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1.
Medicine (Baltimore) ; 99(36): e22023, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899056

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) or combined with western medicine in the treatment of pediatric adenoidal hypertrophy has been widely used in clinical practice, but the overall efficacy and safety is still unclear. This paper aims to evaluate the efficacy and safety analysis of TCM or combined with western medicine for pediatric adenoidal hypertrophy. METHODS: PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database (CBM) were searched for randomized controlled trials of TCM or combined with western medicine for pediatric adenoidal hypertrophy from the date of establishment to July 2020, and Baidu Scholar, Google Scholar, International Clinical Trials Registry Platform (ICTRP), and Chinese Clinical Trials Registry (ChiCTR) were searched for unpublished grey literature. Two researchers independently applied RevMan 5.3 software for data extraction and risk assessment of bias. RESULTS: The effectiveness and safety of TCM or combined with western medicine for pediatric adenoidal hypertrophy is evaluated by means of the Adenoid (A) /(Nasopharyngeal (N) ratio, clinical efficacy, integral score of TCM syndromes, clinical single symptom score, disease specific quality of life for children with obstructive sleep apnea 18 items survey (OSA-18), Interleukin 4 (IL-4) and adverse reaction incidence. CONCLUSION: This study will provide theoretical support for the clinical application of TCM or combined with western medicine for pediatric adenoidal hypertrophy. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/J76AG.


Assuntos
Tonsila Faríngea/patologia , Medicamentos de Ervas Chinesas/uso terapêutico , Hipertrofia/terapia , Medicina Tradicional Chinesa/métodos , Criança , China/epidemiologia , Terapia Combinada , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Interleucina-4/sangue , Masculino , Qualidade de Vida , Segurança , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/psicologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(36): e22039, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899062

RESUMO

BACKGROUND: Clinical studies found that the combination of traditional Chinese herbal formula, and western medicine therapy are better in shrinking fibroids and improve other symptoms. This study aims to systematically evaluate the efficacy and safety traditional Chinese herbal formula combined with western medicine in the treatment of uterine fibroids. METHODS: Randomized controlled trials of traditional Chinese herbal formula combined with western medicine for uterine fibroids patients will be searched in PubMed, Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database (CMB), and Wanfang database from inception to August 2020. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will summarize the present evidence by exploring the efficacy and safety of traditional Chinese herbal formula combined with western medicine in the treatment of uterine fibroids CONCLUSIONS:: The findings of the study will help to determine potential benefits of traditional Chinese herbal formula combined with western medicine in the treatment of uterine fibroids. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/XUA8V.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Leiomioma/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , China/epidemiologia , Terapia Combinada , Prescrições de Medicamentos/normas , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
3.
PLoS Med ; 17(9): e1003308, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898149

RESUMO

BACKGROUND: Concerns over the safety of non-steroidal anti-inflammatory drug (NSAID) use during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been raised. We studied whether use of NSAIDs was associated with adverse outcomes and mortality during SARS-CoV-2 infection. METHODS AND FINDINGS: We conducted a population-based cohort study using Danish administrative and health registries. We included individuals who tested positive for SARS-CoV-2 during the period 27 February 2020 to 29 April 2020. NSAID users (defined as individuals having filled a prescription for NSAIDs up to 30 days before the SARS-CoV-2 test) were matched to up to 4 non-users on calendar week of the test date and propensity scores based on age, sex, relevant comorbidities, and use of selected prescription drugs. The main outcome was 30-day mortality, and NSAID users were compared to non-users using risk ratios (RRs) and risk differences (RDs). Secondary outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and acute renal replacement therapy. A total of 9,236 SARS-CoV-2 PCR-positive individuals were eligible for inclusion. The median age in the study cohort was 50 years, and 58% were female. Of these, 248 (2.7%) had filled a prescription for NSAIDs, and 535 (5.8%) died within 30 days. In the matched analyses, treatment with NSAIDs was not associated with 30-day mortality (RR 1.02, 95% CI 0.57 to 1.82, p = 0.95; RD 0.1%, 95% CI -3.5% to 3.7%, p = 0.95), risk of hospitalization (RR 1.16, 95% CI 0.87 to 1.53, p = 0.31; RD 3.3%, 95% CI -3.4% to 10%, p = 0.33), ICU admission (RR 1.04, 95% CI 0.54 to 2.02, p = 0.90; RD 0.2%, 95% CI -3.0% to 3.4%, p = 0.90), mechanical ventilation (RR 1.14, 95% CI 0.56 to 2.30, p = 0.72; RD 0.5%, 95% CI -2.5% to 3.6%, p = 0.73), or renal replacement therapy (RR 0.86, 95% CI 0.24 to 3.09, p = 0.81; RD -0.2%, 95% CI -2.0% to 1.6%, p = 0.81). The main limitations of the study are possible exposure misclassification, as not all individuals who fill an NSAID prescription use the drug continuously, and possible residual confounding by indication, as NSAIDs may generally be prescribed to healthier individuals due to their side effects, but on the other hand may also be prescribed for early symptoms of severe COVID-19. CONCLUSIONS: Use of NSAIDs was not associated with 30-day mortality, hospitalization, ICU admission, mechanical ventilation, or renal replacement therapy in Danish individuals who tested positive for SARS-CoV-2. TRIAL REGISTRATION: The European Union electronic Register of Post-Authorisation Studies EUPAS34734.


Assuntos
Anti-Inflamatórios não Esteroides , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Dinamarca , Prescrições de Medicamentos , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Rim , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Diálise Renal , Respiração Artificial
6.
Ann Afr Med ; 19(3): 153-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820726

RESUMO

It is now known that thrombotic disorders such as venous thromboembolism, ischemic stroke, and myocardial infarction contribute significantly to global morbidity and mortality. Anticoagulation service must respond to this new development. Warfarin has continued to provide the backbone for anticoagulation service for decades but with considerable drawbacks. The introduction of nonVitamin K oral anticoagulants (NOACs) has created new challenges. This article seeks to discuss how the establishment of appropriate models of anticoagulation could contain the draw backs of the old anticoagulants and improve on the compliance, availability, affordability, and accessibility of newer anticoagulants. Successful anticoagulation has always been defined by a scientific balancing of the risk of thrombosis and the complication of hemorrhage. To be able to maintain such optimal anticoagulation requires rational drug prescription (physician factor), institutelization of monitoring of therapy (anticoagulation clinic factor) as well as active participation of patients receiving therapy (patient factor). New models of service can be created out of this triad in a bid to replace the old routine medical care model. New models of anticoagulation service should include appropriately trained professionals such as Physicians, Pharmacists, Clinical Pharmacologists, Nurses, and Laboratory Scientists who are knowledgeable in diagnostic, management, and monitoring of anticoagulation. The different models of anticoagulation service discussed in this article clearly demonstrate the need for restructuring of this life saving service particularly in the era of NOAC. Newer models of care that should provide safe, efficacious, and cost-effective services are needed.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Anticoagulantes/uso terapêutico , Prescrições de Medicamentos , Tromboembolia/prevenção & controle , Varfarina/uso terapêutico , Administração Oral , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Humanos , Qualidade da Assistência à Saúde , Tromboembolia/tratamento farmacológico , Resultado do Tratamento
7.
BMC Infect Dis ; 20(1): 616, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819280

RESUMO

BACKGROUND: The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population. METHODS: This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006-2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours. RESULTS: The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change - 8.5 [95% CI - 11.9 to - 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections. When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar. CONCLUSIONS: Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.


Assuntos
Plantão Médico/estatística & dados numéricos , Antibacterianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Infecções/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Suécia/epidemiologia
9.
Rev Assoc Med Bras (1992) ; 66(7): 913-917, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844948

RESUMO

OBJECTIVES To evaluate the frequency of prescription of proton pump inhibitors (PPIs) and their indications in patients hospitalized at the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU). METHODS This is a quantitative cross-sectional observational study that analyzes data obtained from patient records on prescriptions of PPIs for patients hospitalized at the HC-UFU and from a questionnaire applied to assistant physicians on the indications of the drug in each case and evaluates the indication based on literature data. RESULTS On a pre-determined day, of a total of 462 inpatients, there was a prescription of PPI for 183 (39.3%), with a higher frequency (73.5%) in the Intensive Care Unit (ICU), followed by the infirmaries and the Emergency Room. The assistant physician was located in 116 cases, and the main motivation referred to prescription was prophylaxis of digestive hemorrhage (77%). However, after reviewing medical records, it was noticed that in 50.8% of the cases, the prescription was not supported by the literature. CONCLUSION The frequency of PPI prescriptions for inpatients in the HC-UFU is among the lowest described in the literature, but there are still unnecessary prescriptions. Instruction and awareness of the assisting team can minimize these numbers.


Assuntos
Prescrições de Medicamentos , Inibidores da Bomba de Prótons , Brasil , Estudos Transversais , Humanos , Padrões de Prática Médica , Inibidores da Bomba de Prótons/uso terapêutico , Centros de Atenção Terciária
11.
PLoS Med ; 17(7): e1003215, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32697803

RESUMO

BACKGROUND: The use of antidepressants in children and adolescents remains controversial. We examined trends over time and variation in antidepressant prescribing in children and young people in England and whether the drugs prescribed reflected UK licensing and guidelines. METHODS AND FINDINGS: QResearch is a primary care database containing anonymised healthcare records of over 32 million patients from more than 1,500 general practices across the UK. All eligible children and young people aged 5-17 years in 1998-2017 from QResearch were included. Incidence and prevalence rates of antidepressant prescriptions in each year were calculated overall, for 4 antidepressant classes (selective serotonin reuptake inhibitors [SSRIs], tricyclic and related antidepressants [TCAs], serotonin and norepinephrine reuptake inhibitors [SNRIs], and other antidepressants), and for individual drugs. Adjusted trends over time and differences by social deprivation, region, and ethnicity were examined using Poisson regression, taking clustering within general practitioner (GP) practices into account using multilevel modelling. Of the 4.3 million children and young people in the cohort, 49,434 (1.1%) were prescribed antidepressants for the first time during 20 million years of follow-up. Males made up 52.0% of the cohorts, but only 34.1% of those who were first prescribed an antidepressant in the study period. The largest proportion of the cohort was from London (24.4%), and whilst ethnicity information was missing for 39.5% of the cohort, of those with known ethnicity, 75.3% were White. Overall, SSRIs (62.6%) were the most commonly prescribed first antidepressant, followed by TCAs (35.7%). Incident antidepressant prescribing decreased in 5- to 11-year-olds from a peak of 0.9 in females and 1.6 in males in 1999 to less than 0.2 per 1,000 for both sexes in 2017, but incidence rates more than doubled in 12- to 17-year-olds between 2005 and 2017 to 9.7 (females) and 4.2 (males) per 1,000 person-years. The lowest prescription incidence rates were in London, and the highest were in the South East of England (excluding London) for all sex and age groups. Those living in more deprived areas were more likely to be prescribed antidepressants after adjusting for region. The strongest trend was seen in 12- to 17-year-old females (adjusted incidence rate ratio [aIRR] 1.12, 95% confidence interval [95% CI] 1.11-1.13, p < 0.001, per deprivation quintile increase). Prescribing rates were highest in White and lowest in Black adolescents (aIRR 0.32, 95% CI 0.29-0.36, p < 0.001 [females]; aIRR 0.32, 95% CI 0.27-0.38, p < 0.001 [males]). The 5 most commonly prescribed antidepressants were either licensed in the UK for use in children and young people (CYP) or included in national guidelines. Limitations of the study are that, because we did not have access to secondary care prescribing information, we may be underestimating the prevalence and misidentifying the first antidepressant prescription. We could not assess whether antidepressants were dispensed or taken. CONCLUSIONS: Our analysis provides evidence of a continuing rise of antidepressant prescribing in adolescents aged 12-17 years since 2005, driven by SSRI prescriptions, but a decrease in children aged 5-11 years. The variation in prescribing by deprivation, region, and ethnicity could represent inequities. Future research should examine whether prescribing trends and variation are due to true differences in need and risk factors, access to diagnosis or treatment, prescribing behaviour, or young people's help-seeking behaviour.


Assuntos
Antidepressivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Antidepressivos/farmacologia , Criança , Pré-Escolar , Estudos de Coortes , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Inibidores de Captação de Serotonina/uso terapêutico
12.
PLoS Med ; 17(7): e1003202, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32702001

RESUMO

BACKGROUND: Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS: We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. CONCLUSIONS: These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.


Assuntos
Infecções/complicações , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos , Feminino , Idoso Fragilizado , Fragilidade , Humanos , Lactente , Recém-Nascido , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Atenção Primária à Saúde , Probabilidade , Encaminhamento e Consulta , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Reino Unido/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto Jovem
14.
PLoS One ; 15(7): e0235671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649689

RESUMO

BACKGROUND: Antibiotics are regularly prescribed by dental professionals in their practice, for the purpose of dental treatment as well as for the prevention of infection. The inappropriate use of antibiotics is a significant factor in the rise of antibiotic resistance. There is an immediate need for the advancement of prescribing guidelines and instructive polices to encourage the rational and appropriate utilization of medications especially antibiotics in dentistry. OBJECTIVE: The aim of this study was to identify the frequency of antibiotic prescription for treating dental infections in children among dentists in teaching institutions of Karachi, Pakistan and whether they are adhering to the prescribed international guidelines. METHODS: A cross-sectional study was conducted in three private and two public colleges of Karachi. After taking written informed consent and checking the inclusion criteria, a total of 380 participants were interviewed using a pre-designed validated questionnaire which included demographic profile and clinical case scenarios. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using chi-square test. The significance level was set at 0.05. RESULTS: Of the 380 subjects, a majority (71.3%) treated 15 or less children per month (n = 271) while 28.7% of dentists (n = 109) treated more than 15 children per month. Overall adherence to American Academy of Pediatric Dentistry guidelines was low from 26.1% to 44.2%. The difference between adherence of dentists with low and high volume of pediatric patients was significantly different for case scenarios 1, 3, 4 and 5 (p<0.001 for all) where dentists who treated 15 or less children per month were more likely to be adherent to standard antibiotic prescription guidelines than those who treated more than 15 children per month. CONCLUSIONS: This study shows that majority of dentists, particularly dentists with high volume of pediatric patients lacked adherence to professional guidelines for prescribing antibiotics for treating dental infection in children. There seem to be a lack of harmony between the recommended professional guidelines and the antibiotic prescribing pattern of dentists. Regular updates and continuing medical education for the health professionals regarding comprehensible and specific professional guidelines may lead to improved adherence of antibiotics prescription amongst dentists.


Assuntos
Antibacterianos/uso terapêutico , Odontólogos/psicologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Doenças Dentárias/tratamento farmacológico , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Lactente , Entrevistas como Assunto , Masculino , Paquistão , Odontopediatria , Inquéritos e Questionários , Doenças Dentárias/microbiologia , Adulto Jovem
15.
N Z Med J ; 133(1518): 33-42, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32683430

RESUMO

AIMS: The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner. METHODS: Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases. The rates of dispensing for patients registered with a general practitioner were measured as antibiotic courses dispensed per 1,000 population per day, and as defined daily doses per 1,000 population per day. RESULTS: Total community antibiotic dispensing in New Zealand, measured as defined daily doses per 1,000 inhabitants per day, decreased by 13.8% during 2015-2018, an average annual reduction of 4.6% per year, with especially large reductions in dispensing of amoxicillin/clavulanate, fluoroquinolones and macrolides. The reductions in dispensing were greatest in children aged 0-4 years old, but lesser reductions were seen in all age groups. Antibiotic dispensing declined regardless of patient ethnicity or level of socioeconomic deprivation. There were marked differences between primary health organisations in the size of the reductions in antibiotic dispensing during 2015-2018, which ranged between 4.8% for the Te Tai Tokerau PHO to 21.5% for the Ngati Porou Hauora Charitable Trust PHO. CONCLUSIONS: Total community antibiotic dispensing has reduced significantly in New Zealand between 2015 and 2018, with large disparities between primary health organisations in the size of the reductions. The overall rates of antibiotic dispensing remain high for non-Maori and non-Pacific people, and prescribers should aim to further reduce inappropriate antibiotic prescribing for these populations. However, the overall rate of antibiotic dispensing for Maori and Pacific people may now approximate an optimal level. Prescribers should aim to further reduce inappropriate antibiotic prescribing, but also to increase appropriate antibiotic prescribing for these populations.


Assuntos
Antibacterianos/farmacologia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Medicina de Família e Comunidade/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Padrões de Prática Médica , Humanos , Nova Zelândia , Estudos Retrospectivos
16.
PLoS One ; 15(7): e0232464, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697808

RESUMO

BACKGROUND: Antibiotic resistance is a major public health concern. It has been associated with factors such as uncontrolled consumption, lack of knowledge, beliefs, and sociodemographic characteristics. Lebanon is characterized by high levels of antibiotic misuse, as almost half of the population self-medicates with antibiotics and over 30% of the antibiotics are dispensed without prescription. To-date, no studies determined adequately the association between knowledge, beliefs and antibiotic misuse in Lebanon. OBJECTIVE: To assess the association between level of knowledge and beliefs about antibiotics, and antibiotic misuse in Lebanon. METHODS: We conducted a cross-sectional study among 1,421 parents of schoolchildren using an anonymous self-administered Knowledge, Attitude and Practices questionnaire. The participants´ level of agreement with each item of knowledge and beliefs was measured using a Likert-type (0-10) scale. Misuse practices in the last month were detected through a series of questions aimed at determining the level of compliance with physicians´ instructions in terms of dosage and duration. Data were analyzed using logistic regression. RESULTS: 277 participants (16%) acknowledged using antibiotics in the previous month, 41% of whom showed at least one misuse behavior. Misconceptions and beliefs about antibiotics substantially increased the odds of their misuse. For instance, participants who believed that antibiotics were effective in treating viruses, cold, or sore throat infections were twice as likely to misuse antibiotics [Adjusted Interquartile Odds Ratio (aIqOR): 2.08 (95%CI: 1.32, 3.19), aIqOR: 1.81 (95%CI: 1.41, 2.29), aIqOR: 2.19 (95%CI: 1.61, 2.93), respectively]. Parents who usually keep antibiotics at home antibiotics for future use were more likely to misuse antibiotics [aIqOR: 2.44 (95%CI: 1.68, 3.46)]. CONCLUSIONS: Our findings indicate that the low level of knowledge and the existence of erroneous beliefs about antibiotics are associated with increased odds of antibiotic misuse. Key elements including rationale prescription and control of dispensing should be addressed when designing educational campaigns against antibiotic misuse.


Assuntos
Antibacterianos , Uso Indevido de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pais , Adulto , Comunicação , Prescrições de Medicamentos/estatística & dados numéricos , Resistência Microbiana a Medicamentos , Feminino , Humanos , Líbano , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários
17.
Int J Clin Pharmacol Ther ; 58(9): 475-481, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32729826

RESUMO

AIMS: The aim of this study was to examine the development in the number of patients receiving cardiovascular or antidiabetic medications from pharmacies in the first quarter of 2020. METHODS: This cross-sectional study was based on the data from more than 10 million patients in the IMS longitudinal prescription (LRx) database. The outcome of this study was the development in the number of patients receiving cardiovascular or diabetic medications from pharmacies in January, February, and March 2020, compared to January, February, and March 2019. RESULTS: From March 2019 to March 2020, there was a 39% increase in angiotensin II antagonist prescriptions, a 33% increase in lipid-lowering drug prescriptions, a 32% increase in calcium channel blocker (CCB) prescriptions, a 30% increase in beta blocker prescriptions, a 27% increase in angiotensin-converting enzyme (ACE) inhibitor, vitamin k antagonist (VKA), and oral antidiabetic prescriptions, a 24% increase in diuretic prescriptions, and an 18% increase in insulin prescriptions. The largest increase was found in the age group of 18 - 40 years (e.g., 57% for VKA, 52% for CCB and angiotensin II antagonists), and the smallest increase occurred in the age group over 80 years (for example, 10% for VKA, 9% for oral antidiabetics, and 3% for insulins). CONCLUSION: The number of patients receiving their drugs from pharmacies was significantly higher in March 2020 than in March 2019, which is an indication of good therapy adherence. Additional studies are needed to examine adherence during the COVID-19 pandemic and possible age differences in adherence.


Assuntos
Anti-Hipertensivos/uso terapêutico , Infecções por Coronavirus/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Pneumonia Viral/epidemiologia , Betacoronavirus , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Alemanha/epidemiologia , Humanos , Pandemias
18.
PLoS One ; 15(7): e0235513, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645026

RESUMO

BACKGROUND: Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. METHODS: A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. RESULTS: Participants were aged between 21-57years, had been practicing for 1-30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: poor use of treatment guidelines, lack of RMU policies, poorly-functioning pharmaceutical and therapeutics committees, stock-outs of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers. Patient-related factors included late presentation, language, and the need to be prescribed many medicines. CONCLUSION: In Eswatini, prescribing practices are influenced by the interaction of factors (health system, provider and patient) that span levels (facility, region, and policy-making) of the health system. Promoting RMU thus goes beyond the availability of guidelines and provider training and requires concerted efforts of multiple stakeholders.


Assuntos
Prescrições de Medicamentos , Uso de Medicamentos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adulto , Essuatíni , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
20.
J Med Internet Res ; 22(8): e19678, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32716892

RESUMO

BACKGROUND: Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called "internet hospital plus drug delivery" (IHDD) has been developed in China, but little is known about this platform. OBJECTIVE: The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China. METHODS: The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients' gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis. RESULTS: A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China. CONCLUSIONS: The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service.


Assuntos
Infecções por Coronavirus/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Internet , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Transportes/estatística & dados numéricos , Adolescente , Adulto , China/epidemiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
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