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Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time.Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time.Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%.Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.

The touch of the product plays an important role in the final decision of the customer when purchasing from physical and online retail, and the sensations that come to be enjoyed through touch enable them to experience the product from all angles. Therefore, considering the importance of touch, this research has investigated the lived experience of touching the product from the point of view of customers of physical and online stores. The following article is done with qualitative method and phenomenological paradigm. The research community is made up of electronic and clothing buyers from online and physical stores: Technolife, Adak, Havadar and Happyland in Tehran, and through semi-structured interviews, evidence was collected based on the purposeful sampling method. The interviews continued until reaching the theoretical saturation, and in this research, the interviews reached saturation with 15 people. Based on the extracted results, the main themes include; Product perception is physical touch, virtual touch, touch experiences, need for touch and touch perceptions. According to the results, managers of physical and online stores should provide conditions (such as the use of modern technologies) that touch and contact with the product happen to both groups of online and physical buyers so that they can buy products based on their needs and wants, and also this research can pave the way for the development of touch literature for researchers.

Aims Our study explored the perceived feasibility of using a home-based telerehabilitation service for older adults with chronic health conditions in Israel. Method This mixed-methods study included two focus groups of registered occupational therapists ( n = 10) working in rehabilitation wards in Israel. Participants completed an open-ended questionnaire and Likert scale items so that data could be gathered on their perspectives regarding using an in-home telerehabilitation service for older adults after discharge from rehabilitation units. Thematic analysis with an a priori coding approach was applied to the data. Results Perceived advantages included transfer to the natural environment and the overcoming of geographical distance. Caregiver support and patient motivation were recognized as enabling factors. Perceived barriers included lack of hands-on contact and the concern that safety could be impeded by technological challenges and the patients’ cognitive status. Conclusions Findings from this study can potentially contribute to facilitating the implementation of a home-based telerehabilitation service as a practical alternative for elderly patients after discharge from rehabilitation units in Israel.

Saray Tabak, Sofia Schreiber-Avissar, Elie Beit-Yannai Clinical Biochemistry and Pharmacology Department, Ben-Gurion University of the Negev, Beer-Sheva, IsraelCorrespondence: Elie Beit-YannaiClinical Biochemistry and Pharmacology Department, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, IsraelTel +972-8-6477374Fax +972-8-6479303Email bye@bgu.ac.ilBackground: Extracellular vesicles (EVs) are capable of manipulating cellular functions for the maintenance of biological homeostasis and disease progression, such as in glaucoma disease. These nano-particles carry a net negative surface charge under physiological conditions that can contribute to EVs:EVs interaction and their uptake by target cells.Purpose: To investigate the effect of glaucoma drugs on EVs physicochemical characters and the implications for their uptake by trabecular meshwork (TM) cells.Methods: TM or non-pigmented ciliary epithelium (NPCE) cells derived EVs were incubated with commercial anti-glaucoma formulation, Timolol maleate, Brinzolamide or Benzalkonium Cl and their size and zeta potential (ZP) and physical interactions of EVs derived from NPCE cells and TM cells were evaluated. The contribution of EVs interactions to up-take by TM cells was examined using fluorescence-activated cell sorting.Results: EVs size and ZP were affected by the ionic strength of the buffer rather than EVs type. Commercial glaucoma eye drops, including β-blocker, α-2-agonist and prostaglandin analogs, reduced NPCE EVs ZP, whereas exposure of EVs to carbonic anhydrase inhibitor caused an increase in the ZP. A correlation was found between increased ZP values and increased NPCE EVs uptake by TM cells. We were able to show that Benzalkonium chloride stands behind this ZP effect and not Timolol or Brinzolamide.Conclusion: Altogether, our findings demonstrate that EVs size, surface membrane charge, and ionic strength of the surrounding have an impact on EVs:EVs interactions, which affect the uptake of NPCE EVs by TM cells.Keywords: extracellular vesicles, trabecular meshwork, non-pigmented ciliary epithelium, primary open-angle glaucoma, zeta potential, ionic strength

Oxidative stress (OS) on tissues is a major pathological insult leading to elevated intraocular pressure (IOP) and primary open-angle glaucoma (POAG). Aqueous humor (AH) produced by the non-pigmentary ciliary epithelium (NPCE) drains out via the trabecular meshwork (TM) outflow pathway in the anterior chamber. The exosomes are major constituents of AH, and exosomes can modulate the signaling events, as well as the responses of their target TM tissue. Despite the presence of molecular mechanisms to negate OS, oxidative damage directly, as well as indirectly, influences TM health, AH drainage, and IOP. We proposed that the expression of microRNA (miRNAs) carried by exosomes in the AH can be affected by OS, and this can modulate the pathways in target cells. To assess this, we subjected NPCE to acute and chronic OS (A-OS and C-OS), enriched miRNAs, performed miRNA microarray chip analyses, and miRNA-based gene targeting pathway prediction analysis. We found that various miRNA families, including miR27, miR199, miR23, miR130b, and miR200, changed significantly. Based on pathway prediction analysis, we found that these miRNAs can regulate the genes including Nrf2, Keap1, GSK3B, and serine/threonine-protein phosphatase2A (PP2A). We propose that OS on the NPCE exosomal miRNA cargo can modulate the functionality of the TM tissue.

Dental autotransplantation (DAT) is a surgical procedure in which a donor's tooth is extracted and transplanted from one site to another in the same person. This treatment modality has received considerable attention worldwide in recent years due to its potential advantages over implants. A survey-based study evaluated dentists’ attitudes towards and practice of DAT in Damascus, Syria from September to December 2020. We asked respondents whether they considered this treatment modality when developing treatment plans and whether they view it viable. Only 73 of the 258 respondents (28.3%) stated that they considered DAT as a treatment option. Additionally, 153 respondents (59.3%) either did not view DAT as a viable treatment option or did not know whether it is viable. DAT was underestimated and underused among Syrian dentists. Given this gap in real-world knowledge and practice, academic dental institutions in Syria should place a greater focus on emerging evidence-based knowledge and protocols regarding this treatment option.