Abstract Background Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults. Methods The study was of a cross-sectional type, assessing the reliability and validity of a newly developed questionnaire for measuring health-related quality of life (HRQoL) in adults residing in western Balkan states (WB-HRQoL). It was conducted on a sample of 489 adults from Serbia, Croatia, Bosnia & Herzegovina, and Montenegro, with a mean age of 52.2±14.4 years and a male/female ratio of 195/294 (39.9%/60.1%). Result The definitive version of the WB-HRQoL scale with 19 items showed very good reliability, with Cronbach’s alpha 0.905. The scale was temporally stable, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis brought to the surface four domains of health-related quality of life, namely the physical, psychical, social, and environmental. Conclusion The WB-HRQoL scale is a reliable and valid generic instrument for measuring HRQoL that takes into account the cultural specifics of the western Balkan region.

Introduction: A gap between evidence-based recommendations for prescribing antipsychotics and its implementation in practice could be overcome by local guidelines. Aim: The aim of our study was to locally adapt the national guideline for schizophrenia and evaluate its impact on prescribing practice as well as on clinical and humanistic outcomes in a long-stay psychiatric hospital Dobrota in Kotor, Montenegro. Subjects and Methods: This was academic, prospective, IV phase interventional study, which measured outcome before and after investigators intervention within healthcare system. The study was conducted in two six-months phases separated by implementation of the local guidelines. Prescribing practices and treatment outcomes were monitored in both phases of the study. Results: Study included 111 patients. Although the guidelines did not infl uence total volume of prescribed antipsychotics, social functioning and environmental aspects of quality of life were improved. Conclusions: Writing and adopting the guidelines for local use might be associated with some benefi t in humanistic outcomes, but multi-faceted intervention should be considered in order to achieve more substantial impact on prescribing practices and clinical outcomes.

Drug-drug interactions (DDIs) with serious adverse consequences for patients at intensive care unit (ICU) occur with the prevalence of 5.3%. The aim of our study was to reveal the risk factors for potential DDIs among the ICU patients. This retrospective cohort analysis took place in the ICU of the Clinical Center Podgorica, Montenegro, between June 1, 2017 and September 30, 2018. The study was conducted as a chart review of the ICU patients (n = 99) who spent ≥ 2 days in the ICU. The main outcome measure was the number of DDIs per patient. Ninety-four percent of patients had at least one potential DDI, while 20% of patients had at least one potential DDI which required a change of therapy. The number of potential DDIs per patient according to the Medscape was 6.6 ± 9.1 and 3.8 ± 4.9 according to the Epocrates. A higher number of drugs (or therapeutic groups) prescribed per patient increased the number of potential DDIs, including those which required a change of therapy. The patients who were prescribed antiarrhythmics, anticoagulants or two antiplatelet drugs experienced more DDIs than patients without these therapeutic groups, while delirium, dementia and drug allergy were protective factors. The main limitation of our study was its uni-centerdness, which allowed for certain degree of bias. Routine screening of the ICU patients with high number of prescribed drugs who receive antiarrhythmics, anticoagulants or double antiplatelet therapy for potential DDIs may prevent a great deal of DDIs with potentially deleterious effects.

Objectives The aim of this study was to evaluate implementation of services provided by a clinical pharmacist for long-term-hospitalised patients with schizophrenia in a pharmaceutical-care-naive developing country. Method This was a prospective, healthcare-system, interventional, ‘before-and-after’ study. Long-term (≥6 months) inpatients with schizophrenia were included. A clinical pharmacist reviewed the full patient notes, identified drug-related problems (DRPs), and proposed interventions using a DRP Registration Form (PCNE classification V6.2). Acceptance rate and outcomes of interventions were assessed. Results For 49 patients, 71 DRPs were identified, ranging from one to four problems/patient (1.43±0.68), predominantly related to tolerability and treatment effectiveness. The DRPs were mostly caused (N=184) by inappropriate drug selection (64%) or dose (23.4%): too many drugs for indication (N=33); a non-cost-effective choice (N=29); inappropriate combination (N=27); an inappropriate drug (N=23); lack of therapeutic drug monitoring (N=14); subtherapeutic (N=13) or supratherapeutic (N=11) dosing. Excessive treatment duration was observed for 14 DRPs. The clinical pharmacist proposed 182 interventions (70% at the drug level): discontinuation of medication (N=58); dosage change (N=35); other interventions (monitoring) (N=35); a change of drug (N=18) or instructions for use (N=9); and/or introduction of a new drug (N=7). Physicians accepted 91 interventions and refused 36. Finally, 38 DRPs were solved (25 completely and 13 partially), for 25 a solution was either not needed or not possible, and, for eight, the outcome was not known. Conclusions The study underlines the high potential for pharmaceutical care to improve prescribing practices in developing countries without shared pharmacist–physician decision-making.

ABSTRACT Background. Although prescribing antipsychotics to patients with schizophrenia is advised by national and/or international evidence-based practice guidelines, the implementation of the guidelines in clinical practice is still matter of concern. Objective. The aim of our study was to estimate schizophrenia guideline adherence and identify eventual barriers to its implementation in Montenegro. Method. This study used focus group methodology. The focus group was composed of two psychiatrists, one psychologist, one pharmacist from a community pharmacy, one pharmacist from the State reimbursement fund, one pharmacist from a drug wholesaler and the chief investigator, a clinical pharmacologist. The focus group took place in Podgorica, Montenegro, in 2013. The analysis of recordings was performed using an iterative, qualitative technique and a constant comparison method. Results. The most important barriers to the implementation of evidence-based guidelines for the treatment of schizophrenia in Montenegro are non-adherence to medication, low level of psychiatrist-patient concordance, restrictive procedures for prescribing atypical antipsychotics, lack of availability of newer antipsychotics and some dosage forms, and mixing primary, secondary and tertiary care services within a tertiary care psychiatric institution. Conclusion. Addressing the barriers identified by this focus group and avoiding the consequences of poor adherence would be the first SAŽETAK Uvod. Mada je propisivanje antipsihotika pacijentima sa šizofrenijom regulisano nacionalnim i/ili međunarodnim smernicama dobre kliničke prakse, zasnovanim na dokazima, primena ovih smernica u praksi je daleko od željene. Cilj. Cilj naše studije je bio da proceni koliko se psihijatri u Crnoj Gori pridržavaju smernica prilikom propisivanja antipsihotika, i da identifi kuje eventualne prepreke za njihovu punu primenu. Metod. U studiji je korišćena matodologija fokus grupe. Fokus grupu su sačinjavali dva psihijatra, jedan psiholog, jedan farmaceut iz vanbolničke apoteke, jedan farmaceut iz Fonda zdravstvenog osiguranja, jedan farmaceut predstavnik veledrogerije i glavni istraživač, klinički farmakolog. Sastanak fokus grupe je održan u Podgorici, Crna Gora, tokom 2013. godine. Analiza fonografskih zapisa sa sastanka je rađena iterativnom kvalitativnom tehnikom i metodom stalnog poređenja. Rezultati. Najvažnije prepreke za punu primenu vodiča za lečenje šizofrenije su ne-pridržavanje propisanoj terapiji, nedovoljno učešće pacijenata u donošenju odluka o njihovom lečenju, komplikovana administrativna procedura za propisivanje atipičnih antipsihotika, nedostupnost novijih antipsihotika i nekih doznih formi, kao i pomešanost primarnih, sekundarnih i tercijernih zdravstvenih usluga u bolnicama namenjenim samo za tercijernu zaštitu. Conclusion. Obraćanje pažnje na prepreke za primenu smernica koje je identifi kovala focus grupa i popravljanje adherence pacijenata su prvi koraci ka boljem planiranju psihijatrijske zdravstvene zaštite u Crnoj Gori.

Introduction: The weak anticonvulsant activity of the analgesic flupirtine led to the creation of ezogabine; an analogue which demonstrated both stronger antiepileptic activity and weaker analgesic effects. It's use as an anticonvulsant has been particularly effective in treating patients who have therapy-resistant epilepsy. Ezogabine binds to the KCNQ potassium channel, thereby decreasing the membrane potential threshold for its activation and increasing the probability of its maximum opening. Areas covered: This drug discovery case history provides an overview of the history of the anticonvulsant, ezogabine, and presents relevant information pertaining to its discovery and preclinical development. The article helps explain the methods of discovery through the explanation of ezogabine's mechanism of action. Further, the authors also highlight the drugs clinical development and its postlaunch developments. Expert opinion: More intense investment in research on the molecular mechanism of action early in the preclinical development of a drug could allow for the more suitable planning of preclinical studies and for the early discovery of specific, but important drug toxicities. This investment would make transitioning from the preclinical to the clinical phase easier and could result in better planning for what will be more productive clinical studies.

OBJECTIVES The objective of our study was to investigate whether submissiveness to medical authorities could interfere with practicing of evidence-based medicine by family physicians. METHODS A qualitative, semi-structured interview on a sample of family physicians in Podgorica, Montenegro, was conducted. The interview schedule was developed through consultations with fellow clinical pharmacists and pharmacologists, and its face and content validity was checked by a pilot study. RESULTS The physicians mostly relied on non-evidence based sources of information such as opinion leaders, colleagues, unsystematic experience, pharmaceutical companies and uncritical internet search. Their main goal was to become “ encouraged” , “affirmed” and “supported” , which resulted with psychological gain, but did not guarantee benefits for the patient. The most trustworthy information sources were national experts recognized by the heath authorities, well known “professors”, regardless whether they were practicing the evidence-based medicine themselves, or not. CONCLUSIONS Although the family physicians have heard of the evidence-based medicine, and they value it as something positive, they do not have sufficient initiative to change routine behaviour and improve their practice. Such attitude has deep roots in hierarchy of power within authoritarian society, and probably will change slowly, together with gradual development of democracy.