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Evaluation of hospital-specific antimicrobial use is necessary for successful national antimicrobial stewardship. This study aimed to identify antimicrobial use in long-term care hospitals (LCHs) in Korea. A multi-centre retrospective study was conducted to evaluate the prescription patterns and appropriateness of antimicrobials in 20 LCHs in Korea. The medical record data of hospitalized patients who were newly prescribed antimicrobials at each hospital were collected manually between 10th July and 31st October 2023 to evaluate the appropriateness of antimicrobial use. The prevalence of antimicrobial prescriptions was 8.9% (365/4086) and 10.3% (402/3892) on 12th July 2023 and 18th October 2023, respectively. In total, 885 antimicrobials were prescribed to 740 patients. Among the antimicrobials, third- or fourth-generation cephalosporins (31.9%) represented the most prescribed antimicrobial class. A large majority of antimicrobials (96.6%, 855/885) were prescribed for the treatment of infectious diseases; however, only 37.7% (322/855) of antimicrobials were prescribed appropriately for infections. The route of administration, dosage and prescribed antimicrobial were appropriate in 99.6% (852/855), 56.1% (480/855) and 62.0% (530/855) of cases, respectively. In total, 35.2% (252/715) of patients were prescribed antimicrobials appropriately. The diagnosis of infectious disease was appropriate for 52.9% (472/892) of cases. Of the five, 15 and 10 antimicrobials used for surgical site infection prophylaxis, medical prophylaxis and other purposes, respectively, none were used appropriately. The proportion of antimicrobials used appropriately is low in Korean LCHs. These data highlight the importance of establishing antimicrobial stewardship in LCHs. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The global surge in non-communicable diseases, like cancer, strains health systems financially and restricts patient access to treatment. Generic drugs offer comparable efficacy, safety, and quality to innovator drugs, improving patient access and well-being. To aid healthcare workers in selecting the best generic drugs, Generic drug Adoption Framework (GRAF) was developed as an evaluation tool. This paper aims to adapt the tool to Colombia for healthcare professional's daily use. Methods: Adapting the tool involved two phases: surveying healthcare workers (oncologists' specialists and pharmacists) to gauge their readiness for adopting generic drugs, additionally and expert consensus was developed to adapt the tool to the Colombian context. Results: Of 62 surveyed healthcare workers, 38.7% were early adopters and 32.3% were late adopters. Pharmacists showed higher early adoption rates (47%) than physicians (33%). In the second phase, experts identified 12 relevant attributes for the Colombian scenario, refining descriptions and scoring scales. Conclusion: The study revealed Colombian healthcare workers' perceptions of generic drugs and differences in adoption rates. The adapted tool to the Colombian healthcare context could clarify misconceptions that require diverse strategies to increase the use of generic drugs, aiding in better patient care. [ABSTRACT FROM AUTHOR]

Abstract Objective To identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan. Methods This cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study. Results The average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting. Conclusion The study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety.

Objective: To identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan. Methods: This cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study. Results: The average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting. Conclusion: The study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety. [ABSTRACT FROM AUTHOR]

Aims: The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools. Methods: This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods. Results: This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. Conclusions: This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications. [ABSTRACT FROM AUTHOR]

Background: Prescribing errors are quite common and according to one estimate out of 100 patients admitted into UK hospitals 15 will have some form of prescribing error in their records. It is a general understanding that most of the time these errors are made due to lack of awareness. Severity of these errors can range from minor to major mistakes that can lead to fatal results. Materials and Methods: A simplified anonymous approach of identifying these errors and then using a step wise approach to educate the prescribers’ especially junior doctors can be quite fruitful in reducing these errors. Unfortunately there are not many studies or projects available to back our proposal however these seems a logical way forward and is exactly what we have shown in our study. Results: We performed a prospective snapshot study involving 100 inpatients to get baseline measurements. The errors and mistakes were identified and fed back to the junior doctors in an anonymous manner. Clear & legible writing, frequency of use, responsible consultant name, allergy box filled, VTE assessment, oxygen prescribing and labeling of medication discontinuation were the most common negligence identified. At the same time junior doctors were reminded of local prescription standards and guidelines which usually don’t form part of induction. Conclusion: Multiple deficient areas were identified during this audit like legible writing, dosage frequency, VTE prophylaxis and oxygen prescription. It was highlighted to junior doctors how important are these components as they play a key role in patient getting better after medical review. Above mentioned steps did improve prescription errors to an extent, but aim should be to achieve 100% results. Repeated reminders are important in this case as that helps to improve practice and avoid clinical accidents.

The aim of this study was to verify if there is a relationship between physicians' specialization, place of practice, or views on issues related to compounded medicines and the frequency of prescribing such formulations. Additionally, the study aimed to determine the factors that influence these views. The study also examined the barriers and encouragements, according to physicians, in the use of compounded medicines. The original questionnaire was developed specifically for this study. Included sample consisted of Polish-speaking physicians whose main specialization was gynaecology, gastroenterology, dermatology, family medicine, internal medicine, otorhinolaryngology, paediatric otorhinolaryngology, paediatrics. Answers were gathered using computer-assisted telephone interview. The majority of surveyed physicians believed that every Polish patient receives treatment tailored to their personal needs (68,7%) and agreed that compounded medicines are a way to facilitate individualization of pharmacotherapy (79,3%). Frequency of prescribing of magistral formulations, as well as views on quality of compounded medicines, ease of prescribing, and filling a prescription vary between specializations and places of practice. The problem that negatively affects the practice of the largest group of respondents was complicated and frequently changing legal regulations (63.3%), while the least frequently indicated problems were concerns about the quality of preparation (16.7%). Based on opinion of surveyed physicians, a simplification of the regulations for prescribing and liberalization of reimbursement rules are main changes to consider in order to improve clinical practice in the areas where it relates to the prescription of compounded medicines.

Background: Unlicensed and off-label (UL/OL) prescriptions have been associated with an increased risk of drug-related problems. Data of their prevalence at hospital discharge remain insufficient. We aimed to describe the prevalence of UL/OL drugs in outpatient prescriptions at discharge in children. Methods: We conducted a retrospective study using the routinely collected health data of children at discharge from 2014 to 2016. The primary reference source for determining licensed labelling was the summaries of product characteristics (SPCs) in a French industry-independent formulary named Thériaque. We described the characteristics of UL/OL prescriptions at discharge and looked for predictors of UL/OL prescriptions. Results: We included 2536 prescriptions of 479 children. Licensed, OL, and UL prescriptions accounted for 58.6% (95% CI: 56.7–60.5), 39.2% (95% CI: 37.3–41.1), and 2.3% (95% CI: 1.7–2.9), respectively. A total of 323 (74%) children received at least one UL/OL drug. Among the licensed drugs, bronchodilators (8.8%) and analgesics (8.6%), and among the OL drugs, antibiotics (2.8%), were the most prescribed. The younger age of the children and higher number of drugs they received increased the probability of UL/OL prescriptions (unadjusted p-value of ≤0.05). Conclusion: The prevalence of UL/OL prescriptions is about 40% at discharge from a pediatric university hospital in France. [ABSTRACT FROM AUTHOR]

To investigate veterinarians' experience and perception of the risk of veterinary prescription medication (VPM) misuse and abuse by the public and veterinary professionals and to determine the clinical context in which respondent veterinarians prescribed certain VPMs. Anonymous online voluntary survey. A total of 361 of 7126 veterinarians registered as practicing in the UK, who provided e-mail contact details to the Royal College of Veterinary Surgeons Knowledge for participation in research. Respondents included general practitioners, with or without further qualifications, and European specialists, covering charity, private or academic small, large or mixed animal practice. The anonymous online survey, open from September to December 2021, posed 27 questions regarding personal experience and perception of VPM misuse or abuse, including which VPMs were considered most at risk of abuse by clients or veterinary staff. Thematic analysis was performed on free-text sections. The participation rate was 5% (361/7126), and the completion rate 60% (216/361 respondents). Of these, 88% of respondents somewhat agreed, agreed or strongly agreed that some VPMs were at risk of abuse. A third (29.9%; 107/358) had suspected an owner of taking VPMs, and one fifth (20.1%; 72/358) had suspected veterinary staff. Perceptions regarding the likelihood of public VPM abuse ranged from not suspecting a problem to having first-hand experience. Drugs considered most at risk of owner abuse were opioids, benzodiazepines and gabapentin, and those for veterinary staff were opioids, benzodiazepines and ketamine. Numerous 'red flags' prompting suspicion of VPM abuse were identified alongside ways of mitigating risk. Veterinarians in the UK reported varied experiences with, awareness of, and attitudes towards VPM abuse by the public and veterinary staff. Although not quantified, the UK veterinary industry could be a source of abusable drugs. [ABSTRACT FROM AUTHOR]

Copyright of Middle East Journal of Legal & Jurisprudence Studies / Mağallaẗ al-Šarq al-Awsaṭ li-l-ʿulūm al-Qānūniyyaẗ wa-al-Fiqhiyyaẗ is the property of Manar Elsharq for Studies & Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood–brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics. [ABSTRACT FROM AUTHOR]

There is growing evidence that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment, especially due to vascular damage, blood–brain barrier disruption and uremic toxins. Given the presence of multiple comorbidities, the medication regimen of CKD patients often becomes very complex. Several medications such as psychotropic agents, drugs with anticholinergic properties, GABAergic drugs, opioids, corticosteroids, antibiotics and others have been linked to negative effects on cognition. These drugs are frequently included in the treatment regimen of CKD patients. The first review of this series described how CKD could represent a risk factor for adverse drug reactions affecting the central nervous system. This second review will describe some of the most common medications associated with cognitive impairment (in the general population and in CKD) and describe their effects. [ABSTRACT FROM AUTHOR]

Abstract Background The present study analysed data on children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) who were referred to the ADHD reference centre of Scientific Institute IRCCS E. Medea (Brindisi, Italy) for ADHD pharmacotherapy initiation and monitoring overtime. The main aim of the study was to examine differences in pharmacological treatment status (i.e., treatment continuation vs discontinuation) between patients. Methods Seventy-seven children and adolescents (mean age at pharmacotherapy initiation = 9.5, standard deviation = 2.6) with ADHD received drugs treatment for ADHD at the reference center between January, 2013 and May, 2022. Demographic and clinical data were obtained from the Italian Registry for ADHD and medical records. Child Behavior Checklist (CBCL) available data were used. Results Pharmacological treatment status was examined for patients (n = 63) with at least 12 months of follow-up after the first pharmacological treatment for ADHD. After starting pharmacotherapy treatment, 77.8% (n = 49) patients were still on treatment whereas 22.2% (n = 14) discontinued it. No between group difference were observed in demographic and clinical data except for the intelligence quotient/intellectual disability and rule-breaking behavior (n = 40). Conclusions This study stressed the need of periodical assessments, monitoring difficulties with treatment and/or reasons for poor treatment compliance to provide individualized care.

Abstract The vast majority of people work a large part of their live, therefore work inevitably has a major impact on health as well. In Germany, great efforts are made to improve health and well-being in the occupational context. To support this, the evaluation of health data especially from employees is one the main scopes in health reporting of the Federal Association of Company Health Insurance Funds (BKK Dachverband). These results are made available to the interested public via various publication channels, including interactive online diagrams. Data from the areas of incapacity to work, outpatient and inpatient care as well as drug prescriptions are applied. Due to the in large parts identically structured representations, comparisons across health care system sectors are also possible. The aim of this article is to describe the provided regional health care data of employees with focus on the interactive data provision, to show by example particularities in single sources and across sources. From this the impact of work as well as workplace health promotion on the health of employees and, in a broader sense, the quality of health care in Germany can be derived.

Background: Dental prescribing is considered a basis for short-term treatment of clinical problems. Therefore, dentists should be familiar with the patterns of rational drug prescription. Neglecting this important issue can lead to misprescription and side effects. Accordingly, the present study aimed to investigate the experiences of a group of dental specialists about prescribing drugs.Methods: This qualitative study was conducted using a conventional content analysis approach. A total of 19 specialists from 5 different fields (oral diseases, pediatric dentistry, oral and maxillofacial surgery, endodontics, and periodontics) participated in this study. Purposive and theoretical sampling was used to collect data and semi-structured in-depth interviews were conducted in the form of focus group discussions from each department at Kerman dental school. Data collection and content analysis were performed simultaneously. Results: The analysis of the data revealed five categories including more frequently prescribed drugs, common concerns about prescribing drugs, recommendations for reducing potential side effects, experience of clinical pharmacology training, and criteria for prescribing new drugs.Conclusion: Since the knowledge of dental students affects the quality and effectiveness of treatment and patient safety, this study emphasized the need to improve clinical pharmacology training provided to dentistry students, residents, and dentists.

IntroductionThis study was conducted to understand the impact of package insert (PI) revision in Japan on 18 June 2019 to allow metformin use for patients with moderately decreased kidney function (30 ≤ estimated glomerular filtration rate (eGFR)

Background: A comprehensive guideline named "Diagnostic Therapeutic Flow Chart for Covid-19″ (DTFC) was released by the Scientific Committee of Covid-19 of Iran's Ministry of Health and Medical Education and regularly was updated. The aim of this study was to compare the prescription pattern of drug treatment in outpatient Covid-19 patients with the DTFC. Methods: A cross-sectional study was conducted on the prescription pattern of drugs given to outpatients with a diagnosis of Covid-19, in Isfahan City from June to September 2021 (concurrent with the fifth peak of Covid-19 in Iran) taking into account the recommendations of the 9th version of DTFC (December 2020). A total of 8250 prescriptions were retrieved from the Public Health Department of Isfahan City. Results: Famotidine 20, 40 mg tablets (N = 936 patients) was the most prescribed drug followed by dexamethasone ampule (N = 588), prednisolone 5, 50 mg tablets (N = 478), azithromycin 250, 500 mg capsules (N = 452), diphenhydramine syrup (N = 362), vitamin D3 soft gel 50,000 Iu (N = 526), naproxen 250, 500 mg tablets (N = 266) and favipiravir 200 mg tablet (N = 191). The following drugs were administered against the recommendation of the DTFC-9: azithromycin, favipiravir, remdesivir, cetirizine, corticosteroids, vitamin C, vitamin B12, multivitamins, proton pump inhibitors (e.g., omperazole, anticoagulants (rivaroxaban,....), aspirin and ivermectin. Administration of analgesics, famotidine, hydroxychloroquine, vitamin D3, diphenhydramine and statins were in concordance with the DTFC-9. Conclusion: In this study, we showed frequent use of drugs with unproven efficacy in outpatient cases of Covid-19 mostly attributed to corticosteroids and antibiotics use. Our research highlights the discrepancy between recommendations for care and clinical practice and the need for strategy to bridge gaps in evidence-based informed decision-making. [ABSTRACT FROM AUTHOR]

Background: The present study analysed data on children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) who were referred to the ADHD reference centre of Scientific Institute IRCCS E. Medea (Brindisi, Italy) for ADHD pharmacotherapy initiation and monitoring overtime. The main aim of the study was to examine differences in pharmacological treatment status (i.e., treatment continuation vs discontinuation) between patients. Methods: Seventy-seven children and adolescents (mean age at pharmacotherapy initiation = 9.5, standard deviation = 2.6) with ADHD received drugs treatment for ADHD at the reference center between January, 2013 and May, 2022. Demographic and clinical data were obtained from the Italian Registry for ADHD and medical records. Child Behavior Checklist (CBCL) available data were used. Results: Pharmacological treatment status was examined for patients (n = 63) with at least 12 months of follow-up after the first pharmacological treatment for ADHD. After starting pharmacotherapy treatment, 77.8% (n = 49) patients were still on treatment whereas 22.2% (n = 14) discontinued it. No between group difference were observed in demographic and clinical data except for the intelligence quotient/intellectual disability and rule-breaking behavior (n = 40). Conclusions: This study stressed the need of periodical assessments, monitoring difficulties with treatment and/or reasons for poor treatment compliance to provide individualized care. [ABSTRACT FROM AUTHOR]

Polymorphisms of genes encoding drug metabolizing enzymes and transporters can significantly modify pharmacokinetics, and this can be associated with significant differences in drug efficacy, safety, and tolerability. Moreover, genetic variants of some components of the immune system can explain clinically relevant drug-related adverse events. However, the implementation of drug dose individualization based on pharmacogenomics remains scarce. In this narrative review, the impact of genetic variations on the disposition, safety, and tolerability of the most commonly prescribed drugs is reported. Moreover, reasons for poor implementation of pharmacogenomics in everyday clinical settings are discussed. The literature analysis showed that knowledge of how genetic variations can modify the effectiveness, safety, and tolerability of a drug can lead to the adjustment of usually recommended drug dosages, improve effectiveness, and reduce drug-related adverse events. Despite some efforts to introduce pharmacogenomics in clinical practice, presently very few centers routinely use genetic tests as a guide for drug prescription. The education of health care professionals seems critical to keep pace with the rapidly evolving field of pharmacogenomics. Moreover, multimodal algorithms that incorporate both clinical and genetic factors in drug prescribing could significantly help in this regard. Obviously, further studies which definitively establish which genetic variations play a role in conditioning drug effectiveness and safety are needed. Many problems must be solved, but the advantages for human health fully justify all the efforts. [ABSTRACT FROM AUTHOR]

Objective: To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis. Methods: We conducted a nested case-control study, identifying all individuals (n=130 cases) diagnosed with CVID in Denmark (1994–2014) and 45 age- and sex-matched population controls per case (n=5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals. Results: In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) (p<0.001). Conclusion: CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies. [ABSTRACT FROM AUTHOR]

The aim of this study was to verify if there is a relationship between a physician's specialization, place of practice, or views on issues related to compounded medicines and the frequency of prescribing such formulations. Additionally, the study aimed to determine the factors that influence these views. The study also examined the barriers and encouragements, according to physicians, in the use of compounded medicines. An original questionnaire was developed specifically for this study. The included sample consisted of Polish-speaking physicians whose main specializations were gynaecology, gastroenterology, dermatology, family medicine, internal medicine, otorhinolaryngology, paediatric otorhinolaryngology, and paediatrics. Answers were gathered using computer-assisted telephone interviews. The majority of the surveyed physicians believed that every Polish patient receives treatment tailored to their personal needs (68.7%) and agreed that compounded medicines are a way to facilitate individualization of pharmacotherapy (79.3%). The frequency of prescribing of magistral formulations as well as views on the quality of compounded medicines, ease of prescribing and filling a prescription varied between specializations and places of practice. The problem that negatively affected the practice of the largest group of respondents was complicated and frequently changing legal regulations (63.3%), while the least frequently indicated problems were concerns about preparation quality (16.7%). Based on the opinions of the surveyed physicians, a simplification of the regulations for prescribing and a liberalization of reimbursement rules were the main changes to consider to improve clinical practice in the areas where it relates to prescribing compounded medicines. [ABSTRACT FROM AUTHOR]

Copyright of Paediatrics & Family Medicine / Pediatria i Medycyna Rodzinna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective was to identify the chronic impact of SARS-CoV-2 virus infection in new diagnostics, pharmacological prescriptions, and use of healthcare resources in patients after acute infection in a case-control study. Methods: Case-control study with observation of new diagnostics codified in the Electronic Health Recordings, with a total population of 604,000 subjects. Cases included patients diagnosed with acute infection. Matched controls in the absence of infection using a Propensity Score were also included. Observational period was 6 months. New diagnostic (CIE10), prescriptions and visits to Health Care Resources were identified. Results: 38,167 patients with a previous COVID infection and the same number of controls were analyzed. Population included < 18 years old, 7586 (mean age 10.2 years, girls 49%), and 30,581 adults (mean age 46.6 years, females 53%). In adults, 25% presented new diagnoses, while the prevalence was 16% in youth. A total of 40 new diagnostics were identified. The most frequent were diagnostics in the neuropsychiatric sphere, with older age, female, and previous admission in the Critical Care Unit being the factors related in adults, while in youth higher age was also a factor. Prescription of psychoanaleptic, psycholeptic and muscle relaxants had increased. An increment of around 20% in visits to Primary Care Physicians, Specialists and Emergency Departments was registered. Conclusion: Compared with a control group, an increment in the number of new diagnostics, new prescriptions and higher use of Health Care resources were observed. Many of the new diagnoses also occur in non-infected subjects, supporting the complex origin of so-called Long-COVID. [ABSTRACT FROM AUTHOR]

The vast majority of people work a large part of their live, therefore work inevitably has a major impact on health as well. In Germany, great efforts are made to improve health and well-being in the occupational context. To support this, the evaluation of health data especially from employees is one the main scopes in health reporting of the Federal Association of Company Health Insurance Funds (BKK Dachverband). These results are made available to the interested public via various publication channels, including interactive online diagrams. Data from the areas of incapacity to work, outpatient and inpatient care as well as drug prescriptions are applied. Due to the in large parts identically structured representations, comparisons across health care system sectors are also possible. The aim of this article is to describe the provided regional health care data of employees with focus on the interactive data provision, to show by example particularities in single sources and across sources. From this the impact of work as well as workplace health promotion on the health of employees and, in a broader sense, the quality of health care in Germany can be derived. [ABSTRACT FROM AUTHOR]

Nurse prescription is a relatively new and developing subject, with many critics and advocates worldwide. However, it is expanding rapidly and is being implemented in many countries. In Iran, nurses are not allowed to prescribe. No significant action has been taken in this regard. In Iran, nurse prescribing requires preparing the ground and providing the necessary conditions. The current study aimed to examine nurse prescribing worldwide and its possible challenges in Iran.This study is a narrative review of the English and Persian articles published in 2022 on nurse prescription in Iran and worldwide. We collected data by searching the international databases of PubMed, Science Direct, and Scopus, and the local databases of SID, Magiran, and Iran Medex for the keywords "nurse prescribing", "nurse prescription", "prescribing factors", "prescribing effect", "prescribing facilitation", "prescribing barriers", "prescribing benefits", "prescriptions", "medication and nursing", "independent nurse prescribing", "supplementary nurse prescribing", "independent prescribing", "nurse prescriber", "prescribing", and the possible combinations. We retrieved all related articles published between 2010 and the end of 2022.A total of 32 case studies were reviewed in this study. The results showed that nurse prescribing occurs globally in one of three forms: independent, supplementary, and patient group protocols. In Iran, nurse prescribing is prohibited, necessitating social support and assistance in policy-making, planning, and nursing education.Due to the unprepared environment in Iran, it is vital to provide assistance for prescribing. Numerous factors play a role in implementing nurse prescribing in Iran, so it is necessary to use the successful experience of countries that have been pioneers in this domain. It is suggested that health officials and those engaged take steps to teach prescribing nurses at the postgraduate and doctoral levels, or create a new discipline of nurse prescription.

BackgroundThe Affordable Care Act expanded Medicaid eligibility allowing low-income individuals greater access to health care. However, the uptake of state Medicaid expansion has been variable. It remains unclear how the Medicaid expansion was associated with the temporal trends in use of evidence-based cardiovascular drugs.MethodsWe used the publicly available Medicaid Drug Utilization and Current Population Survey to extract filled prescription rates per 1000 Medicaid beneficiaries of statins, antihypertensives, P2Y12 inhibitors, and direct oral anticoagulants. We defined expander states as those who expanded Medicaid on or before January 1, 2014, and nonexpander states as those who had not expanded by December 31, 2018. Difference-in-differences (DID) analyses were performed to compare the association of the Medicaid expansion with per-capita cardiovascular drug prescription rates in expander versus nonexpander states.ResultsBetween 2011 and 2018, the total number of prescriptions among all Medicaid beneficiaries increased, with gains of 89.7% in statins (11.0 to 20.8 million), 76% in antihypertensives (35.3 to 62.2 million), and 37% in P2Y12 inhibitors (1.7 to 2.3 million). Medicaid expansion was associated with significantly greater increases in quarterly prescriptions (per 1000 Medicaid beneficiaries) of statins (DID estimate [95% CI]: 22.5 [16.5-28.6], P75% of the expander states had increases in prescription rates of both statins and antihypertensives. In contrast, 44% of nonexpander states saw declines in statins and antihypertensives. The Medicaid expansion was not associated with higher direct oral anticoagulants prescription rates (DID estimate [95% CI] 0.9 [-0.3 to 2.1], P=0.142).ConclusionsThe 2014 Medicaid expansion was associated with a significant increase in per-capita utilization of cardiovascular prescription drugs among Medicaid beneficiaries. These gains in utilization may contribute to long-term cardiovascular benefits to lower-income and previously underinsured populations.

Background: Recent epidemiological evidence suggests associations between air pollution exposure and major depressive disorders, but the literature is inconsistent for other mental illnesses. We investigated the associations of several air pollutants and road traffic noise with the incidence of different categories of mental disorders in a large population-based cohort. Methods: We enrolled 1,739,277 individuals 30 + years from the 2011 census in Rome, Italy, and followed them up until 2019. In detail, we analyzed 1,733,331 participants (mean age 56.43 +/- 15.85 years; 54.96 % female) with complete information on covariates of interest. We excluded subjects with prevalent mental disorders at baseline to evaluate the incidence (first hospitalization or co-pay exemption) of schizophrenia spectrum disorders, bipolar, anxiety, personality, or substance use disorders. In addition, we studied subjects with first prescriptions of antipsychotics, antidepressants, and mood stabilizers. Annual average concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO₂), Black Carbon (BC), ultrafine particles (UFP), and road traffic noise were assigned to baseline residential addresses. We applied Cox regression models adjusted for individual and area-level covariates. Results: Each interquartile range (1.13 µg/m3) increase in PM2.5 was associated with a hazard ratio (HR) of 1.070 (95 % confidence interval [CI]: 1.017, 1.127) for schizophrenia spectrum disorder, 1.135 (CI: 1.086, 1.186) for depression, 1.097 (CI: 1.030, 1.168) for anxiety disorders. Positive associations were also detected for BC and UFP, and with the three categories of drug prescriptions. Bipolar, personality, and substance use disorders did not show clear associations. The effects were highest in the age group 30–64 years, except for depression. Conclusions: Long-term exposure to ambient air pollution, especially fine and ultrafine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders. The association of the pollutants with the prescriptions of specific drugs increases the credibility of the results.

BACKGROUND: Increased fear and anxiety among the general public following the emergence of coronavirus 2019 (COVID-19) can lead to hypochondriasis as well as indiscriminate use of drugs, versus the disease. OBJECTIVE: The present study was conducted to identify the frequency and causes of self-medication and hypochondriasis among students. METHODS: This descriptive cross-sectional study was conducted among 241 students of different disciplines of Khalkhal University of Medical Sciences in northwestern Iran over a period of six months. SPSS 26 software, Chi-square and Fisher tests were used to analyze the data. RESULTS: The rate of self-medication was calculated 51%. The highest rate of self-medication was in the form of tablets (75.6%) and capsules (28.5%) and the highest type of medication was herbal medicine (59.3%) and multivitamins and complementary drugs (54.5%). The most common cause of self-medication was previous use and the effectiveness of the drug in the past (79.7%). The mean score of hypochondriasis was calculated at 21.52 (11.02) and the majority of students (49.8%) were in the healthy group. There was a statistically significant association between hypochondriasis and self-medication (p = 0.002). CONCLUSION: Based on the findings, more than half of the participants in the study had self-medication. About 20% of students also experienced mild to moderate hypochondriasis. Therefore, it is suggested that the necessary training and support be provided to deal with the side effects of these two phenomena. [ABSTRACT FROM AUTHOR]

Introduction: Inadequate prescription communication skills of the medical graduates lead to poor therapeutic outcome and increased burden on the healthcare system. This gap has to be addressed through effective methods for teaching prescription communication skills to medical students. This study compared the effectiveness of Role play and Small Group Discussion (SGD) in teaching prescription communication skills to students of Phase Two of the Bachelor of Medicine and Bachelor of Surgery (MBBS) course.Methods: This was a prospective interventional study done in the Department of Pharmacology affiliated to the Department of Surgery at a Tertiary Care Centre in North Kerala for a period of 3 months from March 2021 to May 2021. After obtaining ethical clearance and informed consent, students of Phase Two of the MBBS course students (n=60) were selected by convenience sampling and divided into 2 groups by simple randomisation. The groups were taught prescription communication skills by Role play and SGD, respectively. Each group received six independent interventions on different topics. An Objective Structured Clinical Examination (OSCE) was conducted 1 week after each session for both groups. At the end of six sessions, feedback on the sessions was collected through a perception questionnaire. Quantitative data were compared using independent t-test. Ordinal data were expressed as percentages. Statistical analysis was done using online statistical calculators. P

Background: Skin diseases of microbial etiology are caused by bacteria, fungi, viruses, and ectoparasites, of which bacterial infections are most common than others. Antibiotic resistance among the micro-organisms is developing due to indiscriminate use of antibiotics and irrational prescription of drugs. Aims and Objectives: The aims of this study were to assess various aspects of prescription pattern and rational use of antibiotics for bacterial infections in the department of dermatology. Materials and Methods: A prospective analysis of 120 patients attending Dermatology Out Patient Department, at Government Medical College, Srikakulam, for 16 months (June 2017–September 2018) was carried out to analyze the usage of antibiotics through various routes to treat dermatological infections. The number of antibiotics prescribed, their name, class of drug, frequency and route of administration, and duration were recorded and analyzed using descriptive statistics. Results: Among the study population, 55.9% were male and 44.1% were female. Acne vulgaris (25%) is the most common condition, for which antibiotics were prescribed followed by impetigo (16.66%). Most commonly prescribed systemic antibiotics were penicillins (51.66%) followed by macrolides (18.33%). Most commonly prescribed topical antibiotic was mupirocin (33.33%) followed by clindamycin (25%). The most preferred route of antibiotic administration was oral route (62.44%). Conclusion: Prescription pattern of antibiotics in this study proved that dermatologists followed rationality and contributed their part to curb the spread of antibiotic resistance. Periodic screening of drug prescribing pattern studies should be done to rationalize the prescription, to reduce errors, and to increase therapeutic benefits and cost-effective management.

Nurse prescription is a relatively new and developing subject, with many critics and advocates worldwide. However, it is expanding rapidly and is being implemented in many countries. In Iran, nurses are not allowed to prescribe. No significant action has been taken in this regard. In Iran, nurse prescribing requires preparing the ground and providing the necessary conditions. The current study aimed to examine nurse prescribing worldwide and its possible challenges in Iran. This study is a narrative review of the English and Persian articles published in 2022 on nurse prescription in Iran and worldwide. We collected data by searching the international databases of PubMed, Science Direct, and Scopus, and the local databases of SID, Magiran, and Iran Medex for the keywords "nurse prescribing", "nurse prescription", "prescribing factors", "prescribing effect", "prescribing facilitation", "prescribing barriers", "prescribing benefits", "prescriptions", "medication and nursing", "independent nurse prescribing", "supplementary nurse prescribing", "independent prescribing", "nurse prescriber", "prescribing", and the possible combinations. We retrieved all related articles published between 2010 and the end of 2022. A total of 32 case studies were reviewed in this study. The results showed that nurse prescribing occurs globally in one of three forms: independent, supplementary, and patient group protocols. In Iran, nurse prescribing is prohibited, necessitating social support and assistance in policy-making, planning, and nursing education. Due to the unprepared environment in Iran, it is vital to provide assistance for prescribing. Numerous factors play a role in implementing nurse prescribing in Iran, so it is necessary to use the successful experience of countries that have been pioneers in this domain. It is suggested that health officials and those engaged take steps to teach prescribing nurses at the postgraduate and doctoral levels, or create a new discipline of nurse prescription. [ABSTRACT FROM AUTHOR]

Background: Unlicensed and off-label (UL/OL) prescriptions have been associated with an increased risk of drug-related problems. Data of their prevalence at hospital discharge remain insufficient. We aimed to describe the prevalence of UL/OL drugs in outpatient prescriptions at discharge in children. Methods: We conducted a retrospective study using the routinely collected health data of children at discharge from 2014 to 2016. The primary reference source for determining licensed labelling was the summaries of product characteristics (SPCs) in a French industry-independent formulary named Thériaque. We described the characteristics of UL/OL prescriptions at discharge and looked for predictors of UL/OL prescriptions. Results: We included 2536 prescriptions of 479 children. Licensed, OL, and UL prescriptions accounted for 58.6% (95% CI: 56.7–60.5), 39.2% (95% CI: 37.3–41.1), and 2.3% (95% CI: 1.7–2.9), respectively. A total of 323 (74%) children received at least one UL/OL drug. Among the licensed drugs, bronchodilators (8.8%) and analgesics (8.6%), and among the OL drugs, antibiotics (2.8%), were the most prescribed. The younger age of the children and higher number of drugs they received increased the probability of UL/OL prescriptions (unadjusted p-value of ≤0.05). Conclusion: The prevalence of UL/OL prescriptions is about 40% at discharge from a pediatric university hospital in France.

Le but de la présente étude est de questionner les conséquences de la crise sanitaire sur le plan psychologique en population pédiatrique, à travers une analyse des variations des données d'activité d'un service de consultations d'urgences pédopsychiatriques. Le travail réalisé est une étude épidémiologique observationnelle rétrospective et comparative reposant sur une analyse des données d'activité d'une consultation d'urgences pédopsychiatriques du centre hospitalo-universitaire de Lille. Les données recueillies sur la période contemporaine aux mesures de restrictions sociales du 17 mars 2020 au 19 mai 2021 ainsi que celles recueillies après la levée de ces mesures du 19 mai 2021 au 31 mai 2022 ont été comparées à l'activité sur ce même dispositif sur les périodes équivalentes entre le 1er janvier 2017 et 17 mars 2020. Des comparaisons centrées sur les 3 périodes de confinement ont également été réalisées. Tout patient entre 0 et 18 ans pris en charge sur la consultation d'urgence était inclus dans cette étude. Une augmentation significative des prescriptions médicamenteuses et consultations pour idées suicidaires était observée pendant mais aussi à distance des mesures de restrictions sociales. Le premier confinement était quant à lui marqué par une baisse importante du nombre de consultations et une augmentation significative de la rédaction d'écrits judiciaires. Ces résultats étaient donc en faveur d'une augmentation de la suicidalité en population pédiatrique pendant et après levée des mesures de restrictions sociales, mais aussi d'une augmentation des situations relevant de la protection de l'enfance au cours du 1er confinement. La hausse significative des prescriptions médicamenteuses à l'issue des consultations discordante avec la hausse plus modeste des hospitalisations laissait présager une inadéquation entre besoins et capacités d'accueil en hospitalisation. Un impact de la crise sanitaire a donc pu être observé sur l'activité d'une consultation d'urgence pédopsychiatrique pendant, mais aussi à distance de la levée des mesures de restrictions sociales. Cela souligne l'importance de ne pas limiter la recherche aux périodes de confinements, ainsi que la question de la réversibilité des variations observées pour la génération considérée. The aim of this retrospective study was to question the psychological consequences of the health crisis in a pediatric population, through an analysis of the variations in the activity data of a pedopsychiatric emergency consultation service. The present study is a retrospective and comparative epidemiological study based on an analysis of activity data from a pedopsychiatric emergency consultation at the Lille University Hospital center collected over the period contemporary of the social restriction measures of March 17th, 2020 to May 19th, 2021 as well as those collected after the lifting of these measures from May 19th, 2021 to May 31st, 2022 by comparing them to the activity on this same service over the equivalent periods between January 1st, 2017 and March 17th, 2020. Comparisons centered around the three confinement periods were also carried out. Any patient between 0 and 18 years old taken care of in this emergency consultation was included in this study. A significant increase in drug prescriptions and consultations for suicidal ideations was observed during, but also at a distance from social restriction measures. The first confinement was marked by a significant drop in the number of consultations and a significant increase in the drafting of child protection documents. These results were therefore in favor of an increase in suicidality in the pediatric population during and after the lifting of social restriction measures, as well as an increase in situations relating to child protection during the first confinement. The significant increase in discordant discharge drug prescriptions with the more modest increase in hospitalizations foreshadowed a mismatch between needs and hospitalization capacity. An impact of the health crisis could therefore be observed on the activity of a pedopsychiatric emergency consultation during, but also after the lifting of social restriction measures. This raises the importance of not limiting research to periods of confinement, as well as the question of the reversibility of the variations observed for the generation considered. [ABSTRACT FROM AUTHOR]

Background: Skin diseases of microbial etiology are caused by bacteria, fungi, viruses, and ectoparasites, of which bacterial infections are most common than others. Antibiotic resistance among the micro-organisms is developing due to indiscriminate use of antibiotics and irrational prescription of drugs. Aims and Objectives: The aims of this study were to assess various aspects of prescription pattern and rational use of antibiotics for bacterial infections in the department of dermatology. Materials and Methods: A prospective analysis of 120 patients attending Dermatology Out Patient Department, at Government Medical College, Srikakulam, for 16 months (June 2017-September 2018) was carried out to analyze the usage of antibiotics through various routes to treat dermatological infections. The number of antibiotics prescribed, their name, class of drug, frequency and route of administration, and duration were recorded and analyzed using descriptive statistics. Results: Among the study population, 55.9% were male and 44.1% were female. Acne vulgaris (25%) is the most common condition, for which antibiotics were prescribed followed by impetigo (16.66%). Most commonly prescribed systemic antibiotics were penicillins (51.66%) followed by macrolides (18.33%). Most commonly prescribed topical antibiotic was mupirocin (33.33%) followed by clindamycin (25%). The most preferred route of antibiotic administration was oral route (62.44%). Conclusion: Prescription pattern of antibiotics in this study proved that dermatologists followed rationality and contributed their part to curb the spread of antibiotic resistance. Periodic screening of drug prescribing pattern studies should be done to rationalize the prescription, to reduce errors, and to increase therapeutic benefits and cost-effective management. [ABSTRACT FROM AUTHOR]

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Background: International Nonproprietary Names (INN) is prescribing the name of the active ingredient. Objective: This study aimed to investigate INN prescription rates and perceived barriers towards INN prescribing at a public Ministry of Health and Population (MOHP) hospital specialized in treating infectious diseases in Egypt. Methods: A retrospective chart review was conducted in a 280-bed specialized Ministry of Health Hospital in Alexandria, Egypt. Medications were described either as brand or generic based on WHO Essential Medicines List (EML) classification system and the Egyptian National Formulary. All physicians with prescribing authority in study hospital were administered a questionnaire composed of two sections. The first section explored the socio-demographic and work characteristics of the physicians, and the second section listed the barriers towards INN prescription. Results: Out of the 400 medical records reviewed, 2279 drugs were prescribed. About half of the medications (52.61%) were prescribed in INN. The medicines which were most frequently prescribed in INN were electrolytes solution (99.5%), laxatives (98.6%), and vitamins and minerals (85.2%) and coagulation medicines (82%). Other medications were exclusively prescribed in brand names as antispasmodics, antidiarrheal, dermatology and vascular insufficiency medications. Only 38.75% were trained using INNs to designate medications, about half of physicians (48%) reported that they rarely use INNs in their practice. The most frequently listed reasons for not prescribing in INN prescribing perceived by physicians were physicians being not familiar with INN (79.0%), doubts about the efficacy, safety, or quality of generic drugs (52.0%) and absence of educational programs regarding INN use (47.0%). Conclusion and Relevance: The current study illustrates only half of the prescriptions are prescribed using INN. A multifaceted approach using explicit policy for obligating INN prescription, together with educational sessions for physicians about the value of INN prescription and the bioequivalence of generic medications to their brand counterparts. [ABSTRACT FROM AUTHOR]

Abstract Background Symptomatic control is essential in palliative care, particularly in end-of-life, in which the pathophysiological changes that characterize this last phase of life strengthen the need to carry out an early therapeutic review. Hence, we aim to evaluate the prescribing pattern at a palliative care unit at two different time points: on admission and the day of the patient’s death. Methods Quantitative, analytic, longitudinal, retrospective and observational study. Participants were adult patients who were admitted and died in a palliative care unit, in Portugal. Sociodemographic, clinical and pharmacological data were collected, including frequencies and routes of administration of schedule prescribed drugs and rescue drugs, from the day of admission until the day of death. Results 115 patients were included with an average age of 70.0 ± 12.9 years old, 53.9 were male, mostly referred by the Hospital Palliative Care Support Teams. The most common pathology was cancer, mainly in advanced stage. On admission, the median scheduled prescription was seven and “as needed” was three drugs. On the day of death, a decrease of prescriptions was observed. Opioids were always the most prescribed drugs. Near death, there was a higher tendency to prescribe butylscopolamine, midazolam, diazepam and levomepromazine. The most frequent route of drug administration was oral on admission and subcutaneous on the day of death. Conclusions Polypharmacy is a reality in palliative care despite specialist palliative care teams. A reduction of prescribed drugs was verified, essentially due less comorbidity-oriented drugs. Further studies are required to analyse the importance of Hospital Palliative Care Support Teams.

Polymorphisms of genes encoding drug metabolizing enzymes and transporters can significantly modify pharmacokinetics, and this can be associated with significant differences in drug efficacy, safety, and tolerability. Moreover, genetic variants of some components of the immune system can explain clinically relevant drug-related adverse events. However, the implementation of drug dose individualization based on pharmacogenomics remains scarce. In this narrative review, the impact of genetic variations on the disposition, safety, and tolerability of the most commonly prescribed drugs is reported. Moreover, reasons for poor implementation of pharmacogenomics in everyday clinical settings are discussed. The literature analysis showed that knowledge of how genetic variations can modify the effectiveness, safety, and tolerability of a drug can lead to the adjustment of usually recommended drug dosages, improve effectiveness, and reduce drug-related adverse events. Despite some efforts to introduce pharmacogenomics in clinical practice, presently very few centers routinely use genetic tests as a guide for drug prescription. The education of health care professionals seems critical to keep pace with the rapidly evolving field of pharmacogenomics. Moreover, multimodal algorithms that incorporate both clinical and genetic factors in drug prescribing could significantly help in this regard. Obviously, further studies which definitively establish which genetic variations play a role in conditioning drug effectiveness and safety are needed. Many problems must be solved, but the advantages for human health fully justify all the efforts.

Abstract Objective From previous studies, it is known that the association between fibromyalgia and thyroid autoimmunity diseases exists. On the other hand, it was recently suggested that in many cases thyroid hormone treatment might be unnecessary. The aim of our study is to explore the thyroid hormone treatment among primary health care fibromyalgia patients. Our study is cross-sectional and based on fibromyalgia study from the city of Nokia Health Center. Clinical examination was performed to participants, patients filled five questionnaires and information from electronic patient records was gathered. In addition to other parameters, we studied patient’s thyroid function levels at the beginning of thyroid hormone treatment. Results From those patients participating in the study (n = 103), 34% (n = 33) had thyroid hormone treatment. From those taking thyroid hormone treatment, 48% (n = 16) had information regarding the initial TSH and T4-V levels at the beginning of the treatment. 37% (n = 6) of them had normal thyroid function. Small sample size and data gathered from single health center effects on the generalizability of our findings. However, we suggest further studies to confirm the potential association between fibromyalgia and inappropriate thyroid hormone treatment.

Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization. Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions. Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres. Conclusion: The abuse in the health service provision is a high risk for health care managers in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

Objective To identify changes in opioid prescribing across a diverse array of medical specialties after the release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Design Interrupted time-series analysis of data from a commercial prescribing database. Subjects De-identified recipients of opioid prescriptions dispensed at U.S. retail pharmacies between 2015 and 2019. Methods Opioid dispensing data were obtained from the IQVIA Longitudinal Prescription (LRx) database, representing more than 800 million opioid prescriptions. Monthly dispensing rates, dosage in morphine milligram equivalents (MME), and mean prescription duration were calculated across 29 medical specialties. Changes in dispensing after the release of the 2016 CDC Guideline were assessed through interrupted time-series analysis. Results Declining trends in opioid dispensing accelerated in 24 of 29 specialty groups after the release of the CDC Guideline (P  < 0.05 for 15 groups). Decreases were greatest among family medicine clinicians, where declines accelerated by 4.4 prescriptions per month per 100,000 persons (P  = 0.005), and surgeons, where declines accelerated by 3.6 prescriptions per month per 100,000 (P  = 0.003). Conclusions These results illustrate that clinicians likely to provide primary care exhibited the greatest decreases in opioid dispensing. However, specialties outside the scope of the CDC Guideline (e.g. surgery) also exhibited accelerated decreases in prescribing. These declines illustrate that specialties beyond primary care could have interest in evaluating opioid prescribing practices, supporting the importance of specialty-specific guidance that balances the individualized risks and benefits of opioids and the role of non-opioid treatments. [ABSTRACT FROM AUTHOR]

Background: Dementia is a group of symptoms that largely affects older people. The majority of patients face behavioural and psychological symptoms (BPSD) during the course of their illness. Alzheimer's disease (AD) and vascular dementia (VaD) are two of the most prevalent types of dementia. Available medications provide symptomatic benefits and provide relief from BPSD and associated health issues. However, it is unclear how specific dementia, antidepressant, antipsychotic, antianxiety, and mood stabiliser drugs, used in the treatment of depression and dementia subtypes are prescribed in hospital admission, during hospital stay, and at the time of discharge. To address this, we apply multi-dimensional data analytical approaches to understand drug prescribing practices within hospitals in England and Wales.Methods: We made use of the UK National Audit of Dementia (NAD) dataset and pre-processed the dataset. We evaluated the pairwise Pearson correlation of the dataset and selected key data features which are highly correlated with dementia subtypes. After that, we selected drug prescribing behaviours (e.g. specific medications at the time of admission, during the hospital stay, and upon discharge), drugs and disorders. Then to shed light on the relations across multiple features or dimensions, we carried out multiple regression analyses, considering the number of dementia, antidepressant, antipsychotic, antianxiety, mood stabiliser, and antiepileptic/anticonvulsant drug prescriptions as dependent variables, and the prescription of other drugs, number of patients with dementia subtypes (AD/VaD), and depression as independent variables.Results: In terms of antidepressant drugs prescribed in hospital admission, during stay and discharge, the number of sertraline and venlafaxine prescriptions were associated with the number of VaD patients whilst the number of mirtazapine prescriptions was associated with frontotemporal dementia patients. During admission, the number of lamotrigine prescriptions was associated with frontotemporal dementia patients, and with the number of valproate and dosulepin prescriptions. During discharge, the number of mirtazapine prescriptions was associated with the number of donepezil prescriptions in conjunction with frontotemporal dementia patients. Finally, the number of prescriptions of donepezil/memantine at admission, during hospital stay and at discharge exhibited positive association with AD patients.Conclusion: Our analyses reveal a complex, multifaceted set of interactions among prescribed drug types, dementia subtypes, and depression. [ABSTRACT FROM AUTHOR]

Objective To assess (i) the pattern of antibiotic prescribing in Danish general practice, (ii) the use of diagnostic tests [point-of-care (POC) and tests analysed at the hospital laboratory (laboratory tests)], and (iii) the frequency of diagnostic testing in relation to antibiotic prescriptions. Design Retrospective cross-sectional register-based study. Setting General practice in a geographical area of Denmark covering 455,956 inhabitants. Subjects We studied redeemed antibiotic prescriptions and performed diagnostic tests in general practice from 2013 to 2017 among inhabitants in nine selected municipalities. Main outcome measures Frequency of antibiotic courses. Frequency and type of diagnostic testing performed in relation to types of antibiotics. Results A total of 783,252 antibiotic courses were redeemed from general practice with an overall decrease of 19% during 2013–2017. Diagnostic testing increased by 6% during this period. POC tests comprised the majority of performed diagnostic tests (83%) with C-reactive protein (CRP) as the most frequently used test. A 27% increase in the use of laboratory tests was observed. Tests were performed in relation to 43% of all antibiotic courses; most in relation to prescriptions for sulphonamide and trimethoprim (57%) and rarely when prescribing tetracyclines (10%). Conflicting with national guidelines, Danish GPs prescribed fluoroquinolones without performing any kind of diagnostic testing in 48% of the cases. Conclusions This study provides an overview of the use of diagnostic tests in relation to antibiotics and creates basis for further research into the variability between types of antibiotics. The study indicates that there is room for improvement to use diagnostic tests as an aid to promote prudent antibiotic use.KEY POINTS Diagnostic tests (point-of-care or tests analysed at the hospital laboratory), can increase diagnostic certainty and lead to a reduction in antibiotic use in general practice. A decrease in antibiotic courses in general practice in Denmark was observed during 2013–2017, while the use of diagnostic tests increased. A diagnostic test was performed in relation to 43% of antibiotic courses. Only 52% of prescribed fluoroquinolones was related to a diagnostic test, conflicting with national guidelines.