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2.
Medicine (Baltimore) ; 99(1): e18524, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895787

RESUMO

Within the southern region of the Netherlands, the Maastricht Study is an on-going observational prospective population-based cohort study that focuses on the etiology of Type 2 diabetes mellitus (T2DM). Representativeness of the participating population is a crucial but often an unknown factor in population-based cohort studies such as the Maastricht Study. We therefore aimed to assess the representativeness of the study population by comparing drug utilization of the participants of the Maastricht Study with the general population of the Netherlands.Since T2DM patients were oversampled in this study, a sampling method was applied in order to ensure a similar distribution of T2DM over the study population. Drug use in the study population was compared with drug use in the population of the Netherlands, using a Z-test to compare 2 independent proportions.In general, drug use in the study was similar compared with national data. However, in the age group 65 to 74 years total drug use was lower in the study population (833/1000 persons) versus nationwide data (882/1000 persons). The use of pulmonary medications was lower (104/1000 persons vs 141/1000 persons) and the use of hypnotics/anxiolytics was higher (90/1000 persons vs 36/1000 persons) in the Maastricht Study as compared with national data.Drug use in the Maastricht Study population is largely comparable to that in the total Dutch population aged 45 to 74. Therefore, data on drug use by participants in the Maastricht Study can be used to perform studies assessing outcomes associated with drug use.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Idoso , Ansiolíticos/uso terapêutico , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos , Fármacos do Sistema Respiratório/uso terapêutico
3.
Medicine (Baltimore) ; 99(2): e18714, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914082

RESUMO

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Antibacterianos/administração & dosagem , Criança , Criança Hospitalizada , Pré-Escolar , China , Estudos Transversais , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Infecções Respiratórias/tratamento farmacológico
4.
Ann Otol Rhinol Laryngol ; 129(2): 175-180, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31625416

RESUMO

OBJECTIVES: The topic of prescription opioid overuse remains a growing concern in the United States. Our objective is to provide insight into pain perception and opioid use based on a patient cohort undergoing common otologic and neurotologic surgeries. STUDY DESIGN: Prospective observational study with patient questionnaire. SETTING: Single academic medical center. SUBJECTS AND METHODS: Adult patients undergoing otologic and neurotologic procedures by two fellowship trained neurotologists between June and November of 2018 were included in this study. During first postoperative follow-up, participants completed a questionnaire assessing perceived postoperative pain and its impact on quality of life, pain management techniques, and extent of prescription opioid use. RESULTS: A total of 47 patients met inclusion and exclusion criteria. The median pain score was 3 out of 10 (Interquartile Range [IQR] = 2-6) with no significant gender differences (P = .92). Patients were prescribed a median of 15.0 (IQR = 10.0-15.0) tablets of opioid pain medication postoperatively, but only used a median of 4.0 (IQR = 1.0-11.5) tablets at the time of first follow-up. Measured quality of life areas included sleep, physical activity, work, and mood. Sleep was most commonly affected, with 69.4% of patients noting disturbances. CONCLUSIONS: This study suggests that practitioners may over-estimate the need for opioid pain medication following otologic and neurotologic surgery. It also demonstrates the need for ongoing patient education regarding opioid risks, alternatives, and measures to prevent diversion.


Assuntos
Analgésicos Opioides , Uso de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Otológicos , Manejo da Dor/métodos , Percepção da Dor , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Procedimentos Cirúrgicos Otológicos/métodos , Medição da Dor , Estudos Prospectivos
5.
Bone Joint J ; 101-B(12): 1570-1577, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787005

RESUMO

AIMS: The aim of this study was to characterize the relationship between pre- and postoperative opioid use among patients undergoing common elective orthopaedic procedures. PATIENTS AND METHODS: Pre- and postoperative opioid use were studied among patients from a national insurance database undergoing seven common orthopaedic procedures using univariate log-rank tests and multivariate Cox proportional hazards analyses. RESULTS: A total of 98 769 patients were included; 35 701 patients were opioid-naïve, 11 621 used opioids continuously for six months before surgery, and 4558 used opioids continuously for at least six months but did not obtain any prescriptions in the three months before surgery. Among opioid-naïve patients, between 0.76% and 4.53% used opioids chronically postoperatively. Among chronic preoperative users, between 42% and 62% ceased chronic opioids postoperatively. A three-month opioid-free period preoperatively led to a rate of cessation of chronic opioid use between 82% and 93%, as compared with between 31% and 50% with continuous preoperative use (p < 0.001 for significant changes in opioid use before and after surgery in each procedure). Between 5.6 and 20.0 preoperative chronic users ceased chronic use for every new chronic opioid user. Risk factors for chronic postoperative use included chronic preoperative opioid use (odds ratio (OR) 4.84 to 39.75; p < 0.0001) and depression (OR 1.14 to 1.55; p < 0.05 except total hip arthroplasty). With a three-month opioid-free period before surgery, chronic preoperative opioids elevated the risk of chronic opioid use only mildly, if at all (OR 0.47 to 1.75; p < 0.05 for total shoulder arthroplasty, rotator cuff repair, and carpal tunnel release). CONCLUSION: Chronic preoperative opioid use increases the risk of chronic postoperative use, but an opioid-free period before surgery decreases this risk compared with continuous preoperative use Cite this article: Bone Joint J 2019;101-B:1570-1577.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Transtornos Relacionados ao Uso de Opioides/etiologia , Procedimentos Ortopédicos , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Bases de Dados Factuais , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Período Pré-Operatório , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
6.
J Surg Oncol ; 120(8): 1456-1461, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680250

RESUMO

BACKGROUND AND OBJECTIVES: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.


Assuntos
Analgésicos Opioides/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/administração & dosagem , Tireoidectomia , Adulto , Procedimentos Cirúrgicos Ambulatórios , Feminino , Humanos , Infusões Intravenosas , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Medição da Dor , Alta do Paciente , Período Pós-Operatório , Estudos Retrospectivos
7.
Tidsskr Nor Laegeforen ; 139(13)2019 Sep 24.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31556524

RESUMO

BACKGROUND: Norwegian national guidelines recommend that clozapine be offered to patients with schizophrenia after two failed attempts with other antipsychotic drugs. One of the main objectives for the introduction of clinical pathways in mental health care is to provide an equal service to patients irrespective of where in the country they live. We wished to investigate the prescribing level of clozapine in various Norwegian counties. MATERIAL AND METHOD: We retrieved aggregated data from the Norwegian Prescription Database, the Norwegian Patient Registry and Statistics Norway on prescribing of clozapine, number of patients in contact with the specialist health service with the diagnosis schizophrenia, and population figures for 2016. RESULTS: Nationwide in 2016, there were 50 users of clozapine per 100 000 inhabitants (95 % confidence interval (CI) 48-52). The number of users was highest in Troms county (76 (95 % CI 63-89) per 100 000 inhabitants) and lowest in Akershus county (38 (95 % CI 33-43) per 100 000 inhabitants). We found no significant correlation between the prescribing rate for clozapine and the proportion of the population in the county who were undergoing treatment for schizophrenia in the specialist health service. INTERPRETATION: Prescribing of clozapine varies among Norwegian counties and is not correlated with the proportion of the population who are undergoing treatment for schizophrenia in the specialist health service. Different levels of implementation of the national guidelines constitute a possible explanation for the geographic differences.


Assuntos
Antipsicóticos/administração & dosagem , Clozapina/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Idoso , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Bases de Dados Factuais , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Guias de Prática Clínica como Assunto , Sistema de Registros , Adulto Jovem
8.
Br J Anaesth ; 123(5): 655-663, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31558315

RESUMO

BACKGROUND: The Korean National Health Insurance Service (NHIS) was developed to provide population data for medical research. The aim of this study was to estimate trends in prescription opioid use in South Korea, and to determine the association between chronic opioid use and 5-yr mortality in cancer and non-cancer patients. METHODS: A population-based cohort study was conducted amongst the South Korean adult population using data from the NHIS. Those prescribed a continuous supply of opioids for ≥90 days were defined as chronic opioid users. Multivariable Cox regression analysis was used to assess the association between chronic opioid use and 5-yr mortality. RESULTS: The proportion of chronic weak opioid users increased from 1.03% in 2002 to 9.62% in 2015. The proportion of chronic strong opioid users increased from 0.04% in 2002 to 0.24% in 2015. In the 2010 cohort (n=822 214), compared with non-users, chronic weak opioid users had a significantly lower 5-yr mortality (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.89-0.96; P<0.001), and chronic strong opioid users had a significantly higher 5-yr mortality (HR: 1.45; 95% CI: 1.28-1.63; P<0.001). Similar results were observed in non-cancer patients, but chronic weak opioid users were not significantly associated with 5-yr mortality in cancer patients (P=0.063). CONCLUSIONS: In South Korea, chronic opioid use has increased since 2002. Chronic strong opioid use was associated with a higher 5-yr mortality, and chronic weak opioid use was associated with a slightly lower 5-yr mortality. However, the findings regarding chronic weak opioid users should be interpreted carefully because there might be residual confounders in this study. Further study is needed to confirm these retrospective findings.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/mortalidade , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos
9.
Urology ; 134: 192-198, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31542460

RESUMO

OBJECTIVE: To test the hypothesis that transurethral prostate procedures (TUPPs) eliminating tissue result in greater medication discontinuation and lower de novo initiation rates than procedures inducing tissue necrosis. METHODS: Retrospective review of all men undergoing first time TUPPs at a large tertiary center from 2001 to 2016 was completed. Procedure type and urologic medication use before, 3-12 months after, and greater than 12 months after TUPP were analyzed with simple open prostatectomy as a comparator. Tissue-eliminating TUPPs included transurethral resection of the prostate and laser prostatectomy. Tissue-necrosing procedures included microwave therapy (transurethral microwave therapy) and radiofrequency ablation (transurethral needle ablation), which were grouped in analyses. Medication types were 5-alpha reductase inhibitors (5ARI), alpha blockers, anticholinergics, and beta-3 agonists (B3A). RESULTS: A total 5150 TUPPs were analyzed. Preoperative medication use significantly varied across TUPPs for 5ARI (P <.01), alpha-blockers (P .01), and anticholinergics (P .047), but not B3A (P .476). Transurethral resection of the prostate and laser prostatectomy were associated with significantly higher medication discontinuation rates and lower resumption and initiation rates compared to tissue-necrosing procedures. Relative to TUPPs, simple prostatectomy had significantly higher medication discontinuation, as well as the lowest resumption and initiation rates. CONCLUSION: Tissue-eliminating benign prostatic hyperplasia procedures were associated with better medication discontinuation, resumption, and de novo initiation rates compared to tissue-necrosing benign prostatic hyperplasia procedures.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Micro-Ondas/uso terapêutico , Prostatectomia , Hiperplasia Prostática/terapia , Terapia por Radiofrequência , Ressecção Transuretral da Próstata , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Idoso , Antagonistas Colinérgicos/uso terapêutico , Desprescrições , Humanos , Masculino , Prostatectomia/métodos , Estudos Retrospectivos
10.
Georgian Med News ; (292-293): 72-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560667

RESUMO

The aims of our study were to determine antibiotic prescribing rates for prevention and treatment of infections in pediatric units, to evaluate the number and type of antimicrobial agents and administration route, reveal commonly used antibiotic subgroups and identify targets for improving the quality of antimicrobial prescribing. A 1-day PPS (Point Prevalence Study) on antibiotic use in hospitalized children was performed in Georgia from 2015 to 2019. 18 clinics in different regions of Georgia were included in the survey. Antimicrobial prevalence rates increased over the years from 60.1% in 2015 to 92.6% in 2018. The most commonly, antibiotics were prescribed for lower respiratory tract infections (LRTI). In 2015 25.1% of LRTI were treated by ampicillin-sulbactam but the next year it replaced with ceftriaxone (37.1% in 2017 and 38.2% in 2018). In pediatric surgical ward, the antibiotics were commonly prescribed for surgical prevention (54.1% in 2015, 32.3% in 2018). The most common conditions treated with antibiotics in neonates were sepsis (30.1%) and LRTI (45.3%). The most used antibiotic was ceftriaxone (33.3% in 2015). Ampicilin-sulbactam was prescribed in 28.1% of pneumonia case in neonates in 2018. In 2015 antibiotics were mainly prescribed empirically (98.0%). In 2018 resistance of MRSA was 8.1%, and resistance to the third-generation cephalosporin 17.3%. Prevalence rate of antibiotics for prevention and treatment of infection disease in pediatric units increased in 2018. Main feasible targets for optimization of antibiotic prescribing have been identified: high use of broad-spectrum antibiotics in hospitals, high frequency of empirical treatment, rarely performed culture tests, prolonged antibiotic prophylaxis in surgery patients and an alarming raise of resistant strains. The implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and improve antibiotic prescription patterns in neonatal and pediatric inpatients over time.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana , Uso de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Feminino , República da Geórgia/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Pediatria , Prevalência , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-31547325

RESUMO

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8-19.43%). The relative consumption of Fluoroquinolone (9.26-9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Antibacterianos/classificação , Antibacterianos/economia , China , Comércio , Uso de Medicamentos/economia , Humanos
12.
Br J Anaesth ; 123(5): 627-636, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563269

RESUMO

BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Humanos , Manejo da Dor/métodos , Cuidados Pós-Operatórios/métodos
13.
Rev Gastroenterol Mex ; 84(3): 303-309, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31383293

RESUMO

INTRODUCTION AND AIMS: Probiotics are effective in gastrointestinal disease management. In Mexico, there are no studies on the use and prescription of probiotics by healthcare professionals. Our aim was to evaluate probiotic use and prescription on the part of gastroenterologists and nutritionists. MATERIALS AND METHODS: An online survey questionnaire was sent to members of the Asociación Mexicana de Gastroenterología (n = 1042), the Asociación Mexicana de Nutriología (n = 220), and healthcare professionals registered at the Fourth International Symposium: Intestinal Microbiota (n = 1328). RESULTS: Response was 34% (997 questionnaires answered) and 570 (64%) of the respondents were women. Mean participant age was 36.2 years (range 18-83). Thirty-six percent of the participants were gastroenterologists, 46% were nutritionists, and 18% were chemists and microbiologists. Seventy-one percent of the respondents knew the Food and Agriculture Organization (FAO) definition of probiotics and recommended them «always¼ (64.9%), «rarely¼ (31.7%), and «never¼ (3.6%). Gastroenterologists indicated probiotics for the treatment of disease (56.5%) and nutritionists for health maintenance (39%). Ninety-seven percent of the gastroenterologists and 98% of the nutritionists evaluated probiotics as effective in gastrointestinal symptom management and considered them safe. The majority of the respondents did not know which probiotic strain was contained in the commercial probiotic product. CONCLUSIONS: The survey results showed that the participating gastroenterologists and nutritionists understood the concept of probiotics, recommended them frequently, and considered them safe. The gastroenterologists prescribed probiotics as therapeutic agents and the nutritionists to maintain health. There was a lack of knowledge about the microbial composition of the products containing probiotics available in Mexico.


Assuntos
Gastroenterologistas/estatística & dados numéricos , Nutricionistas/estatística & dados numéricos , Probióticos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Gastroenteropatias/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , México , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
14.
J Drugs Dermatol ; 18(8): 745-750, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424706

RESUMO

INTRODUCTION: Selecting a systemic therapy for patients with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. The objective of this study was to use data from electronic health records to understand prescribing patterns associated with biologic therapies for psoriasis and utilization of concomitant non-biologic psoriasis therapies in patients on biologics. METHODS: A retrospective cohort study was performed using OptumInSight's electronic health records database. Patients were classified as having psoriasis if they had 2 diagnosis codes for psoriasis or 1 diagnosis for psoriasis and a subsequent prescription for a systemic psoriasis therapy or phototherapy on a separate day. Only patients with at least 1 prescription for a biologic medication were included. The time between the first and last prescription in each prescription episode was calculated; at least 1 prescription every 180 days was required to be considered continuous therapy. We also identified a subgroup of patients with prescription episodes of at least 12 months duration in which to evaluate concomitant use of topical medications, phototherapy, and other systemic agents in patients receiving prescriptions for biologics. RESULTS: There were 34,714 eligible psoriasis patients. The median time between first and last prescriptions was 3.3 - 7.0 months, depending on the drug and up to 50% of patients that received a prescription for a biologic medication did not receive a second prescription for the same medication. In a subset of patients with prescription episodes of at least 12 months duration, more than 50% continued to receive prescriptions for topical therapies, most commonly topical steroids. DISCUSSION: Recognition of prescribing patterns associated with biologic medications for psoriasis is important to understand healthcare utilization and improve health systems practices for patients and providers.


Assuntos
Produtos Biológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psoríase/tratamento farmacológico , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos
15.
Braz Oral Res ; 33: e076, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432927

RESUMO

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.


Assuntos
Analgésicos Opioides/uso terapêutico , Assistência Odontológica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Brasil , Codeína/uso terapêutico , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Valores de Referência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Tramadol/uso terapêutico
16.
Artigo em Alemão | MEDLINE | ID: mdl-31432202

RESUMO

BACKGROUND: Since 2011, German hospitals have been requested to record and evaluate antibiotic use in their institution. In this publication, the use of antibiotics in hospitals belonging to the administrative district Frankfurt/Main between 2012 and 2017 is presented and discussed with regards to the targets set in 2014. These targets are to improve the perioperative prophylaxis, reduce the use of cefuroxime, and increase the penicillin/cephalosporin ratio. METHODS: Since 2012, hospitals in Frankfurt/Main have been transmitting the defined daily doses (DDD) of all antibiotics used, the absolute number of patients, and their days of treatment. Since 2013, the data have also distinguished between intensive care and other units. The Frankfurt health authority calculated the total number of antibiotics and the DDD/100 patient days for all hospitals combined as well as for every hospital compared to each other. RESULTS: From 2012 to 2017, the number of absolute annual patient days increased from 1,592,161 to 1,615,180. Antibiotic use decreased from 1,073,975 DDD to 953,349 DDD, leading to a decrease from 67.5 DDD per 100 patient days to 59.0 DDD per 100 patient days. Cefuroxime was the most frequently used antibiotic in all hospitals. The use of cefuroxime showed a significant decrease between 2012 and 2017 (from 250,398 in 2012 to 165,160 DDD in 2017, a decrease of 34%). The use of ceftriaxone was reduced by 27%, ciprofloxacin by 9%, and levofloxacin by 16%. DISCUSSION: The targets set in 2014 were reached in the entirety of Frankfurt hospitals. However, there were significant differences between the hospitals taking part. The results were given as feedback to the hospitals in order to support their efforts in further improving antibiotic stewardship.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/legislação & jurisprudência , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Uso de Medicamentos/tendências , Revisão de Uso de Medicamentos/estatística & dados numéricos , Alemanha/epidemiologia , Regulamentação Governamental , Pesquisas sobre Serviços de Saúde , Humanos , Vigilância da População
17.
Health Serv Res ; 54(5): 1045-1054, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31372990

RESUMO

OBJECTIVE: To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. DATA SOURCES: 2007-2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. STUDY DESIGN: We derived PDMP composite scores using the number of best practices adopted by states (range: 0-14), classifying states as either no PDMP, low strength (0 < score < median), or high strength (score ≥ median). Using generalized linear models, we quantified the association between the PDMP score category and opioid use measures-overall and stratified by disability/age. Sensitivity analyses assessed the general Medicare sample regardless of pain diagnoses, individual PDMP characteristics, and compared GEE model findings to models with state fixed effects. PRINCIPAL FINDINGS: Compared to non-PDMP states, strong PDMP states had lower opioid cumulative doses (-296 mg; 95% CI: -512, -132), days supplied (-7.84; 95% CI: -10.6, -5.04), prescription fill rates (0.97; 95% CI: 0.95, 0.98), and mean daily doses (-2.31 mg; 95% CI: -3.14, -1.48) but greater prevalence of high opioid doses in disabled adults, whereas there was little or no change in older adults. Findings in states with weak PDMPs were substantively similar to those of strong PDMPs. Results from sensitivity analyses were mostly consistent with main findings except there was a null relationship with mean daily doses and high doses in models with state fixed effects. CONCLUSIONS: Comprehensive or minimal adoption of PDMP best practices was associated with mostly comparable effects on Medicare beneficiaries' opioid use; however, these effects were concentrated among nonelderly disabled adults.


Assuntos
Analgésicos Opioides/normas , Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Medicare/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Dor/tratamento farmacológico , Guias de Prática Clínica como Assunto , Programas de Monitoramento de Prescrição de Medicamentos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estados Unidos
18.
Malar J ; 18(1): 260, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362736

RESUMO

BACKGROUND: Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana. METHODS: A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering. RESULTS AND DISCUSSION: Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002-0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40-245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists. CONCLUSION: Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.


Assuntos
Antimaláricos/efeitos adversos , Competência Clínica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmacêuticos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Adulto Jovem
19.
Helicobacter ; 24(5): e12646, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31368629

RESUMO

BACKGROUND: The Helicobacter pylori eradication rate has decreased with increasing antibiotic resistance. We conducted a prospective, nationwide, multicenter registry study to monitor the real status of H. pylori eradication therapy and to investigate the association between eradication success and antibiotic use density in Korea. MATERIALS AND METHODS: We enrolled 9318 patients undergoing H. pylori eradication therapy from 37 hospitals through "on-line database registry" from October 2010 to July 2015. Demographic data, detection methods, treatment indications, regimens, durations, compliance, adverse events, and eradication results were collected. The use of all commercially available eradication antibiotics was analyzed through the Korean National Health Insurance data of the Health Insurance Review and Assessment Service. The defined daily dose of antibiotics was used to standardize drug use comparisons. RESULTS: Finally, 6738 patients were analyzed. The overall eradication rate of first-line therapy was 71.8%. The eradication success rates were 71.7%, 86.9%, and 74.0% for standard triple therapy for 7 days, quadruple therapy, and concomitant therapy, respectively. The eradication success rate in naive patients was higher than that in those who previously underwent H. pylori eradication. Eradication success was significantly associated with younger age, female sex, and high compliance. Regional differences in eradication rates were observed. The yearly use density of clarithromycin increased statistically in seven regions across the country from 2010 to 2015. The yearly use density of amoxicillin in the Gyeongsang and Chungcheong areas was significantly increased (P < .01), whereas that of other macrolides was significantly lower in the Gyeonggi area than in other areas (P = .01). The overall use of eradication antibiotics has increased while the eradication rate steadily decreased for 5 years. However, there was no significant correlation between antibiotic use density and eradication. CONCLUSION: There was no relationship between the eradication rate and antibiotic use density in Korea.


Assuntos
Antibacterianos/uso terapêutico , Bases de Dados Factuais , Uso de Medicamentos/estatística & dados numéricos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Internet , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Coreia (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
20.
Glob Health Action ; 12(1): 1639388, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339473

RESUMO

Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category 'antibiotic' does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a 'Drug Bag' method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples' everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.


Assuntos
Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Projetos de Pesquisa , África , Animais , Antibacterianos/administração & dosagem , Ásia Sudeste , Feminino , Humanos , Masculino , Prevalência
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