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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Clinical Trials Registry Platform (ICTRP), and Chinese Clinical Trials Registry (ChiCTR) were searched for unpublished grey literature.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 One ; 15(9): e0239257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946507

RESUMO

OBJECTIVE: This comprehensive review examined sex differences in prescription rates and efficacy or effectiveness of pharmacotherapy treatment in girls and women with attention deficit hyperactivity disorder (ADHD), while identifying gaps in the scientific knowledge on this topic. METHOD: A rigorous electronic database search was carried out in order to identify all published studies on female-specific effects of stimulants and non-stimulants in the treatment of ADHD. In total, 2672 studies were screened of which 21 studies (seven on prescription rates, 14 on effects of pharmacotherapy) met the inclusion criteria and were included for analysis. RESULTS: In all seven studies on ADHD prescription rates, girls received significantly less prescriptions than boys, a difference however no longer seen in adults with the exception of one study. Each of the 14 studies on effectiveness / efficacy found at least one sex-difference in the effects of ADHD pharmacotherapy. CONCLUSION: Several sex-differences are demonstrated in the prescription, usage and efficacy /effectiveness of both stimulant and non-stimulant ADHD pharmacotherapy. A single daily use of MPH may possibly not be optimal for girls with ADHD and ATX may be a promising medication for girls and women with ADHD. The robustness of this result requires further investigation.


Assuntos
Cloridrato de Atomoxetina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Caracteres Sexuais , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/patologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Pré-Escolar , Bases de Dados Factuais , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Homens , Metilfenidato/uso terapêutico , Adulto Jovem
4.
Revista Digital de Postgrado ; 9(2): 211, ago. 2020.
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1103439

RESUMO

En años recientes los venezolanos hemos enfrentado problemas de diversa índole con relación a la situación de salud. Entre ellos, problemas en la prescripción y la obtención de medicamentos. En esta publicación se tratarán aspectos importantes para la correcta prescripción y obtención de medicamentos, lo cual, a su vez, debería ser el colofón de la atención médica de primera que siempre ha caracterizado a nuestro país y que hoy, lamentablemente, ha devenido en una situación muy dolorosa. La prescripción y obtención de medicamentos puede verse dificultada por diversos inconvenientes, entre los cuales podemos considerar aquellos que tienen relación con el medicamento propiamente dicho, con el prescriptor y el cliente, con las regulaciones vigentes en nuestro país y con la disponibilidad en los centros autorizados para su venta. Como consecuencia de una prescripción inadecuada y un consumo inapropiado de medicamentos pueden surgir problemas muy serios, entre los cuales habría que destacar, en el campo de los antiinfecciosos, la resistencia bacteriana. Y en el campo de fármacos destinados al tratamiento del dolor, la ansiedad y el insomnio, la posibilidad de adicciones diversas. La prescripción adecuada de medicamentos conlleva la necesidad de conocer, a la par de los efectos beneficiosos y terapéuticos de los mismos, la posibilidad de efectos adversos e interacciones. Todos los prescriptores sanitarios deben conocer los fundamentos de la Farmacovigilancia, la cual permitirá conocer el verdadero balance riesgo-beneficio de los fármacos, por lo cual hacemos una breve mención de la misma al final de esta presentación(AU)


In recent years, Venezuelans have faced various kinds of problems related to the health situation. Among them, problems in prescription and acquisition of medicines. This publication will discuss important aspects for the correct prescription and obtention of medicines, which, in turn, should be the culmination of the excellent medical care that has always characterized our country but that today, unfortunately, has become a very disgraced and sad situation. Prescription and acquisition of medicines can be hindered by various inconveniences, among which we can consider those that are related to the product itself, to the prescriber and the client, to the regulations in force in our country and to the availability in authorized centers for sale. As a result of an inadequate prescription and consumption of medications, very serious problems can arise, among which, in the field of anti-infectives, bacterial resistance should be highlighted. In the field of drugs for the treatment of pain, anxiety and insomnia, the possibility of diverse addictions. Proper prescription of medicaments entails the need to know, along with their beneficial and therapeutic effects, the possibility of adverse effects and interactions. All health prescribers must know the basics of Pharmacovigilance, which allow to know the true risk-benefit balance of drugs, so we make a brief mention of it at the end of this presentation.(AU)


Assuntos
Humanos , Prescrições de Medicamentos/normas , Resistência Microbiana a Medicamentos , Direito à Saúde , Farmacologia Clínica , Especificações Sanitárias , Farmacovigilância
5.
PLoS Med ; 17(8): e1003208, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32813708

RESUMO

BACKGROUND: The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. METHODS AND FINDINGS: Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. CONCLUSIONS: In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.


Assuntos
Antibacterianos/administração & dosagem , Prescrições de Medicamentos , Farmacorresistência Bacteriana/efeitos dos fármacos , Serviço Hospitalar de Emergência/tendências , Febre/tratamento farmacológico , Febre/epidemiologia , Adolescente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana/fisiologia , Serviço Hospitalar de Emergência/normas , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
6.
PLoS One ; 15(8): e0237868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32818951

RESUMO

BACKGROUND: Older adults with chronic kidney disease (CKD) are at heightened risk for polypharmacy. We examined potentially inappropriate prescribing in this population and whether introducing pharmacists into the ambulatory kidney care model was associated with improved prescribing practices. METHODS: Retrospective cohort study using linked administrative databases. We included patients with an eGFR ≤30 mL/min/1.73 m2 ≥66 years of age followed in multidisciplinary kidney clinics in Ontario, Canada (n = 25,016 from 28 centres). The primary outcome was the absence of a statin prescription or the receipt of a potentially inappropriate prescription defined by the American Geriatric Society Beers Criteria® and a modified Delphi panel that identified key drugs of concern in CKD. We calculated the crude cumulative incidence and incidence rate for the primary outcome and used change-point regression to determine if a change occurred following pharmacist introduction. RESULTS: There were 6,007 (24%) and 16,497 patients (66%) not prescribed a statin and with ≥1 potentially inappropriate prescription, respectively. The rate of potentially inappropriate prescribing was 125.6 per 100 person-years and was higher in more recent years. The change-point regression analysis included 2,275 patients from two centres. No immediate change was detected at pharmacist introduction, but potentially inappropriate prescribing was increasing pre-pharmacist introduction, and this rising trend was reversed post-pharmacist introduction. The incidence of potentially inappropriate prescribing still remained high post-pharmacist introduction. CONCLUSIONS: Potentially inappropriate prescribing practices were common. Incorporating pharmacists into the kidney care model may improve prescribing practices. The role of pharmacists in the ambulatory kidney care team warrants further investigation in a randomized controlled trial.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Inadequada/prevenção & controle , Polimedicação , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Canadá/epidemiologia , Gerenciamento de Dados , Feminino , Humanos , Masculino , Farmacêuticos , Lista de Medicamentos Potencialmente Inapropriados , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/patologia , Estudos Retrospectivos
7.
PLoS One ; 15(8): e0238064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841285

RESUMO

BACKGROUND: Inappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs). OBJECTIVE: The aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing. METHODS: A retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index. RESULTS: The Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled ß2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index. CONCLUSION: The prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.


Assuntos
Prescrições de Medicamentos/normas , Medicina Baseada em Evidências , Geriatria , Admissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Padrões de Referência
8.
Medicine (Baltimore) ; 99(29): e21152, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702869

RESUMO

BACKGROUND: The use of antibiotics in the acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Serum C-reactive protein (CRP), a sensitive biomarker for systemic inflammation and tissue damage, is a good indicator of lower respiratory tract bacterial infection. However, due to the small sample size of the existing studies, the clinical value of CRP in guiding the use of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotics is insufficient. The aim of this study was to evaluate the value of CRP-guided treatment strategies for AECOPD patients. METHODS: This review summarizes and meta-analyses randomized controlled trials (RCTs) of CRP guiding antibiotic prescribing for COPD exacerbations. RCTs compare either usual-care or the GOLD strategy have been included. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data. The methodologic quality of RCTs has been assessed using the Cochrane risk assessment tool. All trials included are analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software, and GRADE pro GDT web solution are used for data synthesis and analysis. RESULTS: This review evaluates the effects of CRP testing on the antibiotic use, CCQ, EQ-5D utility scores and adverse events in patients with COPD exacerbations. CONCLUSION: This review provides clear evidence that CRP testing can reduce the use of antibiotics in patients with AECOPD without causing harm.


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Protocolos Clínicos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antibacterianos/administração & dosagem , Biomarcadores/análise , Biomarcadores/sangue , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Metanálise como Assunto , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Revisões Sistemáticas como Assunto
10.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194053

RESUMO

OBJECTIVE: This ex post facto matched control study was conducted to evaluate the effect of targeted short-form messages or continuing medical education (CME) on fluoroquinolone prescribing among high prescribers. METHODS: A total of 11,774 Medscape healthcare provider (HCP) members prescribing high volumes of fluoroquinolones were randomized into three segments to receive one of three unique targeted short-form messages, each delivered via email, web alerts, and mobile alerts. Some HCPs receiving targeted short-form messages also participated in CME on fluoroquinolone prescribing. A fourth segment of HCPs participated in CME only. Test HCPs were matched to third-party-provider prescriber data to identify control HCPs. We used prescriber data to determine new prescription volume; percentage (%) of HCPs with reduced prescribing; new prescription volume for acute bacterial sinusitis (ABS), uncomplicated urinary tract infection (uUTI), and acute bacterial exacerbations of chronic bronchitis in those with chronic obstructive pulmonary disease (ABECB-COPD). Open rates for emailed targeted short-form messages were also measured. RESULTS: Targeted short-form messages and CME each resulted in significant new prescription volume reduction versus control. Combining targeted short-form messages with CME yielded the greatest percentage of test HCPs with reduced prescribing (80.1%) versus controls (76.2%; p < 0.0001). New prescription volume decreased significantly for uUTI and ABS following exposure to targeted short-form messages, CME, or both. Targeted short-form messages containing comparative prescribing information with or without clinical context were opened at slightly higher rates (10.8% and 10.6%, respectively) than targeted short-form messages containing clinical context alone (9.1%). CONCLUSIONS: Targeted short-form messages and CME, alone and in combination, are associated with reduced oral fluoroquinolone prescribing among high prescribers


No disponible


Assuntos
Humanos , United States Food and Drug Administration/normas , Fluoroquinolonas/normas , Antibacterianos , Educação a Distância/métodos , Prescrições de Medicamentos/normas , Educação Médica Continuada/métodos , Análise de Dados
11.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194055

RESUMO

BACKGROUND: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. OBJECTIVE: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. METHODS: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th, 2019, and June 14th, 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines' recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. RESULTS: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%CI 4.79-72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. CONCLUSIONS: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increased adherence to guidelines and may reduce the number of preventable bleeding cases


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/normas , Inibidores da Agregação de Plaquetas/administração & dosagem , Guias de Prática Clínica como Assunto/normas , Farmacêuticos/normas , Doença da Artéria Coronariana/tratamento farmacológico , Estudos Prospectivos , Fibrinolíticos/administração & dosagem , Erros de Medicação/prevenção & controle , Fatores de Risco
12.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194063

RESUMO

OBJECTIVE: Explore the perceptions, attitudes and experiences of pharmacists relating to the up-scheduling of low dose codeine containing analgesics and the impact on pharmacy practice. METHODS: A mixed design method was used consisting of an anonymous online questionnaire survey to quantitatively capture broad pre-scheduling change perceptions paired with a series of in-depth post-scheduling semi-structured interviews to provide a qualitative picture of the impact of codeine up-scheduling on pharmacy practice in Australia. RESULTS: A total of 191 pharmacists completed the quantitative survey and 10 participated in the in-depth interview. The majority of respondents supported the decision to up-schedule over-the-counter combination products containing codeine to some degree. Three main themes emerged from the data: pharmacists' perceptions of the codeine up-scheduling decision, preparing for the up-schedule and impact of the up-schedule on pharmacy practice. Pharmacists were concerned about the impact of up-scheduling on the pharmacy business, patient access to pain relief and the diminishment of their professional role. CONCLUSIONS: There were diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Further research should be conducted to gauge if and how these perceptions have changed over time and to identify whether pain is being managed more effectively post codeine up-scheduling


No disponible


Assuntos
Humanos , Masculino , Feminino , Codeína/administração & dosagem , Percepção , Farmacêuticos/estatística & dados numéricos , Prescrições de Medicamentos/normas , Conhecimentos, Atitudes e Prática em Saúde , Medicamentos sem Prescrição/normas , Inquéritos e Questionários , Analgésicos/administração & dosagem , Austrália
13.
PLoS One ; 15(6): e0234425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542028

RESUMO

BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/terapia , Manejo da Dor/métodos , Padrões de Prática Médica/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Analgésicos Opioides/normas , Sistemas de Apoio a Decisões Clínicas/organização & administração , Prescrições de Medicamentos/normas , Feminino , Humanos , Colaboração Intersetorial , Masculino , Serviços de Saúde Militar/normas , Epidemia de Opioides , Educação de Pacientes como Assunto/organização & administração , Padrões de Prática Médica/normas , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Programas de Monitoramento de Prescrição de Medicamentos/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/normas
15.
PLoS One ; 15(5): e0232903, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407346

RESUMO

BACKGROUND: Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown. AIM: To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections. METHODS: Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality. RESULTS: In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance. CONCLUSIONS: This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/legislação & jurisprudência , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Uso de Medicamentos , Inglaterra/epidemiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto Jovem
16.
J Surg Res ; 252: 169-173, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278971

RESUMO

BACKGROUND: Initial opioid exposure for most individuals with substance use disorder comes from the healthcare system, and overprescription of opioids in ambulatory operations is common. This report describes an academic medical center's experience implementing opioid-free thyroid and parathyroid operations. MATERIALS AND METHODS: This is a retrospective chart review of patients undergoing a thyroid or parathyroid operation before and after implementation of an opioid-free analgesia protocol. The primary endpoint was new postoperative opioid prescription. Secondary endpoints included prescription characteristics and predictors of new opioid prescription. RESULTS: A total of 515 patients were enrolled in the study: 240 in the control or "pre-intervention" cohort (May through October 2017) and 275 in the intervention or "post" cohort (May through October 2018). Patients in the intervention cohort were significantly less likely to receive an opioid prescription (12.0% versus 59.6%, P < 0.001). When opioids were prescribed, they were used for shorter durations and at lower doses in the intervention cohort. Among the patients prescribed opioids in the intervention cohort (N = 33), the only significant predictor of postoperative opioid use was preoperative opioid use (P = 0.001). CONCLUSIONS: Opioids may not be required after thyroidectomy and parathyroidectomy, especially for opioid-naïve patients. Future research should examine patient satisfaction with opioid-sparing analgesia.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Implementação de Plano de Saúde , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Paratireoidectomia/efeitos adversos , Tireoidectomia/efeitos adversos , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Acetaminofen/efeitos adversos , Idoso , Analgésicos Opioides/efeitos adversos , Combinação de Medicamentos , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Hidrocodona/efeitos adversos , Masculino , Pessoa de Meia-Idade , Epidemia de Opioides/prevenção & controle , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
17.
An Real Acad Farm ; 86(1): 75-88, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190874

RESUMO

El incremento de animales de compañía y animales productores de alimentos, junto con el importante gasto sanitario que estos suponen, hacen que el sector del medicamento veterinario esté adquiriendo cada vez más peso en España. Ante esta situación, se nos plantea la duda de si los propietarios, veterinarios y especialmente farmacéuticos, estamos correctamente preparados e informados. Tal como se observa en la recopilación de leyes sobre venta y distribución de medicamentos de uso veterinario realizada en este trabajo, actualmente no existe una legislación que se adecúe a las necesidades sanitarias de estos animales pudiendo observar en su aplicación intrusiones por parte del veterinario en las funciones legalmente establecidas y propias del farmacéutico o la venta ilegal de medicamentos veterinarios por parte de establecimientos sin la debida autorización. Por lo que al farmacéutico respecta, la falta de información y formación en este campo se manifiesta en varios aspectos como la falta de atención farmacéutica o la aceptación de recetas indebidamente cumplimentadas por el veterinario. Todo ello incrementa el riesgo de realizar un mal uso de los medicamentos por parte del propietario suponiendo así un peligro no solo para el propio animal, sino también para las personas como ocurre en el caso concreto de los antibióticos. Por tanto, nos encontramos frente a un importante problema de regulación y falta de información entre propietarios y profesionales sanitarios, que hace necesaria la realización de campañas informativas y la formación de farmacéuticos y veterinarios desde los Colegios Oficiales y Universidades


The veterinary medicinal sector is gaining more and more importance in Spain because of the increasing of livestock population and pets, and the significant healthcare costs that they involve. Given this situation, are the owners, veterinarians and especially pharmacists, properly prepared and informed? As it can be seen in the compilation of laws about sale and distribution of veterinary medicaments presented in this work, nowadays there is not a legislation adapted to the health requirements of these animals. Indeed, there are some problems in the application of the law such the intrusion of veterinarians in the own and legally established pharmacist’s functions and the ilegal sale of veterinary drugs by non properly authorized establishments. Concerning the pharmacist’s role, the lack of information and training in this area, is manifested in several aspects such a limited ability of pharmaceutical advice and the admission of prescriptions improperly filled by the veterinarian. Taken together, it increases the risk of abuse or wrong use of drugs by the owner, assuming a real danger not only for the animal itself, but also for the people, as in the case of antibiotics consumption. In conclusion, we are facing a critical problem of law regulation and lack of knowledge between owners and healthcare professionals. Therefore, it would be necessary that Universities and Official Colleges carry out information campaigns and organize specific training to pharmacists and veterinarians


Assuntos
Humanos , Animais , Papel Profissional , Farmacêuticos , Assistência Farmacêutica , Prescrições de Medicamentos/normas , Legislação de Medicamentos , Drogas Veterinárias/administração & dosagem
19.
Otolaryngol Head Neck Surg ; 163(2): 216-220, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32178580

RESUMO

OBJECTIVE: Approximately 5% of children develop new persistent opioid use after tonsillectomy. Critical review of our prescribing practices revealed inconsistent and excessive opioid prescribing after this procedure in children. We sought to improve our practice by using a standardized electronic medical record (EMR)-based order set. METHODS: Retrospective chart review of outpatient tonsillectomy performed before and after institution of an EMR intervention with comparison of opioid and nonopioid analgesic (NOA) prescription characteristics as well as outcomes including hemorrhage and readmission. RESULTS: Analysis of 276 preorder set and 128 post-order set tonsillectomies revealed a significant increase in NOA utilization following initiation of the order set and a significant reduction in doses of opioid prescribed. Due to a change to a stronger opioid in the order set, morphine dose equivalents (MDEs) prescribed were not decreased in the post-order set cohort. Variability between prescriptions and providers was significantly decreased in the post-order set group in terms of doses and MDEs, and dangerously high outlier prescriptions were eliminated. No differences in pain control, postoperative hemorrhage, presentation to the emergency department, or readmission were identified. DISCUSSION: An EMR-based intervention improved the quality and safety of posttonsillectomy opioid prescribing at our institution. Moving forward, this order set provides a platform with which to titrate opioid prescriptions and NOA to optimal pain control and safety levels. IMPLICATIONS FOR PRACTICE: A standardized EMR-based order set can improve the quality of opioid prescribing after tonsillectomy.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/normas , Registros Eletrônicos de Saúde/normas , Dor Pós-Operatória/tratamento farmacológico , Tonsilectomia , Criança , Pré-Escolar , Humanos , Estudos Retrospectivos
20.
Pain Res Manag ; 2020: 8380171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32148601

RESUMO

Background: Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective: In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results: We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion: There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Canadá , Estudos Transversais , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
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