Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study.

INTRODUCTION: Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS: A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS: A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION: The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Infection and the evaluation of biomarkers in obstetrics and gynecology patients with infectious disease: a retrospective observational study from clinical pharmacists' consultation experience.

BACKGROUND: The use of empirical anti-infective medication calls for the identification of common pathogens and accurate infectious biomarkers. However, clinical pharmacists' anti-infective experience in the field of obstetrics and gynaecology is rare in the literature. This study aimed to retrospectively analyze the correlation between the anti-infective effectiveness after 7 days of antibiotic treatment and infectious biomarkers, according to clinical pharmacists' consultation cases of gynecological and obstetric infections. METHODS: In this retrospective study, clinical pharmacists' anti-infective consultation experiences applied by physicians from January 1, 2018, to December 31, 2020, were included. The exclusion criteria were as follows: (1) the patient died or left the hospital before undergoing an effectiveness evaluation after the consultation; (2) treatment was discontinued due to adverse reactions related to antibiotics; (3) the patient did not undergo an effectiveness evaluation within 3 or 7 days after application of the clinical pharmacist's treatment plan; and (4) the physician did not adopt the clinical pharmacist's suggestions. The registered information included patient characteristics, pathological bacteria, anti-infective medication and changes in infection indices before and after treatment. Statistical analysis of temperature, white blood cells (WBCs), C-reactive protein (CRP), procalcitonin (PCT) and WBCs in urine after 3 days and 7 days of anti-infective treatment, compared with before anti-infective treatment, was performed by the chi-square test. A t test was conducted to further study WBC count and CRP. A receiver operating characteristic curve verified the sensitivity and specificity of WBC count, CRP and PCT. RESULTS: A total of 265 cases were included. The CRP levels of patients 3 d and 7 d after antibiotic treatment were significantly lower than before antibiotic treatment (P < 0.05, P < 0.01), while the WBC count showed a downward trend after 3 days and a significant decrease after 7 days (P < 0.01). The areas under the curve (AUCs) for prognosis on the 7th day for WBC count, CRP and PCT were 0.90, 0.75 and 0.522, respectively. The AUC for WBC count combined with CRP was 0.90, which was higher than that for the biomarkers tested separately, especially compared to PCT. The most common gynecological infections were surgical site infection (SSI), urinary tract infection and fever of unknown origin, and the most common pathogens were E. coli and E. faecalis in Gram-negative and Gram-positive samples, respectively. Pharmacists' recommended treatment plans included carbapenems and ß-lactam antibiotics. CONCLUSIONS: Our dual-center study indicates that the combination of WBC count and CRP can improve diagnostic accuracy and treatment efficiency, and PCT alone is insensitive to gynecological infections, according to clinical pharmacists' experience.

Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists' Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis.

Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non-anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.

Daidzein-loaded nanostructured lipid carriers-PLGA nanofibers for transdermal delivery.

Daidzein is one of the most effective candidates for treating cardiovascular and cerebrovascular disease. However, considering its poor oral absorption and limited bioavailability, daidzein-loaded nanostructured lipid carriers-PLGA nanofibers were designed to handle the drawbacks. Daidzein-NLCs were successfully prepared by an emulsification and low-temperature solidification method. The physicochemical characteristics of NLCs were evaluated afterwards. Based on the preparation of daidzein-loaded NLCs, Daidzein-NLCs-nanofibers were optimized by electrospinning and were observed under Scanning Electron Microscope to capture the appearance. The sustained release profile of daidzein from Daidzein-NLCs-nanofibers in vivo was best fitted to the Kormeyer-Peppas equation. The in vitro skin permeable behavior showed the cumulative amount of daidzein from Daidzein-NLCs-nanofibers reached 21.71 µg cm(-2) at 60 h, which was 3.78 times higher than pure daidzein solution. It demonstrated that the Daidzein-NLCs-nanofibers could significantly enhance the transported amount of drug. Confocal Laser Scanning Microscopy resulting images revealed a more effective content accumulation of Daidzein-NLCs-nanofibers than Daidzein-NLCs in epidermis. In vivo study indicated that Daidzein-NLCs-nanofibers had better skin retention than Daidzein-NLCs in the long term. The skin irritation experiment showed a positive result with no obvious stimulus observed. These results suggested that Daidzein-NLCs-nanofibers could be a potential candidate for transdermal delivery.

Docetaxel-nicotinamide complex-loaded nanostructured lipid carriers for transdermal delivery.

Docetaxel (DTX) proved one of the most effective active pharmaceutical ingredients (APIs) for the treatment of cancers. However, in respect of its low solubility and high lipophilic property, nicotinamide (NCT) was chosen as the co-former to form the docetaxel-nicotinamide complex to handle the drawbacks. As was analyzed by Fourier Transform Infrared spectrometer, thermal analysis and saturated solubility, the complex proved stable. Then, docetaxel-nicotinamide complex nanostructured lipid carriers (DN-NLCs) were prepared by emulsion-evaporation at low temperature method. The average drug entrapment efficiency, particle size and drug loading of docetaxel-NLCs (D-NLCs) and DN-NLCs were 81.41-79.48%, 61.45-59.48nm and 1.60-1.63%, respectively. The physicochemical characteristics of nanoparticles were valued by transmission electron microscope and Powder X Ray Diffraction. The in vitro drug-release profile of nanoparticle formulations fitted the Weibull dynamic equation. The skin permeability test was performed by Vertical Franz-type diffusion cells. It demonstrated that DN-NLCs transported drugs more easily than D-NLCs. Confocal Laser Scanning Microscopy observation showed DN-NLCs permeated more effectively than D-NLCs. In vivo study demonstrated that DN-NLCs maintained most in the skin. These results suggest that the DN-NLCs can be a useful method to increase skin permeation of docetaxel.