Results: Totally, 11315 (50.4% male) subjects were studied. The results regarding death of relatives revealed that 360 deaths occurred (66.9% male). COD in 95 cases (26.4%) was cardiovascular diseases, 64 (17.8%) motor vehicle accidents, 41 (11.4%) cancers, 23 (6.4%) unintentional injuries, 22 (6.1%) intentional injuries, 10 (2.8%) stroke, 8 (2.2%) lower respiratory infections, 6 (1.8%) diabetes, and 91 (25.3%) other reasons. The average YLL due to all COD was 34.4±18.5. YLL for motor vehicle accidents and injuries (unintentional and intentional) were higher than cardiovascular diseases (p<0.001). In addition, person years of life lost for motor vehicle accidents were 2613.1 years. Cardiovascular diseases (2159.4 years), cancers (1321.0 years), and unintentional injuries (990.4 years) were in the next ranks. Conclusion: Based on the findings, it seems that cardiovascular diseases, motor vehicle accidents, cancers, intentional and unintentional injuries are the major causes of death in Iranian population. Most of years of life lost were due to motor vehicle accidents, cardiovascular diseases and cancers, intentional and unintentional injuries, respectively.
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                Author and article information

                Journal
                J Res Pharm Pract
                J Res Pharm Pract
                JRPP
                Journal of Research in Pharmacy Practice
                Wolters Kluwer - Medknow (India )
                2319-9644
                2279-042X
                Apr-Jun 2019
                : 8
                : 2
                : 45-51
                Affiliations
                [1 ]Students' Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Gilan, Iran
                [2 ]Department of Clinical Pharmacy, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Gilan, Iran
                [3 ]Hematology-Oncology Research Center and Stem Cell Transplantation, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Address for correspondence: Dr. Hamidreza Taghvaye-Masoumi, E-mail: taghvahamidreza@ 123456yahoo.com
                Article
                JRPP-8-45
                10.4103/jrpp.JRPP_18_32
                6636423
                05a94baf-916e-46df-95cd-8bfbc0c95a87
                Copyright: © 2019 Journal of Research in Pharmacy Practice

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : April 2018
                : January 2019
                Categories
                Original Article

                community pharmacy,package insert,patient information,regulations

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