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1.
Schmerz ; 33(5): 443-448, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478141

RESUMO

BACKGROUND: Since March 2017 the law amending narcotics and other legal regulations has made it possible for doctors to prescribe cannabis and cannabis-derived medicines. The introduction of § 31 para 6 of the Social Code Book V (SGB V) allows that patients can be treated with cannabis-derived medicines at the expense of the statutory health insurance if they have a severe illness. COURT DECISIONS: The law requires the approval of a prescription of cannabis for medical purposes by the health insurance before the granting of benefits. Due to denied permission, numerous cases are pending before the social tribunals. The article presents which legal issues are decided and why there is still no case law from the Federal Social Court on the essential questions. OUTLOOK: The possibility of prescribing cannabis as medicine at the expense of the health insurance is an important advance in social law. The § 31 para 6 SGB V should be evaluated as soon as possible. The provisions of SGB V for the reimbursement of off-label treatment should be harmonized with § 31 para 6 SGB V.


Assuntos
Cannabis , Seguro Saúde , Médicos , Prescrições , Assistência à Saúde/legislação & jurisprudência , Alemanha , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Médicos/legislação & jurisprudência , Prescrições/estatística & dados numéricos
2.
Artigo em Inglês | MEDLINE | ID: mdl-31413891

RESUMO

Background: Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods: IQVIA's Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results: Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion: The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications.


Assuntos
Antipsicóticos/uso terapêutico , Prescrições/estatística & dados numéricos , Transtornos de Tique/tratamento farmacológico , Síndrome de Tourette/tratamento farmacológico , Adolescente , Aripiprazol/uso terapêutico , Criança , Pré-Escolar , Feminino , Guanfacina/uso terapêutico , Humanos , Lactente , Masculino , Farmacoepidemiologia , Risperidona/uso terapêutico , Transtornos de Tique/epidemiologia
3.
MMWR Morb Mortal Wkly Rep ; 68(31): 679-686, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31393863

RESUMO

BACKGROUND: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends considering prescribing naloxone when factors that increase risk for overdose are present (e.g., history of overdose or substance use disorder, opioid dosages ≥50 morphine milligram equivalents per day [high-dose], and concurrent use of benzodiazepines). In light of the high numbers of drug overdose deaths involving opioids, 36% of which in 2017 involved prescription opioids, improving access to naloxone is a public health priority. CDC examined trends and characteristics of naloxone dispensing from retail pharmacies at the national and county levels in the United States. METHODS: CDC analyzed 2012-2018 retail pharmacy data from IQVIA, a health care, data science, and technology company, to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and recipient characteristics, including age group, sex, out-of-pocket costs, and method of payment. Factors associated with naloxone dispensing at the county level also were examined. RESULTS: The number of naloxone prescriptions dispensed from retail pharmacies increased substantially from 2012 to 2018, including a 106% increase from 2017 to 2018 alone. Nationally, in 2018, one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. Substantial regional variation in naloxone dispensing was found, including a twenty-fivefold variation across counties, with lowest rates in the most rural counties. A wide variation was also noted by prescriber specialty. Compared with naloxone prescriptions paid for with Medicaid and commercial insurance, a larger percentage of prescriptions paid for with Medicare required out-of-pocket costs. CONCLUSION: Despite substantial increases in naloxone dispensing, the rate of naloxone prescriptions dispensed per high-dose opioid prescription remains low, and overall naloxone dispensing varies substantially across the country. Naloxone distribution is an important component of the public health response to the opioid overdose epidemic. Health care providers can prescribe or dispense naloxone when overdose risk factors are present and counsel patients on how to use it. Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships.


Assuntos
Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Farmácias/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Epidemias/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
5.
Expert Opin Pharmacother ; 20(16): 2041-2052, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422709

RESUMO

Background: Information on prescriptions of oral analgesics for the treatment of pain is beneficial. However, there have been few reports on the prescription status of oral analgesics from a nation-wide, large-scale prescription database in Japan. Research design and methods: The authors analyzed the prescription data of 2,042,302 patients prescribed oral analgesics in 2017. The numbers/proportions of patients prescribed oral analgesics, adherence with approved doses, co-prescription patterns, dose changes, drug adherence, and treatment-discontinuation rates were evaluated. Results: Loxoprofen was prescribed to 32.5% of the patients, followed by celecoxib, prescribed to 16.0% of patients. Acetaminophen and pregabalin were prescribed to 10.5% and 9.4% of patients, respectively. Many analgesics were prescribed at lower doses than the approved doses. The most frequently used concomitant medication was pregabalin. For duloxetine and pregabalin, high proportions of patients were prescribed these drugs for > 90 days. Conclusions: Loxoprofen was the most prescribed of the non-steroidal anti-inflammatory drugs in Japan. The information obtained provides an overview of prescribed oral analgesics in Japan and could be useful for potential research into prescribed oral analgesics in the future.


Assuntos
Analgésicos/uso terapêutico , Dor/tratamento farmacológico , Prescrições/estatística & dados numéricos , Administração Oral , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Japão , Masculino , Pessoa de Meia-Idade , Fenilpropionatos/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
7.
Drug Discov Ther ; 13(3): 137-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327789

RESUMO

Existing evidence suggests that protease inhibitors (PIs) used to prevent or treat pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) are ineffective, and their use is not recommended by clinical practice guidelines. However, in Japan, PIs are administered with the aim to prevent or treat post-ERCP pancreatitis. This study aimed to clarify the gap between guideline recommendations and contents of practice. We used the health insurance claims database of Japan Medical Data Center. Among patients who had undergone ERCP, those with acute pancreatitis or post-ERCP pancreatitis recorded in claims as disease names were defined as post-ERCP pancreatitis patients. The study period was divided into three terms according to the date of publication of clinical practice guidelines for acute pancreatitis. Among 2,945 patients who had undergone ERCP, 2,847 were eligible for analysis. Of these, 1,375 (48.3%) patients had claims with pancreatitis recorded as the disease name; PIs were prescribed to 1,238 (90.0%). Rates of prescription of PIs were 72.3% in 2005-07, 70.9% in 2008-09, and 83.6% in 2010-15, showing a significant increase (p < 0.001). In conclusion, PIs are administered in clinical practice in Japan for the purpose of preventing or treating pancreatitis, with an increasing trend in prescription in recent years.


Assuntos
Pancreatite/prevenção & controle , Pancreatite/terapia , Lacunas da Prática Profissional/métodos , Inibidores de Proteases/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica , Medicina Baseada em Evidências , Feminino , Humanos , Revisão da Utilização de Seguros , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prescrições/estatística & dados numéricos , Inibidores de Proteases/uso terapêutico
8.
BMC Public Health ; 19(1): 482, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046720

RESUMO

BACKGROUND: There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient's motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention. METHODS: The study included 444 patients with metabolic risk factors who were aged 27 to 85 years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6 months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis. RESULTS: Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient's preparedness and confidence regarding readiness to change PA; a BMI <  30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87-95% vs. 62-75%). CONCLUSIONS: This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level. TRIAL REGISTRATION: ClinicalTrials.gov ; NCT03586011 . Retrospectively registered on July 17, 2018.


Assuntos
Exercício , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Síndrome Metabólica/terapia , Prescrições/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Estudos Prospectivos , Autoeficácia
9.
Yakugaku Zasshi ; 139(4): 547-550, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30930386

RESUMO

The "Choosing Wisely" campaign is an activity to promote conversations between patients and doctors about unnecessary examinations, treatments, or procedures. A "Top five list" published by a number of specialty societies consists of five evidence-based recommendations in their own fields. Choosing Wisely Japan was launched in 2016; the campaign soon became widespread among primary care physicians. To make wiser choices in prescriptions of any medicine, it is necessary to consider the balance between its efficacies, risks, and costs. The purpose of this campaign is not only to publish recommendations to reduce waste in health care resources but also to disseminate and implement the recommendations contents. To put them into practice, it is necessary to think about interprofessional and interdisciplinary approaches.


Assuntos
Análise Custo-Benefício , Prática Clínica Baseada em Evidências , Recursos em Saúde/economia , Prescrição Inadequada/prevenção & controle , Sobremedicalização/prevenção & controle , Médicos de Atenção Primária , Padrões de Prática Médica , Medição de Risco , Recursos em Saúde/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Japão , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Padrões de Prática Médica/economia , Prescrições/estatística & dados numéricos
10.
Gen Hosp Psychiatry ; 58: 94-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031213

RESUMO

OBJECTIVE: This study describes medication prescribing patterns in patients with motor functional neurological disorder (mFND) treated in South London and Maudsley NHS Foundation Trust (SLaM), comparing outcomes to a control group of psychiatric patients from the same hospital trust. METHOD: This is a retrospective case-control study using a psychiatric case register. Cross-sectional data were obtained from 322 mFND patients and 644 psychiatry controls who had had contact with SLaM between 1st January 2006 and 31st December 2016. RESULTS: A slightly lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, OR: 0.59, CI: 0.39-0.89, p < 0.05). Of medication recipients, mFND patients were prescribed a higher number of agents (mean: 4.7 v 2.9, p = 0.001) and had higher prescription rates of antidepressants, anti-epileptics, analgesics, and certain non-psychotropic medications. Higher numbers of prescriptions were associated with co-morbid physical conditions, and previous psychiatric admissions. CONCLUSIONS: This is the first study to describe medication prescriptions in a large cohort of mFND patients. Patients were prescribed a wide range of psychiatric and physical health medications, with higher rates of polypharmacy than controls. Psychotropic medication prescription is not necessarily the first line treatment for mFND, where physiotherapy and psychotherapy may be offered initially. There is limited, early-phase evidence for pharmacological therapies for mFND, and as such, the benefit-to-risk ratio of prescribing in this complex and poorly understood disorder should be carefully assessed.


Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Transtornos Motores/tratamento farmacológico , Doenças do Sistema Nervoso/tratamento farmacológico , Prescrições/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Transtornos Somatoformes/tratamento farmacológico , Medicina Estatal/estatística & dados numéricos , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos Motores/psicologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/psicologia , Reino Unido
11.
Am J Cardiol ; 124(1): 1-7, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31029413

RESUMO

Despite strong evidence for the use of statins for patients with atherosclerotic cardiovascular disease (ASCVD), statin prescription is still suboptimal. We aimed to determine the rates and factors that influence statin prescription using national survey data. This is a cross-sectional retrospective study on 8,468 patients with clinical ASCVD who were drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from years 2011 to 2015. Survey-weighted analysis was conducted to estimate weighted prevalence and odds ratios for statin prescription. There was a significant increase in statin prescription from the years 2011 to 2015. Nevertheless, only 52% of ASCVD patients (55.4% in coronary heart disease and 37.7% in noncoronary heart disease) were prescribed a statin. Based on multivariable regression analysis, after adjusting for covariates, males had 1.28 (1.06, 1.55) higher odds of statin prescription, in coronary heart disease patients only. In the overall study population, Black n on-Hispanics had 31% lower odds of statin prescription compared with White non-Hispanics, and patients seen only by a healthcare provider other than a physician were 80% less likely to have a statin prescribed to them. In conclusion, the disparity in statin prescription in patients with ASCVD exists across minority groups, and our findings underscore existing variations in healthcare delivery.


Assuntos
Aterosclerose/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prescrições/estatística & dados numéricos , Adolescente , Adulto , Idoso , Aterosclerose/diagnóstico , Aterosclerose/etnologia , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
12.
Ophthalmic Physiol Opt ; 39(3): 148-161, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30957261

RESUMO

PURPOSE: To survey a large number of UK-based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. METHODS: One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. RESULTS: Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre-school children (aged 2-4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5-7 years: 25% vs 47%, 8-11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann-Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non-strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. CONCLUSIONS: This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK-based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence-based resources to inform their decision-making relating to use of cycloplegia in paediatric examination.


Assuntos
Ciclopentolato/administração & dosagem , Óculos/estatística & dados numéricos , Midriáticos/administração & dosagem , Optometria/métodos , Padrões de Prática Médica/estatística & dados numéricos , Erros de Refração , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prescrições/estatística & dados numéricos , Erros de Refração/diagnóstico , Erros de Refração/reabilitação , Reino Unido
13.
Ophthalmic Physiol Opt ; 39(3): 194-204, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30957274

RESUMO

PURPOSE: The aim of this cross-sectional study was to survey Australian optometrists regarding their attitudes towards, and knowledge of, blue light-blocking lenses designed to attenuate blue light transmission to the eye. METHODS: A 29-item survey was distributed at a major national optometry education conference and through professional networks. Respondents provided information regarding their demographics and practice modalities, knowledge about the potential effects of blue light, and attitudes towards prescribing blue light-blocking ophthalmic devices. Ordinal logistic regression analysis was performed to assess the factors that predicted optometrists' prescribing of blue light-blocking lenses. RESULTS: Of 372 respondents, 75.3% indicated prescribing blue light-blocking spectacle lenses in their clinical practice. Forty-four per cent of optometrists considered daily environmental exposure to blue light as a potential cause of retinal damage, and approximately half of respondents thought blue light emitted from computer screens was an important factor in causing computer vision syndrome. About half of optometrists considered placebo effects to potentially play a role, at least sometimes, in patients' experiences with blue light-blocking lenses. Most optometrists estimated that they first prescribed a blue light-blocking lens in 2016. The most common reason optometrists prescribed these devices was for patients who were computer or electronic device users (87.9%). The two main sources of information used to guide practitioners' management approaches were conference presentations and manufacturer product information. Practitioners were significantly more likely to prescribe blue light-blocking lenses if they considered blue light to cause either retinal damage (odds ratio, OR 2.28, 95%CI 1.34-3.88, p = 0.002) or computer vision syndrome (OR 2.52, 95%CI 1.41-4.50, p = 0.002) compared with practitioners who did not consider such factors to be relevant. CONCLUSION: Prescribing trends by Australian optometrists in relation to blue light-blocking lenses reflect the inconclusive nature of several aspects of the evidence in this field. Blue light-blocking lens prescribing has increased since 2010, despite practitioners acknowledging the lack of high-quality evidence to support their use and also commonly believing that placebo effects may have a role in patient responses to these lenses. Information from this study will help inform the development of resources to guide evidence-based prescribing of blue light-blocking lens products.


Assuntos
Lentes de Contato , Conhecimentos, Atitudes e Prática em Saúde , Optometria/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos
14.
J Hosp Infect ; 102(2): 157-164, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30880267

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhoea with peak incidence in late winter or early autumn. Although CDI is commonly associated with hospitals, community transmission is important. AIM: To explore potential drivers of CDI seasonality and the effect of community-based interventions to reduce transmission. METHODS: A mechanistic compartmental model of C. difficile transmission in a hospital and surrounding community was used to determine the effect of reducing transmission or antibiotic prescriptions in these settings. The model was extended to allow for seasonal antibiotic prescriptions and seasonal transmission. FINDINGS: Modelling antibiotic seasonality reproduced the seasonality of CDI, including approximate magnitude (13.9-15.1% above annual mean) and timing of peaks (0.7-1.0 months after peak antibiotics). Halving seasonal excess prescriptions reduced the incidence of CDI by 6-18%. Seasonal transmission produced larger seasonal peaks in the prevalence of community colonization (14.8-22.1% above mean) than seasonal antibiotic prescriptions (0.2-1.7% above mean). Reducing transmission from symptomatic or hospitalized patients had little effect on community-acquired CDI, but reducing transmission in the community by ≥7% or transmission from infants by ≥30% eliminated the pathogen. Reducing antibiotic prescription rates led to approximately proportional reductions in infections, but limited reductions in the prevalence of colonization. CONCLUSION: Seasonal variation in antibiotic prescription rates can account for the observed magnitude and timing of C. difficile seasonality. Even complete prevention of transmission from hospitalized patients or symptomatic patients cannot eliminate the pathogen, but interventions to reduce transmission from community residents or infants could have a large impact on both hospital- and community-acquired infections.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Uso de Medicamentos , Controle de Infecções/métodos , Modelos Teóricos , Adulto , Idoso , Humanos , Lactente , Prescrições/estatística & dados numéricos , Prevalência , Estações do Ano
15.
Malar J ; 18(1): 36, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736864

RESUMO

BACKGROUND: Injectable artesunate (AS) is the World Health Organization (WHO) recommended medication for the treatment of severe malaria followed with an oral artemisinin-based combination therapy (ACT). There are few studies indicating how physicians prescribe injectable AS, injectable quinine (Q) or injectable artemether (AR) and ACT for severe malaria. This study was undertaken to evaluate prescription compliance to the WHO recommendation in 8 public health facilities in Ghana and Uganda. This was a modified cohort event monitoring study involving patients who were administered with injectable anti-malarial for treatment of presumed or confirmed severe malaria. Patients prescribed at least one dose of injectable artesunate, artemether or quinine qualified to enrol in the study. Patients were recruited at inpatient facilities and followed up in the hospital, by phone or at home. Following WHO recommendations, patients are to be prescribed 3 doses of injectable AS, Q or AR for at least 24 h followed with oral ACT. Compliance rate was estimated as the number of patient prescriptions that met the WHO recommendation for treatment of severe malaria divided by the total number of patients who completed the study by end of follow up. Log-binomial regression model was used to identify predictors for compliance. Based on the literature and limitations of available data from the patients' record, the diagnosis results, age, gender, weight, and country were considered as potential predictors of prescriber adherence to the WHO recommendations. RESULTS: A total of 1191 patients completed the study, of which 93% were prescribed injectable AS, 3.1% (injectable AR or Q) with 32.5% prescribed follow-on oral ACT and 26% on concomitant antibiotics. 391 (32.8%) were in Ghana and 800 (67.2%) in Uganda. There were 582 (48.9%) women. The median age was 3.9 years (IQR = 2, 9) and median weight was 13 kg (IQR = 10, 20). Of the 1191 patients, 329 of the prescriptions complied with the WHO recommendation (compliance rate = 27.6%; 95% CI = [25.2, 30.2]). Diagnostic results (Adjusted prevalence ratio (aPR) = 4.56; 95% = [3.42, 6.08]; p < 0.0001) and weight (20 + kg vs < 10 kg: aPR = 0.65; 95% = [0.44, 0.96]; p = 0.015) were identified as factors independently associated with compliance. CONCLUSION: Injectable AS is the most commonly prescribed medicine in the management of severe malaria in Ghana and Uganda. However, adherence to the WHO recommendation of at least 3 doses of injectable anti-malarial in 24 h followed by a full course of ACT is low, at less than 30%.


Assuntos
Antimaláricos/uso terapêutico , Malária/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Competência Profissional/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Gana , Guias como Assunto , Instalações de Saúde , Humanos , Masculino , Uganda , Organização Mundial da Saúde
16.
J Foot Ankle Res ; 12: 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30700994

RESUMO

Background: Guidelines recommend foot orthoses for people with both early (< 2 years) and established rheumatoid arthritis (RA). While prefabricated foot orthoses are cheaper and can exhibit comparable effects to customised devices, the available evidence for their effectiveness is inconsistent. Little is known about what types of foot orthoses clinicians prescribe. This study describes the foot orthoses prescription habits of podiatrists for people with rheumatoid arthritis. Methods: One hundred and eighty-three podiatrists from the United Kingdom (UK) (n = 88), Australia (n = 68) and New Zealand (n = 27) completed a self-administered, online survey regarding the types of foot orthoses prescribed in clinical practice for people with RA. This study forms part of a wider international survey exploring foot orthosis prescription habits. Results: UK respondents were more likely to prescribe prefabricated orthoses for early RA (n = 47, 53%) and customised orthoses for established RA (n = 47, 53%). Respondents in Australia were more likely to prescribe customised orthoses for both early (n = 32, 47%) and established (n = 46, 68%) RA, whilst respondents in New Zealand were more likely to prescribe prefabricated orthoses for both early (n = 16, 59%) and established (n = 10, 37%) disease.Irrespective of disease stage, the use of foam impression boxes was more prevalent in the UK and New Zealand when capturing a model of the feet prior to manufacturing customised orthoses. In contrast, electronic scanning and plaster of Paris were more common in Australia. Computer aided manufacture was utilised more frequently among respondents in Australia than in the UK and New Zealand. Respondents in all three countries specified more flexible shell materials for established RA, compared to early disease. Cushioning top covers (e.g. PORON® or polyurethane) were most frequently specified in all countries for both disease stages. Conclusions: Considerable variation was seen in the self-reported foot orthoses prescription habits of respondents for people with RA. Variation between countries and disease stage was seen in type of orthoses, specific brands, manufacturing methods, and materials prescribed. The results allow podiatrists and broader health service providers to compare their practice against reported national and international patterns.


Assuntos
Artrite Reumatoide/reabilitação , Órtoses do Pé/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Austrália , Estudos Transversais , Feminino , Hábitos , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Nova Zelândia , Podiatria/estatística & dados numéricos , Desenho de Prótese , Reino Unido
18.
J Endod ; 45(3): 263-271.e1, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30803533

RESUMO

INTRODUCTION: Physicians are often patients' first point of contact for management of nontraumatic dental conditions (NTDCs). This study's aim was to evaluate the knowledge and practices of Ontario physicians in managing NTDCs, with a specific focus on antibiotic usage. METHODS: A Web-based survey featured 4 NTDC clinical scenarios: irreversible pulpitis, localized acute apical abscess with or without systemic involvement, and chronic apical abscess. The survey link was distributed to active Ontario family and emergency physicians. The sample group was asked questions about their management of and experience with NTDCs, and demographic and practice characteristics were collected. Descriptive and multivariate logistic regression analyses were undertaken (P ≤ .05). RESULTS: Sampled Ontario physicians tend to manage NTDCs in a manner that is not consistent with evidence-based care. For irreversible pulpitis and for localized acute apical abscess with or without systemic involvement, most physicians would prescribe an antibiotic (57.4%, 84.8%, and 96.3%, respectively), and 23.5% would prescribe an antibiotic for chronic apical abscess. Approximately half the sample (52.9%) felt discomfort in managing NTDCs, and 85.3% felt they were inadequately trained to manage NTDCs. CONCLUSION: Areas that present opportunities for improvement in the physician management of NTDCs were identified, including the incorporation of further NTDC training in medical curricula and continuing medical education courses, and development and dissemination of guidelines for physicians in managing NTDCs.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/estatística & dados numéricos , Serviços Médicos de Emergência , Medicina de Família e Comunidade , Conhecimentos, Atitudes e Prática em Saúde , Abscesso Periapical/diagnóstico , Abscesso Periapical/terapia , Médicos/psicologia , Pulpite/diagnóstico , Pulpite/terapia , Doença Aguda , Canadá/epidemiologia , Doença Crônica , Estudos Transversais , Prática Clínica Baseada em Evidências , Humanos , Prescrição Inadequada/psicologia , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica , Prescrições/estatística & dados numéricos
19.
Ann Biol Clin (Paris) ; 77(1): 10-12, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30799290

RESUMO

Today, medical prescriptions of proteinuria or albuminuria, which are depending on medical status of patients, still depend on doctors. Indeed, according to their medical specialty or to the recommendations they are following, they could prescribe either proteinuria or albuminuria. The consequences are practical for laboratories and economical for patients and doctors. This article resumes different situations, which result in an erroneous interpretation of medical prescriptions.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Proteinúria/tratamento farmacológico , Proteinúria/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/tratamento farmacológico , Albuminúria/epidemiologia , Feminino , Humanos , Masculino , Erros de Medicação/estatística & dados numéricos , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Gravidez , Prescrições/normas , Adulto Jovem
20.
Medicine (Baltimore) ; 98(4): e14128, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681574

RESUMO

To determine whether cataract or glaucoma and combined cataract and glaucoma surgery (CGS) affect glaucoma medication usage.We recruited patients who received new diagnoses of glaucoma, either primary open-angle glaucoma (POAG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 365.1) or primary angle-closure glaucoma (PACG) (ICD-9-CM code 365.2), between 1998 and 2011 and had undergone cataract surgery alone (CS), glaucoma surgery alone (GS), or CGS under the National Health Insurance program in Taiwan. CS, GS, and CGS in all the patients were performed after the glaucoma diagnosis date. The patients were subdivided into CS, CGS, and GS groups. The number of glaucoma medications, including prostaglandin analogs, ß-blockers, carbonic anhydrase inhibitors, α-agonists, pilocarpine, and a combination of drugs, in each prescription, were compared before and after surgery.The mean number of glaucoma medications in each prescription before the surgery increased from approximately 0.5/1 (CS/CGS + GS) to a peak of 1.75/3 within 3 months before the index date. The mean number of glaucoma medications in each prescription reduced to 0 (CS group) and to approximately 0.5 (CGS and GS) at the end of the 3-year follow-up period. The mean number of glaucoma medications in each prescription significantly reduced at the time points within 6 months, between 6 months and 2 years, and during 2 to 3 years after surgery in each group. At the end of the 3-year period, the reduction effect was most evident in the CS group. Similar trends were also observed in the POAG and PACG group.CS, GS, and CGS significantly reduced the number of glaucoma medications used by the glaucoma patients.


Assuntos
Extração de Catarata/estatística & dados numéricos , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Prescrições/estatística & dados numéricos , Trabeculectomia/estatística & dados numéricos , Agonistas alfa-Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Estudos de Casos e Controles , Catarata/complicações , Bases de Dados Factuais , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Pilocarpina , Prostaglandinas Sintéticas/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
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