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1.
BMJ Open ; 12(8): e062657, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940832

RESUMO

OBJECTIVES: To compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care. DESIGN: In this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017. SETTING: The study was based on administrative data provided by the statutory health insurance fund 'Allgemeine Ortskrankenkasse', in the state of Baden-Wurttemberg, Germany. PARTICIPANTS: The intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention. RESULTS: Overall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group. CONCLUSION: Coordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders. TRIAL REGISTRATION NUMBER: German Clinical Trials Register (DRKS00017548).


Assuntos
Analgésicos Opioides , Osteoartrite , Analgésicos Opioides/uso terapêutico , Dor nas Costas/tratamento farmacológico , Atenção à Saúde , Humanos , Osteoartrite/tratamento farmacológico , Prescrições , Estudos Retrospectivos
2.
BMJ Open ; 12(8): e062041, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940841

RESUMO

INTRODUCTION: Cognitive behavioural therapy for insomnia (CBT-I) is effective at treating chronic insomnia, yet in-person CBT-I can often be challenging to access. Prior studies have used technology to bridge barriers but have been unable to extensively assess the impact of the digital therapeutic on real-world patient experience and multidimensional outcomes. Among patients with insomnia, our aim is to determine the impact of a prescription digital therapeutic (PDT) (PEAR-003b, FDA-authorised as Somryst; herein called PDT) that provides mobile-delivered CBT-I on patient-reported outcomes (PROs) and healthcare utilisation. METHODS AND ANALYSIS: We are conducting a pragmatically designed, prospective, multicentre randomised controlled trial that leverages Hugo, a unique patient-centred health data-aggregating platform for data collection and patient follow-up from Hugo Health. A total of 100 participants with insomnia from two health centres will be enrolled onto the Hugo Health platform, provided with a linked Fitbit (Inspire 2) to track activity and then randomised 1:1 to receive (or not) the PDT for mobile-delivered CBT-I (Somryst). The primary outcome is a change in the insomnia severity index score from baseline to 9-week postrandomisation. Secondary outcomes include healthcare utilisation, health utility scores and clinical outcomes; change in sleep outcomes as measured with sleep diaries and a change in individual PROs including depressive symptoms, daytime sleepiness, health status, stress and anxiety. For those allocated to the PDT, we will also assess engagement with the PDT. ETHICS AND DISSEMINATION: The Institutional Review Boards at Yale University and the Mayo Clinic have approved the trial protocol. This trial will provide important data to patients, clinicians and policymakers about the impact of the PDT device delivering CBT-I on PROs, clinical outcomes and healthcare utilisation. Findings will be disseminated to participants, presented at professional meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04909229.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Humanos , Estudos Multicêntricos como Assunto , Prescrições , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
3.
PLoS One ; 17(8): e0272385, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944052

RESUMO

PURPOSE: We evaluated the prevalence of opioid prescriptions after injury and associated characteristics among workers receiving workers' compensation for a lost work time injury. METHODS: Injured workers identified in Michigan's Workers' Compensation records from 2016 to 2018 were linked to the opioid prescription history in the Michigan Automated Prescription System. RESULTS: Among the 46,934 injured workers with paid claims, the prevalence of receiving an opioid prescription, morphine milligram equivalents (MME) per prescription, number of opioid prescription and probability of receiving opioids prescription>90 days after injury decreased from 2016-2018. Despite the decrease over 50% of the injured workers received an opioid prescription. Being over 34 years, a male, having had an opioid prescription before the injury, working in construction or having an amputation or sprain/strain of the shoulder had a significantly higher probability of receiving an opioid prescription, a higher MME per prescription, a higher number of opioid prescriptions and a higher probability having opioids prescription >90 days after the injury. CONCLUSIONS: Even though opioid prescribing patterns generally decreased from 2016 to 2018 (64.5-52.8%), injured workers in Michigan had a higher prevalence of opioid prescription after injury, than those reported from other states.


Assuntos
Analgésicos Opioides , Indenização aos Trabalhadores , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Humanos , Masculino , Michigan/epidemiologia , Padrões de Prática Médica , Prescrições
5.
COPD ; 19(1): 315-323, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35946353

RESUMO

BACKGROUND AND OBJECTIVE: Triple therapy with an inhaled corticosteroid (ICS), a long-acting ß2-agonist bronchodilator (LABA) and a long-acting muscarinic antagonist (LAMA) is recommended as step-up therapy for chronic obstructive pulmonary disease (COPD) patients who continue to have persistent symptoms and increased risk of exacerbation despite treatment with dual therapy. We sought to evaluate different treatment pathways through which COPD patients were escalated to triple therapy. METHODS: We used population health databases from Ontario, Canada to identify individuals aged 66 or older with COPD who started triple therapy between 2014 and 2017. Median time from diagnosis to triple therapy was estimated using the Kaplan-Meier method. We classified treatment pathways based on treatments received prior to triple therapy and evaluated whether pathways differed by exacerbation history, blood eosinophil counts or time period. RESULTS: Among 4108 COPD patients initiating triple therapy, only 41.2% had a COPD exacerbation in the year prior. The three most common pathways were triple therapy as initial treatment (32.5%), LAMA to triple therapy (29.8%), and ICS + LABA to triple therapy (15.4%). Median time from diagnosis to triple therapy was 362 days (95% confidence interval:331-393 days) overall, but 14 days (95% CI 12-17 days) in the triple therapy as initial treatment pathway. This pathway was least likely to contain patients with frequent or severe exacerbations (22.0% vs. 31.5%, p < 0.001) or with blood eosinophil counts ≥300 cells/µL (18.9% vs. 22.0%, p < 0.001). CONCLUSION: Real-world prescription of triple therapy often does not follow COPD guidelines in terms of disease severity and prior treatments attempted.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Idoso , Broncodilatadores/uso terapêutico , Progressão da Doença , Quimioterapia Combinada , Humanos , Antagonistas Muscarínicos/uso terapêutico , Ontário , Prescrições , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
6.
Curr Sports Med Rep ; 21(8): 280-288, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35946847

RESUMO

ABSTRACT: Hypertension is the leading risk factor for cardiovascular disease and an independent predictor of mortality. The prevalence of hypertension has doubled in the last two decades and evidence suggests that almost half the individuals are unaware of their condition. The antihypertensive effects of exercise are now undisputable, and exercise training is recommended by the major professional and scientific societies, including the American College of Sports Medicine (ACSM), as first-line treatment to prevent, treat, and control hypertension. This review aims to overview the evidence supporting the current ACSM Frequency, Intensity, Time, and Type exercise recommendations for hypertension, discuss new and emerging evidence on exercise in the treatment of hypertension from our laboratories; and propose future directions of research integrating this new and emerging evidence.


Assuntos
Doenças Cardiovasculares , Hipertensão , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Terapia por Exercício , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Prescrições , Estados Unidos
7.
Curr Pharm Teach Learn ; 14(7): 892-899, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35914852

RESUMO

BACKGROUND AND PURPOSE: Prescription verification is a practice-ready expectation for pharmacy graduates. Entrustable professional activities (EPAs) should be applied to practice-ready skills-based assessments. This manuscript describes the technique of two different institutions in assessing prescription verification aligned to the Practice Manager domain of the Core EPAs as defined by the Academic Affairs Standing Committee 2015-2016 report. EDUCATIONAL ACTIVITY AND SETTING: Virginia Commonwealth University School of Pharmacy (VCU) and University of Maryland Eastern Shore (UMES) School of Pharmacy and Health Professions describe their two methods of evaluating prescription verification with the EPA Practice Manager domain. Each program performed the activities in first-year skills-based laboratory courses. FINDINGS: Fulfillment of a medication order was framed into law, medication label, and dispensing accuracy. Both institutions' assessments were high-stakes assessments that included errors. Overall, the majority of both programs' students passed with the institution-specified level of entrustment on their first attempt, with 75.9% to 77.5% of VCU students per each assessment and 74.5% for UMES. The lowest performance, Level 1, assessment scores for the first attempt were 10% for VCU and 2% for UMES, requiring repetition of the assessment for those students. All students achieved a minimum of Level 3 during the reassessments. SUMMARY: Different assessment techniques may arise from program design and institutional resources. However, it is important to ensure EPAs are met for all students in prescription verification. Faculty should consider their own verification activities and level of trust expected for students to meet prior to pharmacy practice experiences.


Assuntos
Avaliação Educacional , Assistência Farmacêutica , Competência Clínica , Avaliação Educacional/métodos , Humanos , Prescrições , Virginia
9.
Zhongguo Zhen Jiu ; 42(8): 949-55, 2022 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-35938341

RESUMO

Through collecting the prescriptions for headache treated with acupuncture in Huangdi Neijing (Yellow Emperor's Inner Classic) till the Qing Dynasty, the literature traceability research is undertaken to determine the extant literature documents with the earliest recorded acupuncture prescriptions and identify the repeated ones in later generations; and then, the acupoint use frequency in the earliest recorded literature of acupuncture prescriptions in the extant documents and acupuncture treatment verses is analyzed separately. It is found that the most of acupoints of high use frequency are overlapped between such two kinds of literature. By integrating and classifying the same or similar contents of acupuncture prescription articles between headache and migraine, the common characteristics and acupoint selections are extracted, the regularity of acupoint selection is explored in view of etiology, complication and affected location, and the attributed fourteen meridians are analyzed statistically in terms of the acupoints in the earliest recorded prescriptions. Finally, the experience of ancient medical masters in acupuncture treatment for headache is obtained.


Assuntos
Terapia por Acupuntura , Meridianos , Pontos de Acupuntura , Cefaleia/terapia , Humanos , Prescrições
10.
Pediatr Int ; 64(1): e15227, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35912458

RESUMO

BACKGROUND: Intensive care unit (ICU) settings typically have a high-volume prescription of carbapenems. Antimicrobial stewardship programs (ASPs) aim to promote appropriate antibiotic use. Handshake stewardship (HS) is adapted from ASPs but focuses on direct feedback to physicians who prescribed antibiotics regarding the appropriateness of antibiotic prescription. This study aimed to evaluate the impact and acceptability of HS on carbapenem consumption in pediatric critical care settings. METHODS: This study was conducted over 18 months spanning pre-and post-implementation of HS. Carbapenem prescriptions were automatically discontinued during the pre-implementation period after 72 h if no indications existed. During the post-implementation, HS was performed by direct feedback to ICU physicians regarding the appropriateness of carbapenem prescriptions within 24 h. The primary outcome was the carbapenem consumption rate, defined as days of therapy (DOT)/1,000 patient-ICU days. Secondary outcomes were the acceptability of HS, length of critical care stay (LOCS), 30-day infection-related mortality rate, and the rate of carbapenem-resistant Enterobacteriaceae (CRE). RESULTS: There were 212 carbapenem prescriptions (163 patients) and 174 carbapenem prescriptions (110 patients) in the pre-and post-implementation periods, respectively. Carbapenem consumption decreased significantly from 667 to 369 DOT/1,000 patient-ICU days, with a median difference of 292 DOT/1,000 patient-ICU days (P < 0.001; 95% confidence interval: 175-408) after HS implementation. The acceptability of the HS was 95.4%. The LOCS, 30-day infection-related mortality, and CRE rate were not significantly different between pre-and post-implementation periods. CONCLUSIONS: Handshake stewardship significantly reduced carbapenem prescription in critically ill pediatric patients without negatively affecting patient outcomes.


Assuntos
Gestão de Antimicrobianos , Carbapenêmicos , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Criança , Cuidados Críticos , Humanos , Prescrições
11.
Front Public Health ; 10: 936830, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937213

RESUMO

Compared with normal people, patients with intellectual disability have poor cardiopulmonary and muscle fitness levels, and their daily physical activity generally cannot reach the "guideline-recommended amount," which increases the risk of obesity and cardiovascular disease in this group. From the perspective of six elements of exercise prescription (frequency, intensity, time, form of exercise, amount of exercise, and progressive rate), this paper systematically reviews the current situation of the formulation and implementation of exercise prescription for patients with intellectual disabilities. The results show that the design idea of aerobic fitness exercise prescription for patients with intellectual impairment follows the six-element 5paradigm, but the insufficient recommended amount of each element is a common problem. In the design of muscle fitness exercise prescription, due to the differences of different exercise forms, the description of the six elements is very inconsistent. Although most prescription execution effects show that it is beneficial to improve cardiopulmonary and muscle fitness, there is a great debate on whether it is beneficial to improve body composition. People with intellectual disabilities are highly heterogeneous groups. In the initial stage of exercise intervention, the elements of exercise prescription need to be adjusted individually to obtain sustainable positive benefits.


Assuntos
Deficiência Intelectual , Exercício Físico , Terapia por Exercício/métodos , Humanos , Aptidão Física/fisiologia , Prescrições
12.
Pharm Biol ; 60(1): 1533-1541, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35943740

RESUMO

CONTEXT: Wuzi Yanzong Prescription (WYP) has long been used to treat male infertility, with convincing clinical evidence. However, its mechanism of action is not clear. OBJECTIVE: WYP chemical components were quantified by HPLC, and the effect on oligoasthenozoospermia rats was explored based on UPLC-Q-TOF-MS metabonomics technology. MATERIALS AND METHODS: The solution was extracted by alcohol and water; the content of eight components in the extracting solution was determined by HPLC. Twenty-four Sprague-Dawley rats were randomly divided into control (CG), model (MG) and administration (PG) groups. Oligoasthenozoospermia was induced for 30 days in all, but the CG with daily oral doses of 20 mg/kg Tripterysium glycosides (TG). PG was given daily oral doses of WYP solution (1.08 g/kg), CG and MG received the same volume of distilled water, all administered for 30 days. After the last administration, the serum samples were collected and detected by UPLC-Q-TOF-MS. RESULTS: An HPLC method for simultaneous determination of chlorogenic acid (0.081%), ellagic acid (0.021%), hyperoside (0.032%), verbascoside (0.011%), isoquercitrin (0.041%), astragalin (0.026%), kaempferol (0.009%) and schisandrin (0.014%) was established. Moreover, the 74 potential biomarkers and eight metabolic pathways related to oligoasthenozoospermia were identified by multivariate analysis and metabolite profiling. WYP can regulate 36 markers, mainly involving amino acid metabolism, lipid metabolism and nucleotide metabolism. DISCUSSION AND CONCLUSIONS: This is a simple and accurate method for quality control of WYP. It further enriches the potential mechanism of WYP in the treatment of oligoasthenozoospermia. It can provide a theoretical basis for the rational application of WYP.


Assuntos
Medicamentos de Ervas Chinesas , Animais , Biomarcadores , Cromatografia Líquida de Alta Pressão , Masculino , Metabolômica , Prescrições , Ratos , Ratos Sprague-Dawley , Água
13.
J Pediatr Orthop ; 42(8): e868-e873, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35856498

RESUMO

BACKGROUND: Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). METHODS: AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients showed median consumption of 29 doses of oxycodone after PSF [preintervention cohort (PRE-INT)]. All eligible patients during the study period were discharged with 30 doses of oxycodone and standard nonopioid analgesics. Only study participants received education on postoperative pain control. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were collected. Requests for opioid refills were documented. RESULTS: Forty-nine patients were enrolled. POST-INT was divided into low (L, ≤8 doses), average (AVE, 9-25), and high (H, >25) opioid use groups. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were similar between the groups. However, there was a difference in days of oxycodone use, doses consumed in the first week, and leftover doses ( P <0.001). Comparison to the PRE-INT L (≤16 doses), AVE (17 to 42), and high (H, >42) use groups showed that POST-INT L and AVE consumed less oxycodone (L: P =0.002; AVE: P <0.001). Also, the overall POST-INT cohort had fewer mean days of oxycodone use (5.6 vs. 8.9, P <0.001) and doses used in the first week (14 vs. 23, P <0.001) compared with the PRE-INT cohort. Subanalysis showed fewer study participants requested and received an opioid refill [3/49 patients (6%)] compared with eligible patients who declined to participate, withdrew, or missed enrollment [8/35 patients (23%)] ( P =0.045). CONCLUSIONS: Preoperative patient education and smaller prescription quantity successfully reduced opioid use while maintaining excellent pain control after PSF for AIS. Setting expectations regarding postoperative pain management is critical, as nonstudy participants were significantly more likely to request an opioid refill. LEVEL OF EVIDENCE: Level II-therapeutic.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Analgésicos Opioides/uso terapêutico , Humanos , Cifose/etiologia , Oxicodona/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Educação de Pacientes como Assunto , Padrões de Prática Médica , Prescrições , Estudos Prospectivos , Escoliose/etiologia , Escoliose/cirurgia , Fusão Vertebral/métodos
14.
Expert Rev Clin Pharmacol ; 15(6): 659-670, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35802958

RESUMO

INTRODUCTION: A non-hormonal prescription vaginal pH modulator (VPM) gel (Phexxi®), with active ingredients lactic acid, citric acid and potassium bitartrate, has recently been approved for prevention of pregnancy in the United States. The objective of this review is to compile the evidence available from published preclinical and clinical trials to support its use. AREAS COVERED: PubMed was searched for published literature on VPM gel. Two Phase III trials were found on clinicaltrials.gov database. The results demonstrated that VPM gel is safe, with minimal side effects, and effective (cumulative 6-7 cycle pregnancy rate of 4.1-13.65%, (Pearl Index 27.5) as a contraceptive. Microbicidal effects suggest potential for the prevention of sexually transmitted infections (STIs); currently a Phase III clinical trial is being conducted to evaluate prevention of chlamydia and gonorrhea. EXPERT OPINION: Non-hormonal reversible contraceptive options have been limited to the highly effective copper-releasing intrauterine device that requires insertion by a trained clinician, and less effective coitally associated barrier and spermicide options which are typically available over-the-counter. Spermicides, which improve efficacy of barrier devices, may increase the risk of HIV/STIs. VPM gel provides a new safe, effective non-hormonal contraceptive option, with potential for prevention of STIs.


Assuntos
Infecções Sexualmente Transmissíveis , Espermicidas , Ácido Cítrico , Anticoncepção/métodos , Anticoncepcionais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico , Laxantes , Potássio , Gravidez , Prescrições , Infecções Sexualmente Transmissíveis/prevenção & controle , Estados Unidos
15.
Psychiatry Res ; 315: 114704, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35830755

RESUMO

BACKGROUND: Few studies investigated the impact of the pandemic on antidepressant (AD) use. METHODS: The Social and Health Information System of Friuli Venezia Giulia region, Italy, provided data on AD use. Sex, age, AD class and month used the amount of AD prescriptions, measured by defined daily doses (DDD) per 1000 inhabitants per day, to compare AD use in 2020 with the period 2015-2019. A linear trend model predicted AD use for 2020, based on years 2015-2019. RESULTS: AD use was on average 20% higher in each month of 2020 when compared with the same month for the period 2015-2019, with an increase of more than 30% in the first four and in the last two months of 2020. The observed AD use in 2020 was higher than predicted, particularly in men, and in the 30-59 years age group. LIMITATIONS: Descriptive study of AD use without analysis of data at the individual level. No information on psychiatric diagnoses of AD users. CONCLUSION: AD use was higher in the first year of the COVID-19 pandemic. Further research is warranted to understand if this may be related to a rise in mental disorders in the general population during the COVID-19 pandemic.


Assuntos
COVID-19 , Transtornos Mentais , Antidepressivos/uso terapêutico , COVID-19/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pandemias , Prescrições
16.
Ther Innov Regul Sci ; 56(5): 859-866, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35908005

RESUMO

BACKGROUND: Major antihypertensive drug classes (but not Imidazoline Receptor Agonists) have been demonstrated to reduce cardiovascular morbidity and mortality. In 2017, Latvia and Lithuania had the highest cardiovascular mortality among the Eastern, Central, Northern, and Western Member States of the European Union (EU). Cardiovascular mortality in Estonia is much lower than in Lithuania and Latvia. OBJECTIVE: To evaluate the consumption of Imidazoline Receptor Agonists in the Baltic States and its potential implications. MATERIALS AND METHODS: The study included data on the sales of Imidazoline Receptor Agonists in Lithuania, Latvia, and Estonia; the marketing authorization databases of the competent authorities; the guidelines on the treatment of hypertension, and the reimbursement conditions. RESULTS: The study showed a very high consumption of the Imidazoline Receptor Agonists in Lithuania and Latvia. From 2016 to 2019, the average consumption of Imidazoline Receptor Agonists in Lithuania was 15.5 times higher than in Estonia; in Latvia, it was 8.9 times higher than in Estonia. The guidelines recommend the use of the Imidazoline Receptors Agonists as one of the last options in hypertension therapy, but the marketing authorizations do not restrict their line of therapy. CONCLUSIONS: Consumption of IRAs in Lithuania and Latvia is very high. The authorized use of the IRAs in the EU Member States is not in line with the guidelines on the management of arterial hypertension and therefore patients might be deprived of therapies that reduce the cardiovascular risk. The drug regulatory authorities of the EU should review the data on the safety and efficacy of the IRAs and restrict their therapeutic indications if necessary.


Assuntos
Anti-Hipertensivos , Hipertensão , Anti-Hipertensivos/uso terapêutico , União Europeia , Humanos , Hipertensão/tratamento farmacológico , Lituânia , Prescrições
17.
Molecules ; 27(14)2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35889512

RESUMO

LJF and LF are commonly used in Chinese patent drugs. In the Chinese Pharmacopoeia, LJF and LF once belonged to the same source. However, since 2005, the two species have been listed separately. Therefore, they are often misused, and medicinal materials are indiscriminately put in their related prescriptions in China. In this work, firstly, we established a model for discriminating LJF and LF using ATR-FTIR combined with multivariate statistical analysis. The spectra data were further preprocessed and combined with spectral filter transformations and normalization methods. These pretreated data were used to establish pattern recognition models with PLS-DA, RF, and SVM. Results demonstrated that the RF model was the optimal model, and the overall classification accuracy for LJF and LF samples reached 98.86%. Then, the established model was applied in the discrimination of their related prescriptions. Interestingly, the results show good accuracy and applicability. The RF model for discriminating the related prescriptions containing LJF or LF had an accuracy of 100%. Our results suggest that this method is a rapid and effective tool for the successful discrimination of LJF and LF and their related prescriptions.


Assuntos
Medicamentos de Ervas Chinesas , Lonicera , Cromatografia Líquida de Alta Pressão , Medicamentos de Ervas Chinesas/química , Lonicera/química , Extratos Vegetais , Prescrições , Espectroscopia de Infravermelho com Transformada de Fourier
19.
Harm Reduct J ; 19(1): 84, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35883136

RESUMO

BACKGROUND: Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020. METHODS: A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD. RESULTS: In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03). CONCLUSIONS: Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.


Assuntos
COVID-19 , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Hospitais , Humanos , Masculino , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pandemias , Prescrições , Estudos Retrospectivos , Estados Unidos
20.
J Am Board Fam Med ; 35(4): 821-826, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35896449

RESUMO

PURPOSE: Prediabetes is a serious public health concern, with 34.5% of US adults meeting the criteria for prediabetes. The American Diabetes Association has highlighted metformin therapy as a consideration for individuals with BMI ≥ 35 kg/m2, those aged < 60 years, and women with a history of gestational diabetes. We examined metformin prescription rates among a national sample of commercially insured, higher risk patients with prediabetes. METHODS: We gathered 2012 to 2018 demographic, laboratory, and prescription data for 53,551 patients with prediabetes from the IBM MarketScan research database. Our primary outcome was metformin prescription rates 1 or 3 years after a laboratory confirmation of prediabetes among patients who have a BMI ≥ 35 kg/m2 or are aged < 60 years. RESULTS: Overall, 2.4% (n = 1,124) of patients received a metformin prescription within 1 year of a laboratory confirmed prediabetes result, including 2.4% of patients aged < 60 years and 10.4% of those with BMI ≥ 35 kg/m2. By a 3 year follow-up, 4.1% (n = 1901) received a metformin prescription, including 3.9% of patients aged < 60 years and 14.0% with BMI ≥ 35 kg/m2. Patients who developed type 2 diabetes within the 1 (n = 2,769) or 3 year (n = 7,268) follow-up periods were excluded from analysis. CONCLUSIONS: Few prediabetes patients who were either obese or aged < 60 years received a metformin prescription between 2012 and 2018. Prescription rates increased slightly between 1 and 3 years after a prediabetes diagnosis, so strategies to support timely intervention among higher risk patients with prediabetes are critically needed.


Assuntos
Diabetes Mellitus Tipo 2 , Metformina , Estado Pré-Diabético , Adulto , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Estado Pré-Diabético/tratamento farmacológico , Estado Pré-Diabético/epidemiologia , Prescrições
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