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Background: How state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown. Objective: To examine how prescription drug monitoring programs (PDMPs), pain management clinic regulations, initial prescription duration limits, and mandatory continued medical education affected total and high-dose prescribing. Design: A county-level multiple-policy difference-in-difference event study framework. Subjects: A total of 2,425,643 individuals in a large national commercial insurance deidentified claims database (aged 12–64 years) with acute pain diagnoses and opioid prescriptions from 2007 to 2019. Main Measures: The total number of acute pain opioid treatment episodes and number of episodes containing high-dose (> 90 morphine equivalent daily dosage (MEDD)) prescriptions. Key Results: Approximately 7.5% of acute pain episodes were categorized as high-dose episodes. Prescription duration limits were associated with increases in the number of total episodes; no other policy was found to have a significant impact. Beginning five quarters after implementation, counties in states with pain management clinic regulations experienced a sustained 50% relative decline in the number of episodes containing > 90 MEDD prescriptions (95 CIs: (Q5: − 0.506, − 0.144; Q12: − 1.000, − 0.290)). Mandated continuing medical education regarding the treatment of pain was associated with a 50–75% relative increase in number of high-dose episodes following the first year-and-a-half of enactment (95 CIs: (Q7: 0.351, 0.869; Q12: 0.413, 1.107)). Initial prescription duration limits were associated with an initial relative reduction of 25% in high-dose prescribing, with the effect increasing over time (95 CI: (Q12: − 0.967, − 0.335). There was no evidence that PDMPs affected high-dose opioids dispensed to individuals with acute pain. Other high-risk prescribing indicators were explored as well; no consistent policy impacts were found. Conclusions: State opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis. [ABSTRACT FROM AUTHOR]

This review highlights the importance of judicious antibiotic prescribing practices for orofacial infections in pediatric patients. It emphasizes the need to adhere strictly to guidelines to mitigate the rising threat of antibiotic resistance. Antibiotics, alongside analgesics, are commonly prescribed by dentists due to their efficacy in treating infections. However, a significant portion of antibiotic prescriptions are unnecessary, contributing to the development of microbial resistance. Research indicates a concerning trend of low adherence to professional clinical guidelines among dental students, dentists, and pediatric dentists regarding antibiotic prescriptions. Despite the historical success of antibiotics in dental treatments, their overuse poses a risk to this achievement. Therefore, it’s crucial to limit antibiotic use to reduce the risk of resistance development. Insufficient knowledge about significant clinical indications for antibiotic prescriptions among pediatric dentists exacerbates the problem, leading to overuse and contributing to antibiotic resistance in children. Addressing this knowledge gap and promoting adherence to guidelines is essential in preserving the effectiveness of antibiotics in pediatric dental care.

Does academic writing in economics reflect the political orientation of economists? We use machine learning to measure partisanship in academic economics articles. We predict the observed political behaviour of a subset of economists using phrases from their academic articles, show good out-of-sample predictive accuracy and then predict partisanship for all economists. We then use these predictions to examine patterns of political language in economics. We estimate journal-specific effects on predicted ideology, controlling for author and year fixed effects, that accord with existing survey-based measures. We show considerable sorting of economists into fields of research by predicted partisanship. We also show that partisanship is detectable even within fields, even across those estimating the same theoretical parameter. Using policy-relevant parameters collected from previous meta-analyses, we then show that imputed partisanship is correlated with estimated parameters, such that the implied policy prescription is consistent with partisan leaning. For example, we find that going from the most left-wing authored estimate of the taxable top income elasticity to the most right-wing authored estimate decreases the optimal tax rate from 77% to 60%. [ABSTRACT FROM AUTHOR]

Background Oxygen is one of the most common therapeutic agents utilised in both hospital emergency department (ED) and medical wards, therefore correct administration is paramount. The primary aim of this audit was to assess current local implementation of guidelines on oxygen prescription in the ED and medical wards, along with adequate documentation in treatment charts or plans. Methods This audit involved data collection for a total of 5 weeks (in the months of November 2021 to December 2021) from patients who were being assessed at ED and then subsequently admitted to medical wards in Mater Dei Hospital (Malta). Results 300 patients were recruited over the period of 5 weeks, all having a presenting complaint of 'shortness of breath'; oxygen was administered to 82.7% (n=248) of patients. 260 were given a plan on oxygen administration, out of whom 253 had an oxygen prescription written in the management plan (only 92 also had documentation on the treatment chart as well). Regarding the oxygen delivery being delivered in the ward, only 163 (62.7%) matched with the latest plan, whilst 86 (33.1%) did not match and 11 (4.2%) were started on NIV. When comparing the data to the audit performed in 2011, the greatest differences were regarding the lack of oxygen prescription in the treatment chart (35.4% in this audit, compared to 51.8% previously) and correct oxygen administration, being much higher (62.7%) when compared to the older values (7.1%). Conclusion Oxygen should be clearly mentioned in management plans and correctly written on treatment charts, the lack of which could lead to inappropriate oxygen administration. A designated oxygen prescription sheet could be utilised for possible improvements. [ABSTRACT FROM AUTHOR]

Introduction Medications play a critical role supporting the health of military service members. Little is known about the broad use of medications prescribed to this population. Active duty service members (ADSMs), while often younger and having fewer diagnosed comorbid conditions, face unique health challenges that benefit from pharmacotherapy. Understanding prescribing patterns is instrumental to illuminate potential areas for research and to guide education so that military health care professionals can maintain competency, improve outcomes, and support medical readiness. This study aimed to characterize commonly dispensed medications among ADSMs and to compare these prescriptions with those of the general population. Materials and Methods A retrospective, cross-sectional analysis using data extracted contained in the Military Health System Information Platform focused on ADSMs who consulted with a clinical pharmacist during the 2019 fiscal year. Descriptive statistics were used to summarize patient and prescription data. The 100 most frequently prescribed medications and 20 most frequently prescribed therapeutic classes were identified. Analyses were performed using Statistical Analysis System (SAS) software, and a non-metric multidimensional scaling plot was generated in R to illustrate the relationships between the 20 most frequently used therapeutic classes and the branches of service. Results The study analyzed 719,788 prescriptions for 30,012 service members, revealing a high prescription rate for pain, inflammation, and psychiatric condition treatments. Antidepressants and nonsteroidal anti-inflammatory drugs were among the most commonly prescribed across all military branches. Some medication uses varied, which may indicate distinct needs within different service branches. Conclusions Understanding medication patterns among ADSMs may be able to help health care professionals proactively address pharmacological challenges and optimize pharmaceutical use in this unique population. This knowledge can also aid in the development of training modules focused on medication side effects, interactions, counseling, and implications on military deployment for the most commonly used medications. Future examination into prescribing cascades and medication use related to proton-pump inhibitors, docusate, benzonatate, and muscle relaxants may identify opportunities to provide better care or lower cost. [ABSTRACT FROM AUTHOR]

This review highlights the importance of judicious antibiotic prescribing practices for orofacial infections in pediatric patients. It emphasizes the need to adhere strictly to guidelines to mitigate the rising threat of antibiotic resistance. Antibiotics, alongside analgesics, are commonly prescribed by dentists due to their efficacy in treating infections. However, a significant portion of antibiotic prescriptions are unnecessary, contributing to the development of microbial resistance. Research indicates a concerning trend of low adherence to professional clinical guidelines among dental students, dentists, and pediatric dentists regarding antibiotic prescriptions. Despite the historical success of antibiotics in dental treatments, their overuse poses a risk to this achievement. Therefore, it’s crucial to limit antibiotic use to reduce the risk of resistance development. Insufficient knowledge about significant clinical indications for antibiotic prescriptions among pediatric dentists exacerbates the problem, leading to overuse and contributing to antibiotic resistance in children. Addressing this knowledge gap and promoting adherence to guidelines is essential in preserving the effectiveness of antibiotics in pediatric dental care. [ABSTRACT FROM AUTHOR]

Introduction: Historically, antimicrobials have been used to treat microbial illnesses in humans and animals. But throughout this time, antibiotics that had been successful against particular microorganisms started to lose their effectiveness due to rising inappropriate use brought on by ignorance, negligent attitudes, and improper methods. Our goal in conducting this study was to ascertain the knowledge, attitudes, and practices of doctors with relation to the use of antibiotics in light of the growing global and Sub-Saharan African problem of antimicrobial resistance. Methods: In a tertiary hospital in Mogadishu, Somalia, a cross-sectional survey study was carried out to assess experts' and research assistants' knowledge, attitudes, behavior, awareness, and practices regarding the use of antibiotics and antibiotic resistance. A questionnaire consisting of 2 sections and 22 questions was applied to the participants on a voluntary basis. Results: Among the 202 doctors that participated in the study, 49 (24.3%) were specialists, and 153 (75.7%) were assistants. Prescriptions for one to ten antibiotic boxes per week on average were reported by 146 respondents (72.3%). Of the physicians, just 27 (13.4%) did not require assistance when prescribing an antibiotic. The most often accessed sources of support were experts in infectious diseases (43.1%) and national/international antimicrobial guidelines (32.2%). The top three factors contributing to antibiotic resistance in Somalia include misuse of antibiotics (61.4%), unnecessary prescriptions written by doctors (44.6%), and an absence of infectious disease specialists in most institutions (44.1%). Conclusion: As an alarming level of antimicrobial resistance has been observed globally in recent years, the results of our survey will help educate our doctors by gauging their perceptions, attitudes, and knowledge about rational antibiotic use in Sub-Saharan Africa. This will provide better patient outcomes. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, premenstrual syndrome (PMS) was predominantly studied among university students who were in their early 20s; as a result, little is known about the prevalence of premenstrual syndrome among adolescent girls. Therefore, this study aimed to determine the prevalence of premenstrual syndrome and identify factors associated with premenstrual syndrome among secondary school female students in the Dessie city administration, 2023. Methods: An institutional-based cross-sectional study was conducted involving a sample of 630 participants. A structured self-administered data collection tool was used to gather the necessary information. To ensure data quality, the pretesting and training of the data collectors and supervisors were conducted. The collected data were entered into Epi-data software and analyzed using SPSS version 25. Frequency tables, graphs, means, and medians were used to describe the characteristics of the study participants. Binary logistic regression was employed to identify significant factors. Variables with a p-value ≤ 0.05 with 95% confidence interval (CI) of adjusted odds ratio (AOR) in the final multivariable logistic regression were reported as statistically significant factors associated with PMS. Model fitness was evaluated using the Hosmer and Lemeshow goodness-of-fit test. Results: In the present study, the prevalence of PMS was 22%, 95% CI = 19-26%. Factors: Age ≥ 18 years (AOR = 0.54; 95% CI: 0.34, 0.86), duration of menstruation ≥ 7 days (AOR = 3.61; 95% CI: 1.25, 10.37), presence of chronic illness (AOR = 2.08; 95% CI:1.04, 4.16), coffee intake (AOR = 6.05; 95% CI: 2.05, 17.87), alcohol intake (AOR = 0.49; 95% CI: 0.28, 0.86), use of pain medication (AOR = 2.06; 95% CI:1.10, 3.86), use of hormonal contraceptives (AOR = 3.9; 95% CI:1.58, 9.62), sleep disturbance (AOR = 3.82; 95% CI: 2.29, 6.42) and physical exercise (AOR = 0.50; 95% CI: 0.28, 0.87) were significantly associated with PMS. Conclusion: A significant number of students in this study were affected by premenstrual syndrome. Age, duration of menstruation, presence of chronic illness, coffee intake, use of pain medication, use of hormonal contraceptives, and sleep disturbance were significantly associated with PMS. Students should avoid excessive use of alcohol, coffee intake and use of pain medication without prescription. [ABSTRACT FROM AUTHOR]

Background: The scarcity of medical resources and personnel has worsened due to COVID-19. Telemedicine faces challenges in assessing wounds without physical examination. Evaluating pressure injuries is time consuming, energy intensive, and inconsistent. Most of today's telemedicine platforms utilize graphical user interfaces with complex operational procedures and limited channels for information dissemination. The study aims to establish a smart telemedicine diagnosis system based on YOLOv7 and large language model. Methods: The YOLOv7 model is trained using a clinical data set, with data augmentation techniques employed to enhance the data set to identify six types of pressure injury images. The established system features a front-end interface that includes responsive web design and a chatbot with ChatGPT, and it is integrated with a database for personal information management. Results: This research provides a practical pressure injury staging classification model with an average F1 score of 0.9238. The system remotely provides real-time accurate diagnoses and prescriptions, guiding patients to seek various medical help levels based on symptom severity. Conclusions: This study establishes a smart telemedicine auxiliary diagnosis system based on the YOLOv7 model, which possesses capabilities for classification and real-time detection. During teleconsultations, it provides immediate and accurate diagnostic information and prescription recommendations and seeks various medical assistance based on the severity of symptoms. Through the setup of a chatbot with ChatGPT, different users can quickly achieve their respective objectives. [ABSTRACT FROM AUTHOR]

This article discusses the importance of physical activity in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). It emphasizes the need for healthcare providers to screen patients for physical activity, provide counseling on the benefits of exercise, and either create an exercise prescription or refer patients to exercise professionals. The article recommends a combination of aerobic and resistance training, as well as low-impact high-intensity interval training (HIIT). Healthcare providers should routinely screen and counsel patients with MASLD on physical activity and refer them to exercise professionals. The article highlights the importance of consistent physical activity in improving health outcomes for patients with MASLD. [Extracted from the article]

Pharmacists are increasingly becoming the healthcare professional who interacts most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment. With the relative scarcity of clinical exercise physiologists in the United States, pharmacists are expected to provide lifestyle advice to their patients, especially in community (i.e. retail) pharmacy settings, but student pharmacists typically receive no formal or informal training in exercise physiology and prescription. To address this deficit, an elective course was developed to provide student pharmacists with the knowledge and skill set that will enable them to apply evidence-based physical activity guidelines in the pharmacy. The course utilized the Exercise is Medicine resources for chronic diseases and disorders that are routinely encountered in community pharmacies, in addition to analysis of interactions between exercise and medications commonly prescribed for these conditions. After completion of the course, students reported being significantly more comfortable discussing physical activity with their patients compared to the start of the course (P < 0.001). Similarly, at the end of the course, 99% of students reported that they felt confident in their ability to apply evidence-based recommendations of common diseases and disorders to their patients. Postcourse student evaluations clearly demonstrated that student pharmacists viewed the course positively and as essential in their professional training. These data highlight the feasibility and efficacy of improving self-perceptions for the provision of physical activity recommendations via an elective course in physical activity prescription in a Doctor of Pharmacy program. NEW & NOTEWORTHY: This study describes a new elective course in physical activity prescription for Doctor of Pharmacy students. After completing the course, students reported improved self-perceptions for the provision of physical activity recommendations. This course fills a gap in pharmacy education and this study provides future directions to improve training in lifestyle modifications. [ABSTRACT FROM AUTHOR]

Background: To examine whether the "Effectiveness of Guideline for Dissemination and Education in psychiatric treatment (EGIUDE)" project affects the rate of prescriptions of hypnotic medication and the type of hypnotic medications prescribed among psychiatrists, for schizophrenia and major depressive disorder in Japan. Methods: The EGUIDE project is a nationwide prospective study of evidence-based clinical guidelines for schizophrenia and major depressive disorder in Japan. From 2016 to 2021, clinical and prescribing data from patients discharged from hospitals participating in the EGUIDE project were used to examine hypnotic medication prescriptions The prescribing rate of hypnotics and the prescribing rate of each type of hypnotic (benzodiazepine receptor agonist, nonbenzodiazepine receptor agonist, melatonin receptor agonist, and orexin receptor antagonist) were compared among patients who had been prescribed medication by psychiatrists participating in the EGUIDE project and patients who had been prescribed medication by nonparticipating psychiatrists. Multivariate logistic regression analysis was performed to examine the effect of the EGUIDE project on the prescription of hypnotic medications. Results: A total of 12,161 patients with schizophrenia and 6,167 patients with major depressive disorder were included. Psychiatrists participating in the EGUIDE project significantly reduced the rate of prescribing hypnotic medication and benzodiazepine receptor agonists for both schizophrenia (P < 0.001) and major depressive disorder (P < 0.001) patients. Conclusion: This is the first study to investigate the educational effects of guidelines for the treatment of psychiatric disorders on psychiatrists in terms of prescribing hypnotic medications to patients. The EGUIDE project may play an important role in reducing hypnotic medication prescription rates, particularly with respect to benzodiazepine receptor agonists. The results suggest that the EGUIDE project may result in improved therapeutic behavior. [ABSTRACT FROM AUTHOR]

Background: Prescription writing skills are essential for physician practice. This study describes the development and implementation of a curricular intervention focused on improving the knowledge and confidence of preclerkship medical students' prescription writing practices utilizing an interprofessional education model, with a focus on electronic prescribing. Methods: Medicine and Pharmacy Faculty from a large, urban university collaborated to develop the content of the workshop and a simulation platform was used for the e-prescribing activity. Second-year medical students attended a mandatory in-person workshop facilitated by fourth-year pharmacy students. A pre and post knowledge test and confidence survey were used to assess students' knowledge, confidence, and satisfaction. Outcomes from the knowledge test were evaluated with paired-samples proportions tests, and confidence survey data was evaluated with paired t-tests and Wilcoxon signed-rank tests in a pre-post study design. Results: Students demonstrated a significant increase in prescription writing knowledge and confidence after completing the workshop. On the pre-test, 7% of students (21/284) completed the electronic prescribing assessment correctly and 51% of students (149/295) completed it correctly on the post-test. All items on the confidence survey showed a significant increase in pre- versus post-survey comparisons (p < 0.001). Conclusions: This interprofessional prescription writing workshop facilitated by pharmacy students shows promise for improving the knowledge and confidence of prescription writing and electronic prescribing practices in preclerkship medical students. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce. Methods: A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest). Results: 31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5–87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8–81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated. Conclusion: The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education. [ABSTRACT FROM AUTHOR]

Introduction: Despite having the competences to write prescriptions and prescribe medication, nurses do not always want to use these competences or do not feel the need to supplement their training through specialised courses, for example. They have concerns related to various factors. The aim of the paper was to determine factors influencing the use of the competences of nursing staff for writing prescriptions and prescribing medication in studied primary healthcare facilities in Świętokrzyskie Province. Material and methods: The study was carried out between May and September 2021 in 19 primary healthcare facilities located in Kielce. Two facilities from each of the 13 districts of Świętokrzyskie Province were also drawn to participate in the study. The drawing was done using the R Project for Statistical Computing (R Program). The survey was conducted among 188 nurses. The research tool was an original survey questionnaire. Results: The reasons for the lack of interest in obtaining new qualifications by the surveyed professional nursing group were mainly concerns about liability for the prescribed medicine (39; 26.71% vs. 8; 19.05%), the possibility of conducting a physical examination in the place of work (32; 21.92% vs. 4; 9.52%), and multiple responsibilities - workload (19; 13.01% vs. 1; 2.38%). Another barrier was the expectation to receive additional remuneration for performing these activities as part of the job (28; 19.18% vs. 6; 14.29%). Conclusions: Irrespective of their qualifications, nurses point to various factors that may limit their willingness to write prescriptions. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists are engaged in various professional activities starting from drug dispensing to promoting the well‑being of patients. They dispense medications as stated in the prescription and are also licensed to prescribe over‑the‑counter (OTC) medications. Self‑medication is widely practiced in various countries, which may lead to irrational drug use. The objectives of this study were to identify the factors associated with dispensing errors, to find ways to minimize dispensing errors, to identify patients’ reasons for self‑medication, and to find the drugs commonly utilized by patients as OTC medications and the sources of their drug information. Methods: A cross‑sectional survey of a convenience sample of 286 registered community pharmacists all over Tabuk was conducted using a self‑administered questionnaire. Results: Physician’s unclear handwriting in the prescription was the major factor for dispensing error (2.6 out of 3) and writing the prescription clearly by the physician or using a printed form of prescription was an important factor in minimizing dispensing errors (2.91 out of 3). Previous similar complaints in the past were the main reason for self‑medication (2.45 out of 3) with analgesics and antipyretics being the commonly dispensed drug groups dispensed as OTC medications (2.95 out of 3). Conclusion: Self‑medication practices and dispensing errors are widespread in Tabuk. Antibiotics were dispensed as OTC medication, which may lead to more chance of irrational drug use. Writing the prescription clearly and legibly would reduce dispensing errors. It is the community pharmacists’ responsibility to increase awareness regarding the appropriate use of drugs to the public. [ABSTRACT FROM AUTHOR]

Opioid overdose is a major cause of mortality in the United States. In spite of efforts to increase naloxone availability, distribution to high-risk populations remains a challenge. To assess the effects of multiple different naloxone distribution methods on patient obtainment of naloxone in the emergency department (ED) setting. Naloxone was provided to patients in three 12-month phases between February 2020 and February 2023. In Phase 1, physicians could offer patients electronic prescriptions, which were filled in a nearby in-hospital discharge pharmacy. In Phase 2, physicians directly provided patients with take-home naloxone at discharge. In Phase 3, distribution was expanded to allow ED staff to hand patients take-home naloxone at time of discharge. The total number of prescriptions, rate of prescription filling, and amount of take-home naloxone kits provided to patients were then statistically analyzed using 95% confidence intervals (CI) and chi-squared testing. In Phase 1, 348 naloxone prescriptions were written, with 133 (95% CI 112.5–153.5) filled. In Phase 2, 327 (95% CI 245.5–408.5) take-home naloxone kits were given to patients by physicians. In Phase 3, 677 (95% CI 509.5–844.5) take-home naloxone kits were provided to patients by ED staff. There were statistically significant increases in naloxone distribution from Phase 1 to Phase 2, and Phase 2 to Phase 3. Take-home naloxone increases access when compared with naloxone prescriptions in the ED setting. A multidisciplinary approach combined with the removal of regulatory and administrative barriers allowed for further increased distribution of no-cost naloxone to patients. [ABSTRACT FROM AUTHOR]

Background: COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. Methods: A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children's Hospital of The King's Daughters (CHKD) were included in the study. Patients were between the ages of 8–18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined "pre-pandemic months" as January 2019 through March 2020 and "pandemic months" as April 2020 through June 2022. Results: The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31–44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33–50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. Conclusions: Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed. [ABSTRACT FROM AUTHOR]

Aim: Our study aimed to audit prescriptions for the prescription indicators given by WHO and to analyze prescription errors, evaluating the frequency and types of prescription errors. Methodology: Prospective study was done in Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, under Pharmacology Department in October 2020. The prescriptions from all the OPD (outpatient departments) were collected from the pharmacy store. Prescriptions for the follow‑up medication and devoid of medicine were excluded from the study. Results: Total of 1451 errors were found from 400 collected prescriptions, out of which 324 (22.3%) were errors of omission and 145 (10.0%) were errors of commission related to drugs whereas 982 (67.7%) were the error of omission other than drug details. A total of 1257 drugs were prescribed making an average of 3.14 drugs per prescription, out of which 28.72% drugs were prescribed by generic name. About 34.0% of patients were prescribed antibiotics and 2.25% of patients were prescribed injectable drugs. All the drugs were prescribed from the National Essential Drug List (NEDL). Conclusion: The prescription audit showed that there is a need to train prescribing doctors as per the standard MMC and NMC guidelines for rational prescription writing to minimize the chance of major errors like not writing the dose of the drug, not writing it in capital letters, drug‑related instructions, diagnosis and so on. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system. [ABSTRACT FROM AUTHOR]

Socio-economic deprivation is strongly associated with poor asthma outcomes in England, but this relationship is not primarily due to poor adherence to inhaled corticosteroids (ICS). The study investigated the associations between adverse asthma outcomes, socio-economic deprivation, and ICS adherence at a population level in England. The data showed that areas with greater socio-economic deprivation had worse asthma outcomes, but better levels of ICS adherence. This suggests that while ICS non-adherence may lead to worse asthma outcomes at an individual level, it is not the main factor contributing to the population-level association between socio-economic deprivation and poor asthma outcomes. Further research is needed to explore alternative mechanisms by which socio-economic deprivation may lead to adverse asthma outcomes. [Extracted from the article]

OBJECTIVES: Educational interventions with proven effectiveness to reduce medication prescribing errors are currently lacking. Our objective was to implement and assess the effectiveness of a curriculum to reduce medication prescribing errors on a surgery service. METHODS: This was a prospective observational cohort study at a Canadian academic hospital without an electronic order entry system. A pharmacist-led medication prescribing curriculum for surgery residents was developed and implemented over 2 days (2 h/day) in July 2019. Thirteen (76%) out of 17 surgery residents contributed pre-implementation data, while 13 (81%) out of 16 surgery residents contributed post-implementation data. Medication prescribing errors were tracked for 12 months pre-implementation and 6 months post-implementation. Errors were classified as prescription writing (PW) or decision making (DM). RESULTS: There were a total of 1050 medication prescribing errors made in the pre-implementation period with 615 (59%) PW errors and 435 (41%) DM. There were a mean of 87.5 (SD = 14.6) total medication prescribing errors per month in the pre-implementation period with 51.3 (11.9) PW and 36.3 (6.0) DM errors. There were a total of 472 medication prescribing errors made in the post-implementation period with 260 (55%) PW and 212 (45%) DM errors. There were a mean of 78.7 (10.3) total medication prescribing errors per month in the post-implementation period with 43.3 (9.5) PW and 35.3 (4.2) DM errors. In the first quarter of the academic year, there were significantly fewer mean total errors per month post-implementation versus pre-implementation (77.7(12.7) versus 107.3(8.1); P =.035), with significantly fewer PW errors per month (40.7(13.2) versus 68.7(9.3); P =.046) and no difference in DM errors per month (37.0(2.0) versus 38.7(5.7); P =.671). There were no differences noted in the second quarter of the academic year. CONCLUSION: Medication prescribing errors occurred from PW and DM. Medication prescribing curriculum decreased PW errors; however, a continued education program is warranted as the effect diminished over time. [ABSTRACT FROM AUTHOR]

Background: The physical activity (PA) prescription workshop for physicians, through the global health initiative "Exercise is Medicine" (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015. Methods: A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers' and students' contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs). Results: The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers. Conclusions: Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs. [ABSTRACT FROM AUTHOR]

Objective: To assess the knowledge and skills of prescription writing among dental house officers from different hospitals. Methods: This cross-sectional study was conducted from July to September, 2022. A self-administered, structured questionnaire was used to collect data from 180 house officers from four teaching dental hospitals (n=45 each). The participants were asked to write a prescription for an adult and a pediatric patient. The prescription was evaluated according to WHO criteria. Analysis was done using SPSS v.20. Data was presented as frequencies and percentages. Results: Among the 180 participants, 42.9% were males and 57.1% were females. 33.9% participants reported prescription writing to be a difficult task. Only 36.7% participants reported to be trained in prescribing pediatric medications. None of the prescriptions completely fulfilled the WHO criteria. Doctor related information (name, address and contact no) was written by only 3.8% of the participants while 10% of the participants mentioned the patient related information (name, address and age). Dosage of the prescribed drugs was the most commonly drug-related missing parameter which was mentioned in 30% of the pediatric prescriptions and 21% of the adult prescriptions. Conclusion: There is a general lack of knowledge among the dental house officers regarding prescription writing as they were found to be unaware of the essential elements of a prescription. The findings call for an urgent change in the undergraduate teaching of prescription writing skills with special emphasis on pediatric drugs and dosage. [ABSTRACT FROM AUTHOR]

Objective To explore the academic experience and thought of Professor Zeng Qingqi, a guidance teacher for inheriting the academic experience of seventh batches of national veteran traditional Chinese medicine experts, on the treatment of erectile dysfunction (ED), and inherit the academic ideas of famous traditional Chinese medicine. Method The effective prescriptions of Professor Zeng Qingqi on ED treatment were collected from Andrology Department of the First Clinical School of Nanjing University of Traditional Chinese Medicine from October 1, 2021 to July 31, 2022, and the used drugs and treatment symptoms were input into the Chinese Medicine Inheritance Assistance Platform V3. 0 for data analysis. Result A total of 252 effective prescriptions on ED treatment were collected. Nature and taste analysis showed that warm drugs were used the most frequently, followed by cold drugs; Sweet drugs had the highest frequency of use, followed by spicy drugs; The analysis of meridian tropism showed that the frequency of drugs targeting the liver meridian was the highest, followed by drugs targeting the kidney meridian; The efficacy analysis showed that the use frequency of tonifying deficiency drugs was the highest, followed by regulating qi drugs; The results of drug frequency analysis, drug use pattern analysis, drug use rule analysis and network topology analysis showed that the commonly used drugs for ED treatment included Bupleuri radix, Paeoniae radix alba, Glycyrrhizae radix et rhizoma, Aurantii fructus, Rehmanniae radix, Corni fructus, Dioscoreae rhizoma, Alismatis rhizoma, Moutan cortex, Poria, Aconiti lateralis radix praeparata, and Cinnamomi ramulus. Cluster analysis obtained three new prescriptions. Conclusion Professor Zeng Qingqi has updated the theory of male Qi Heng Fu and proposed the academic theory of "premature ejaculation, impotence, and irritability depression". He believes that the basic pathogenesis of ED is liver depression and kidney deficiency, and the treatment method is to use both tonifying and tonifying, and the treatment principle is to soothe the liver and tonify the kidney. He is skilled in using the combination of Sini San and Jin Kui Shen Qi pill as the basis for treatment of various types of ED through flexible modification. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to establish a supported and validated reference point for Machiavellianism as an antecedent to the contemporary management philosophy of business process reengineering (BPR). Design/methodology/approach: This paper analyzes BPR and Machiavellianism by using the seminal work of Hammer and Champy (1993) on BPR and the original writings of Machiavelli coupled with the personal correspondence of Machiavelli with his contemporaries. Findings: The findings of this research indicate that the constructs of Machiavellian thought transcend the five centuries since the publication of The Prince, and can be found in the contemporary managerial framework of BPR. This comparison of historical leadership frameworks demonstrates how recent management decisions in companies show the rise of Machiavellian as BPR. In an analysis of these theories, the authors show similarities in five significant tenets of business leadership and argue how these repackaged ideas and prescriptions undermine employee-centric advances. Research limitations/implications: This comparison reviews the managerial frameworks presented in Machiavelli's The Prince and Hammer and Champy's book Reengineering the Corporation through the theoretical tenets of leadership. Practical implications: Employment of Machiavellianism and BPR results in an expendable utilization of followers and employees. Implications abound for modern managers, as the authors emphasize the elements and outcomes which lead to deleterious organizational outcomes. Social implications: In an analysis of these theories, the authors argue how these strategies undermine employee-centric advances within human relations by embracing these repackaged ideas and concepts. Originality/value: This research leverages historical perspective to provide a qualitative understanding of the follies of recycled versions of Machiavelli's ideas. The overall study and inquiry of BPR from a leadership perspective is not robust and leaves antecedents and influences critically unevaluated. [ABSTRACT FROM AUTHOR]

Research suggests that medical students are not confident and may be ill-prepared to prescribe competently. Therefore, changes to standard education may be required to fortify medical student prescribing skills, confidence, and competence. However, specific education to write a safe and legal prescription is generally lacking. Furthermore, the term prescribe and the skill thereof is not clearly defined. This review compares additional education for medical students to no identified additional education or another educational modality on the skill of prescription writing. Secondary aims include review of education modalities, prescribing skill assessments, educator professional background, and timing of education within the medical curriculum. This systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched included: CINAHL, Cochrane Library, EMBASE, Emcare (Ovid), MEDLINE (Ovid), PubMed and Scopus. Search terms included: medical education, medical undergraduate, medical student, medical school, and prescriptions. The search was conducted in February 2023, and quantitative outcomes were reported. Of the 5197 citations identified, 12 met the inclusion criteria. Eleven studies reported significant improvements in prescribing skills of medical students after additional educational intervention(s). Various educational modalities were implemented, including case-based teaching (n=3), patient-based teaching (n=1), tutorial-based teaching (n=2), didactic teaching (n=1), and mixed methods (n=6). There were no commonalities in the professional background of the educator; however, five studies used faculty members. There was no consensus on the best assessment type and time to implement prescription writing education during medical training. There are a range of interventions to educate and assess prescribing competencies of medical students. Despite heterogenous study designs, there is evidence of the superiority of additional prescription writing education versus no identified additional education to develop prescription writing skills. The introduction of formal teaching and standardised assessment of prescribing skills for medical students is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Southern Appalachia is a region of the United States that is disproportionately affected by the opioid epidemic and by increasing rates of neonatal abstinence syndrome (NAS). NAS rates increased approximately 400% between 1999 and 2012. Buprenorphine prescriptions written to treat opioid use disorder also increased dramatically. The present study was undertaken to ascertain any relationship between the number of buprenorphine prescriptions compared with NAS rates in southern Appalachia. Methods: A total of 250 southern Appalachian counties across seven states, including all of West Virginia and portions of Virginia, Kentucky, Maryland, North Carolina, Ohio, and Tennessee were identified. A retrospective cohort analysis of these counties was conducted for the years 2005-2018. All of the data were obtained from publicly accessible sources or direct communication with government offices. Measures from each county in southern Appalachia included annual NAS rates, buprenorphine prescription rates, drug-induced death rates, and opioid prescribing rates. Associations among these variables were examined using a generalized linear regression. Results: Significant linear associations exist between the rising rate of NAS diagnoses and the rising rate of buprenorphine prescriptions (r = 0.977, R2 = 95.53%, P < 0.001) and between the rising rate of buprenorphine prescriptions and the increase in drug-induced deaths (r = 0.712, R2 = 50.82%, P = 0.031). Conclusions: This is the first report that documents an association between rising NAS rates and increasing buprenorphine prescribing. Between the years 2010 and 2018, the NAS rate in southern Appalachia rose by 335%, and the number of buprenorphine prescriptions rose by 413%. Discussions regarding the current policies for buprenorphine management during pregnancy are warranted. We suggest a reevaluation of buprenorphine prescribing recommendations during pregnancy and further research on establishing the lowest effective buprenorphine dose for each pregnant patient. [ABSTRACT FROM AUTHOR]

Objectives: The prescription errors and prescribing fault analysis was assessed, the rationality of the prescriptions was checked, and the medication error was categorized according to the NCC MERP Index. Materials and Methods: A cross-sectional, observational study was designed as per STROBE guidelines and conducted for 2 months in the pharmacy stores after approval of the Institutional Review Board. Patients' written informed consent was taken before getting their prescriptions, and each of the prescriptions procured in this way was photographed for record. The completeness of 320 prescriptions of outpatients of all age groups regarding the details about the doctor and the patient and clinical diagnosis/indication was analyzed. The rationality of prescription was based on WHO core drug use indicators. Descriptive analysis was done by using Microsoft Excel. Results: A total of 320 prescriptions were analyzed from eight departments. Information about patients and prescribers was mentioned in 100% of prescriptions. The diagnosis (40%), an indication was written in 195 prescriptions. Instructions for dispensing drugs (89%), instructions to patients (90%), duration of treatment (100%), follow-up visits (19%), and non-pharmacological instructions (13%) were mentioned. In total, 82% of prescriptions were legible. In a total of 1004 drugs, 92% of drugs were prescribed with a generic name, 100% from the essential drug list. The route and frequency of drug administration were mentioned for all drugs. According to NCCMERP, the category of medication errors falls under category B. Conclusion: To reduce medication errors, we can implement an electronic system, involve clinical pharmacologists, utilize prescription charts, and organize nationwide workshops on rational prescription writing. We should encourage regular prescription audits and reporting to improve the healthcare system in the country. [ABSTRACT FROM AUTHOR]

Opioid addiction and related deaths have been called one of the most severe public health crises in our time. The current study focuses on rates of opioid prescribing. We hypothesized that poor adult mental health, affordability of health care, poverty, and number of practicing primary care physicians (per 100,000 persons in the state) would be associated with the number of prescriptions written (per 100 persons in the state). We found that each of these variables was significantly correlated with the number of prescriptions written (poor mental health r =.76, poverty r =.54, affordability r =.53, number of physicians r = −.51). Forward and backward linear multiple regression analyzed the degree to which the independent variables predicted the number of opioid prescriptions written. Results suggest that two predictor variables (poor adult mental health and number of physicians) accounted for a total of 75% of the variance in prescriptions written. [ABSTRACT FROM AUTHOR]

Introduction Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion The virtual format allowed multiple institutions to participate from various locations. It broadened the learners’ experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.