Social Pharmacy in Health Care

Safety as a determining factor in the pharmaceutical drug development for patients of the pediatric population

A. A. Kotvitska — 2024-12-05

Patients in the pediatric population are characterized by differences in the pharmacokinetics and pharmacodynamics of drugs and the range of acceptable dosage forms compared to adult patients. The development of safe drugs is designed to reduce the incidence of adverse reactions in this group.

Aim. To highlight physiological features of the body of patients in the pediatric population, the corresponding differences in the pharmacological characteristics of drugs, and approaches to minimizing the risks of pharmacotherapy at the stage of pharmaceutical drug development.

Materials and methods. Such general scientific theoretical methods as system analysis, generalization, and system approach, as well as the bibliographic method consisted in processing scientific sources of information on drug use in pediatrics and developing pediatric dosage forms were used.

Results. When prescribing drugs to pediatric patients, the physiological features of the child’s body development should be considered, using a flexible approach to pharmacotherapy. Many drugs used in pediatrics have not been officially studied in pediatric clinical trials, and therefore, children often receive them off-label. The use of drugs in pediatrics requires special knowledge about the influence of age-related aspects of the child’s physiology on the absorption, distribution, metabolism and excretion of a drug, as well as on its interaction with receptors and organs. This article discusses approaches to the pharmaceutical development of drugs for use in the pediatric population.

Conclusions. In pharmaceutical development of drugs for use in pediatric practice, it is necessary to keep in mind the features of drugs due to age and physiological factors in this category of patients, as well as to take into account the route of administration, the choice of the optimal dosage form, the safety profile of excipients, taste and ease of use of drugs. The development of new medicinal products, including multiparticulate solid dosage forms, is designed to improve the safety profile of drugs in children.

The review of innovations and prospects for the development of physical therapy in modern medicine

I. O. Dubina — 2024-12-05

Aim. To study and summarize the main modern approaches to physical therapy, namely kinesiotherapy, robotic rehabilitation system and virtual platforms; to analyze their effectiveness in different clinical settings and the problem of individualization of rehabilitation programs and the need to develop personalized approaches to patients with different types of pathologies.

Materials and methods. The research materials were materials from scientific publications and thematic Internet sites. The methods of data systematization and generalization were used in the study.

Results. Physical therapy is an important component of medical care, especially for patients who need to recover from injuries, surgeries, or suffer from chronic diseases of the musculoskeletal system and nervous system. Recent decades have been marked by a significant development in physical rehabilitation methods, including the use of the latest technologies and interdisciplinary approaches. Kinesiotherapy is a method of physical therapy based on the use of motor activity to restore body functions. It is one of the most widespread and scientifically proven approaches to the treatment of various pathologies. Robotic rehabilitation systems are one of the most promising areas of modern medicine. Robotic exoskeletons and rehabilitation platforms provide the ability to perform movements with a high level of control and correction, which helps to avoid incorrect exercise performance and speeds up the recovery process. Virtual reality (VR) and telemedicine allow patients to participate in rehabilitation programs in a safe and controlled environment that can be adapted to their needs. A literature review has shown that the use of a personalized rehabilitation program increases the effectiveness of a patient’s physical therapy.

Conclusions. Based on the analysis, it has been found that traditional methods of kinesiotherapy remain the basis of rehabilitation programs, but their effectiveness can be significantly improved through the use of innovative technologies, such as robotic systems, virtual reality and telemedicine platforms. In addition, the combination of different physical rehabilitation methods allow achieving better results in restoring the patients’ physical functions, which is confirmed by the results of many studies. The implementation of such comprehensive approaches can reduce rehabilitation time and improve the quality of life of patient.

The pharmacoeconomic assessment of the rationality of the use of memantine and its combinations with acetylcholinesterase inhibitors in the treatment of dementia in Alzheimer’s disease in Ukraine

M. S. Fedotova — 2024-12-05

Aim. To conduct the pharmacoeconomic assessment of the rationality of using memantine and its combinations with acetylcholinesterase inhibitors in the treatment of dementia in Alzheimer’s disease in Ukraine.

Materials and methods. Historical, analytical and comparative, systematic, graphic, logical, hypothetical-deductive, as well as marketing, pharmacoeconomic, and mathematical and statistical methods of analysis were used. The pharmacoeconomic studies were conducted using the cost-effectiveness method. CER and ICER indicators were calculated for dementia treatment regimens in Alzheimer’s disease containing memantine and its combinations with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) in the period of 12 and 24 weeks of their use. The pharmacoeconomic analysis used data on the clinical effectiveness of dementia treatment regimens in Alzheimer’s disease presented in the Sochrane library (ID Number: CN-01071444; Accession Number: PUBMED 25932260e).

Results. It was found that despite the clinical advantages of using the memantine+galantamine regimen proven by scientists according to the MMSE scale, the use of the memantine+rivastigmine regimen seemed to be rational (CER1 = 23.13 and CER2 = 34.57 USD/unit of increased efficiency). The clinical and economic benefits of using the memantine+galantamine regimen in the treatment of dementia patients with Alzheimer’s disease were proven in the 12- and 24-week regimen (MMSE scale). In the case of using the AADL scale, it was rational, from the point of view of economical use of resources, in the 12-week regimen of treating patients, the use of the memantine + rivastigmine regimen was less expensive (CER₁ = 18.30 $/unit of AADL score reduction), while in the 24-week regime it was the memantine + placebo regimen (CER₂ = $37.58 $/ unit of AADL score reduction).

Conclusions. The research results presented can be used in forming drug purchases carried out by specialized healthcare institutions under the conditions of limited budget funding and growing needs of psychoneurological patients in effective medical and pharmaceutical care.

Nebulizers in pulmonary physical therapy: market overview and selection criteria

T. V. Diadiun — 2024-12-05

Aim. To analyze the market of nebulizers used to provide physical therapy for patients with pulmonary diseases in Ukraine.

Materials and methods. The study was based on scientific publications, data from the State Register of Medical Devices of Ukraine, data from the websites of pharmacy chains, and the results of a survey of pharmaceutical professionals. The research methods were scientific generalization, comparison, graphical and mathematical analysis, and questionnaires.

Results. The data on the technical characteristics of modern nebulizers and the peculiarities of their use in physical therapy of different groups of patients were summarized. The analysis of the range of nebulizers in the pharmaceutical market of Ukraine showed that the dominant models were compressor-type models (almost 68 % of the range). The share of ultrasonic and mesh nebulizers was insignificant – 26 % and 6 %, respectively. Among the manufacturers of compressor nebulizers, the main share in the assortment belonged to models made in Ukraine (28 % of the subgroup assortment). In general, this type of nebulizers was supplied to the market by manufacturers from 10 countries. The share of domestic models in the ultrasonic nebulizer assortment was 23 %, while the remaining 6 countries accounted for 77 % of the range, respectively. Mesh nebulizers were available from 3 countries (Germany, Japan, China). It was found that the inhaler with the best reviews among doctors was the ArhiMED MESH Pro mesh nebulizer model (Poland), the second place was occupied by the B.Well pro-115 ultrasonic model (Switzerland), and the third place was occupied by the Medisana IN 525 compressor-type model (Germany). The analysis of price characteristics of nebulizers showed that the greatest fluctuations in cost indicators were experienced by the Medisana IN 510 compressor-type models (Germany) – the value of the price growth index was 2.4. Based on the calculations of the affordability index, it was determined that the Beurer IH 21 nebulizer (Germany) with an affordability index value of 1.43 was the most affordable during the period of analysis. The results of the survey of pharmacists involved in the selection of nebulizers for pharmacy visitors showed that compressor-type nebulizers were in the greatest demand, and the price category from UAH 1000 to UAH 1500 was acceptable for consumers to purchase this type of medical equipment.

Conclusions. The results of the analysis indicate the physical availability and a wide range of nebulizers for providing physical therapy to patients with pulmonary diseases. However, it has been determined that to ensure the affordability of these devices, it is necessary to implement government measures and programs for the relevant groups of patients. In addition, it can be argued that developing and implementing standardization of criteria for assessing the effectiveness of various types of nebulizers, as well as determining the long-term impact of nebulizer therapy on patients with respiratory diseases, is relevant.

The study of the level of professional burnout among pharmacists

I. V. Bondarieva — 2024-12-05

Aim. To determine the level of professional burnout among pharmacists in different regions of Ukraine and evaluate the main factors contributing to the occurrence of this condition.

Materials and methods. During the study, the methods of system analysis, generalization, comparison, logical analysis, as well as the survey method according to Maslach and the developed author’s questionnaire were used.

Results. Most pharmaceutical workers experience fatigue, reduced interest in work and difficulty waking up in the morning, which indicates a high level of occupational stress and burnout. In addition, a significant percentage of respondents complain of emotional exhaustion and depression, which deepens the negative impact on their motivation. The main factors contributing to burnout are job monotony, low financial remuneration, workplace conflicts and lack of proper support from colleagues and management. In addition, most pharmaceutical workers feel that their work is underestimated, which reduces overall satisfaction with the profession. The consequences of professional burnout are deterioration in the quality of customer service, an increase in the number of errors in the pharmacists’ work, and an increase in staff turnover in pharmacies.

Conclusions. The vast majority of pharmacists experience signs of professional burnout, which often forces them to change their workplace or even their field of activity. In order to reduce this phenomenon, it is necessary to take comprehensive measures aimed at optimizing the workload, providing psychological support, creating favorable working conditions and properly evaluating the professional efforts of pharmaceutical workers. Special attention should be paid to the implementation of programs for the development of professional stress management skills.

Physical therapy after femur fracture in elderly patients at the long-term rehabilitation stage

A. A. Kotvitska — 2024-12-05

Femoral neck fractures are the leading cause of disability among the elderly. Rehabilitation is fundamental to restore functionality that was before the fracture.

Aim. To conduct an observational cohort study to compare the effectiveness of rehabilitation programs in different therapeutic settings.

Materials and methods. Elderly patients who underwent surgical stabilization of femur fracture were included in the study. The participants were divided into 3 groups: group 1 – outpatient rehabilitation; group 2 – inpatient rehabilitation; group 3 – rehabilitation at home. Rehabilitation results were determined at the initial stage, 3 and 6 months after the fracture. The Barthel index, passive and active range of motion in hip flexion and extension, and the muscle strength in flexion, extension, and extension of the knee joint were assessed.

Results. In 6 months, all three groups showed statistically significant improvement (p < 0.05) in all indices compared to baseline. Considering the intergroup analysis, the final Barthel index score was significantly higher in patients who were treated as outpatients (88.00 ± 9.6) than inpatients (68.57 ± 11.7), but no statistical difference was found between patients who were treated as outpatients and at home (82.5 ± 10.4). In general, patients who were treated in outpatient settings showed better functional outcomes, while patients who were rehabilitated in inpatient settings had worse outcomes. Patients treated at home showed intermediate final functional outcomes more similar to outpatients. Patients with hip fracture undergoing outpatient rehabilitation were more likely to have better long-term effects of the rehabilitation protocol regarding the functional status, muscle strength in hip flexion, hip extension, and knee extension. Patients referred to home rehabilitation showed intermediate results, closer to outpatients, although they started rehabilitation treatment faster after the hospital discharge.

Conclusions. The data obtained indicate that rehabilitation leads to significant functional recovery after femur fracture in elderly patients. Both outpatient and home-based rehabilitation are acceptable rehabilitation options for femoral fractures.

Analysis of the structure and dynamics of epidemiological indicators of renal cell carcinoma in the world and Ukraine

O.V. Kaiota — 2024-12-05

Aim. To analyze the structure and dynamics of epidemiological indicators of renal cell carcinoma (RCC) worldwide and in Ukraine.

Materials and methods. The study materials were publications in scientific journals, statistical reports of international and national health organizations, including data from the Global Cancer Observatory (GLOBOCAN) and European Association of Urology databases, as well as data from the Ukrainian National Cancer Registry Bulletin and official statistics from various regions of Ukraine. The methods of content analysis, comparative, logical, analytical, mathematical, graphical methods, and generalization of information were used in the study.

Results. According to the results of the analysis, it has been found that the incidence of RCC varies considerably around the world, with the highest rates in North America, Eastern and Northern Europe and the lowest in Africa and South Asia. In the United States, about 79,000 new cases of RCC are registered annually, while in Europe, 145,000 cases were reported in 2022. In Ukraine, 3,544 people fell ill with RCC in 2022, of whom 1,238 died. The highest number of cases of RCC was observed in men (2126 cases versus 1418 among women). Among the new cases of RCC in 2022, 20.3 % of patients did not live more than one year. It has been determined that there is heterogeneity in the incidence of RCC in different regions of Ukraine. Thus, the largest number of reported cases of RCC (absolute value) in 2022 was observed in Dnipro (344 cases), Lviv (313 cases) regions and the city of Kyiv (234 cases). The lowest number of new cases of renal malignancies was recorded in the temporarily occupied areas from the active hostilities zone (Luhansk, Donetsk, Kherson regions), as well as in Mykolaiv (39 cases) and Chernivtsi (68 cases) regions. The regional differences identified in the morbidity and mortality of patients with RCC may be due to various factors, including, first of all, epidemiological, socio-demographic, and medical factors.

Conclusions. It has been determined that RCC occupies a significant position in the structure of morbidity and mortality among different age and gender groups of the population both in Ukraine and in the world. In general, there is an increase in the number of cases of RCC among both men and women in the world with a significant predominance among men. It has been found that the dynamics of morbidity in Ukraine has a heterogeneous trend with an increase in the number of cases in 2019 compared to 2018; at the same time, a significant decrease in 2020 and 2022 compared to previous years. The study of the data on epidemiological indicators of RCC will further expand the possibilities for evaluating medical technologies and, accordingly, forming directions for improving existing approaches to pharmacotherapy for this group of patients in Ukraine.

Theoretical aspects of the environmental management system of modern pharmaceutical market entities as a factor of the sustainable development

R.V. Sahaidak-Nikitiuk — 2024-12-05

Aim. To develop the theoretical foundations for implementing the environmental management system in the activities of pharmaceutical market entities.

Materials and methods. The materials used in writing the article were the works of scientists, statistical data of the State Statistics Service of Ukraine (Derzhstat). The research methods, such as analysis, synthesis, generalization, structural, system analysis, were used.

Results. The environmental management system of pharmaceutical market entities is closely related to the country’s economy and is one of the tasks of the sustainable development of organizations. According to the environmental paradigm, it is necessary to integrate the environmental management into the general structure of the organization. The environmental management system integrates environmental policies, environmental strategies and environmental programs, which allow the pharmaceutical market entity to create innovative products in eco-friendly productions. The article analyzes the definition of the “environmental management” and suggests that the environmental management of a pharmaceutical market entity should be understood as a part of the management system that has a clear organizational structure and aims to achieve the provisions specified in the organization’s environmental policy through the implementation of the environmental protection programs and management of environmental aspects.

Conclusions. The relevance of implementing the environmental management system in the activities of domestic pharmaceutical market entities has been studied. Based on the research conducted, the definition of the concept of the “environmental management of a pharmaceutical market entity” and its concept has been proposed.