A prospective study has been carried out to assess the incidence, prevalence and cost implications of drugrelated problems in patients with chronic diseases dwelling in a south Indian rural community setting. Details of patients with chronic diseases were recorded in a suitably designed data collection form and assessed for the potential drug-related problems in the prescriptions with the patient's consent. Hepler and Strand classification was used to categorize the identified drug related problems. Each drug-related problem was assessed for its significance level and graded either as minor, moderate or major based on expected clinical outcome. Cost implications due to drug-related problems were also evaluated. During the study period, the research pharmacist visited 550 houses and interviewed 2370 people. Among the interviewed individuals, 215 (8.36%) people were found with chronic diseases. A total of 90 drug-related problems were observed in the patients' prescriptions who met the study criteria. Noncompliance (22), untreated indications (18) and drug interactions (14) were the most commonly found drug-related problems. Among all drug-related problems, 9 problems were graded as major, 37 were moderate and 44 were minor in severity. It is estimated that, a sum of 84 64 950 rupees could have been saved through the pharmacist intervention.

Context:Advent of trastuzumab has brought tremendous changes in the survival of human epidermal growth factor receptor 2 (Her2)-positive breast cancer patients. Despite the availability of the drug, it is still out of reach for many patients. There is very limited real world data regarding treatment challenges and survival analysis of these patients.Aims and Objectives:Primary objective is disease-free survival (DFS) and secondary objective is overall survival (OS) and toxicity profile.Statistics:Statistical analysis is done using GraphPad Prism 7.02.Materials and Methods:This is a retrospective study of all patients diagnosed with Her2-positive (Her2+) nonmetastatic invasive breast cancer from January 2007 to December 2013.Results:In the period of this study, 885 patients are diagnosed with carcinoma breast, of which 212 are Her2/neu positive (23.9%). Of the 212 patients, only 76 (35.8%) patients received trastuzumab along with chemotherapy. Patients receiving trastuzumab with chemotherapy have longer 5-year DFS compared to those receiving chemotherapy alone, 92% and 52.6%, respectively (P = 0.0001). Five-year OS is 90.5% and 41.7% in those patients who received chemotherapy with and without trastuzumab, respectively (P = 0.0001). Seven patients (9.45%) developed Grade II reversible diastolic dysfunction. Grade II/III peripheral neuropathy due to paclitaxel is the main adverse effect seen in 21 patients.Conclusion:In spite of improvement in DFS and OS with trastuzumab, the number of patient receiving targeted therapy is very low due to financial constraints which need to be addressed to bridge the gap in survival of Her2+ patients.

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Those elderly patients are vulnerable to digoxin toxicity due to their diminished organ functions and tendency to occur drug interactions with digoxin. The aim of this research was to describe the exposure patterns of prescribed Chinese Medications (CM) and its associated factors among elderly patients taking digoxin. METHODS: A retrospective population-based cohort study was conducted Longitudinal Health Insurance databases in Taiwan. Those elderly patients being prescribed with digoxin in outpatient settings during 2006 were evaluated for their concurrent use of prescribed CM (prevalence, incidence [excluding concurrent use of CM six month prior], duration). After 1 to 4 randomly matching for those CM-digoxin users and digoxin-along users, the multivariate logistic regression was performed to explore factors associated with concomitant CM-digoxin use and exposure to specific potential interactions. RESULTS: Of 185,076 elderly in 2006 in Taiwan, 6,364 (3.4%) used digoxin and 754 (0.4%) were CM-digoxin users. Within one-year following-up, the prevalence and incidence of concomitant CM use among digoxin elderly users were 13.4% and 7.1%, respectively. The average durations were 190.7±136.7 days for digoxin elderly users, 30.8±49.6 days for prevalent CM-digoxin users, and 17.25±23.9 days for incident CM-digoxin users. While other factors were not statistically significant associated with incident CM-digoxin use, patients with coronary heart diseases (CAD) increased 218% likelihood of incident CM-digoxin use. Those with CAD and BPH and used more health care resources tended to use specific CM with digoxin. CONCLUSIONS: With substantial amount of CMdigoxin users among the elderly, further study is needed to explore the impact of patient outcomes on concurrent use of CM with digoxin.

Introduction:Desisting from disease directed treatment in the past weeks of life is a quality criterion in oncology service. Patients with advanced cancer have unrealistic expectations from chemotherapy and hold on to it as a great source of hope. Many oncologists continue futile and unnecessary treatments, instead of conveying to the patients the lack of benefit, resulting in delayed referral for palliative care (PC).Materials and Methods:This is a retrospective analysis of case records from June 2014 to December 2015. The primary objective was to study, how far back in time terminally ill cancer patients received definitive cancer directed therapy (DCDT). Apart from patient demographics, the diagnosis, stage, and details of DCDT, and death were captured. PC referral data were recorded. DCDT to death was taken as treatment-free interval (TFI). Analysis was performed using IBM SPSS Statistics for Windows, Version 20.Results:A total of 292 case records were evaluated. Seventy-three had inadequate treatment details. Hence, 219 records were analyzed. PC referral was done in 78.5% of patients. Only best supportive care (BSC) without any DCDT was given in 27 patients. The most common reason for BSC was a poor performance status in 92.5%. The median time from PC referral till death was 43.5 days (range: 1–518 days). Chemotherapy was the most common DCDT in 52.9% of patients. The median time from DCDT and death was 49 days (range: 0–359 days). Cervical and ovarian cancers patients had the longest TFI; shortest in unknown primary. Most patients died at home (70.4%). Patients receiving PC preferred home or hospice as place of death. Of the 80 patients given hospice care, 39 (36.5%) died in the hospice.Conclusion:While DCDT needs to be started at the right time, it should also be discontinued when futile. Early involvement of the PC team, even while patients are on DCDT makes the transition smoother and more meaningful.