Administration Interval Research Articles

Clinical profile and outcome of AKI in snake bite in a tertiary care hospital, India

Introduction: Acute kidney injury (AKI) is one of the complications of envenomation that is frequently fatal. Aim: To evaluate the clinical profile and outcome of AKI in snake bite patients and to identify the predictors of mortality in these patients. Methods: All patients admitted with history of envenomation and AKI were included in the study. A detailed history was obtained from all the patients about the time of antisnake venom administration and time interval between the event and admission in hospital, and then hematological and biochemical investigations were performed. Results: A total of 202 patients were diagnosed with snake bite induced AKI, of which 8.6% had died. Majority of patients were males (82.7%). The dialysis requirement was significantly higher in patients who died as compared to those who survived (100% vs. 72.6%, p = 0.013). The disseminated intravascular coagulation was found to be higher in patients who died due to snake bite (p < 0.001). The median (range) length of hospitalization was shorter for the nonsurvivors than the survivors (3.0 [1.0–4.0] days vs. 8.0 [3.0–27.0] days; p < 0.001). Compared to patients who survived, the total leukocyte count and serum urea were significantly higher among patients who died due to snake bite induced AKI. Conclusion: The present study revealed that higher dialysis requirement, high complication rate, and lower duration of hospital stay were the risk factors associated with patients who died due to snake bite induced AKI.

Integração PK/PD para determinação de doses intramusculares de cloxacilina sódica para infecções causadas por Staphylococcus spp em caprinos

ABSTRACT This study aims to determine therapeutic protocols of intramuscular sodium cloxacillin (IM) in goats with potential antibacterial effects against Staphylococcus spp. We constructed a pharmacokinetic (PK) model of IM, followed by a pharmacokinetic/pharmacodynamic integration (PK/PD). Simulations of different therapeutic protocols were then performed, with the doses ranging from 30 to100 mg/kg every 8, 12, or 24 hours. We calculated the probability to target attainment (PTA) of reach protocol's therapeutic according to the minimum inhibitory concentration (MIC) range of 0.06 to 4 μg/mL. The PK/PD index (PDT) used was "time above the MIC for 40% of the time" (T>MIC ≥40%). Protocols with single administration per day were incapable of achieving PTA ≥ 90% for any of the estimated MICs. However, by decreasing the administration interval, the PTA was increased. Thus, from the dose of 50 mg/kg every 12 hours, a PTA≥ 90% for MICs ≤ 0.5 μg/mL was achieved, while the 30 mg/kg dose every 8 hours was able to achieve a PTA≥ 90% for MICs of 2 μg/mL. The results suggest using 30 mg/kg dose every 8 hours in clinical studies of agents with MICs ≤ 2μg/mL; Nevertheless, the practitioner should adjust the dose in severe patients.

Growth Response and Yield of Pagoda Mustard Plant (Brassica narinosa) Due to Concentration and Time Interval of Liquid Bokashi Administration of Rice Washing Water

The purpose of this study was to determine the growth response and yield of pagoda mustard (Brassica narinosa) due to the concentration and time interval for applying liquid bokashi to rice washing water. The research was conducted from December 2019 to February 2020 in Lumbang Village, Lumbang District, Probolinggo Regency. This study used a factorial randomized block design method with two factors, namely concentration and time interval for giving liquid bokashi rice washing water 3 times. The treatment consisted of 2 factors. The first factor is the concentration of liquid bokashi rice washing water (K), namely: K0 = 0% (control/without giving liquid bokashi. The second factor is the time interval for giving liquid bokashi (L). Observation variables consist of plant height (cm), number of leaves (fruit), leaf area (cm2), wet stover weight (g), dry stover weight (g), root length (cm), In this study using a linear model. Data will be analyzed by means of the F test, If the factor variance If there is a significant effect on the interaction, it is tested with 5% DMRT. The conclusions of this study are 1). The concentration of liquid bokashi had a significant effect on the parameters of plant height, number of leaves, leaf area, wet stover weight, dry stover weight and root length, 2). The time interval for bokashi administration had no significant effect on all observation parameters, 3). administration of liquid bokashi and time interval of administration on the growth and yield of pagoda mustard in almost all observed parameters.

The Quantitative and Qualitative Analysis of Antibiotic Use in Bone Fracture Patients in a Public Hospital in Indonesia

Introduction: Prophylactic antibiotic therapy has an important role in facilitating optimal postoperative healing. Inappropriate use of antibiotics in hospitals will increase the cost of therapy and the incidence of nosocomial infections of infectious microorganisms. Preoperative prophylactic antibiotics are believed to reduce the incidence of surgical site infections. Objective: This study aims to determine the pattern of antibiotic use and analyse the use of antibiotics qualitatively by the Gyssen method and quantitatively by the defined daily dose (DDD) method in inpatients with bone fractures at the Haji General Hospital Surabaya, Indonesia. Methods: This study was a descriptive observational study conducted on 89 samples. Data were collected retrospectively through medical records in the period January-December 2019. Antibiotic use data were then analysed qualitatively and quantitatively using the Gyssen and DDD methods. Results: In this study, the antibiotic that was widely used as a prophylactic and therapeutic antibiotic in patients with bone fractures was ceftriaxone. Quantitative analysis using the DDD method showed that the value of ceftriaxone was 45.6/100 patient-days and cefazoline was 3.1/100 patient-days. Analysis of antibiotic use in bone fracture patients using the Gyssen method showed that the rational use of antibiotics was 84.3%, the use of antibiotics was not timely as much as 4.5%, and the interval of antibiotic administration was not appropriate as much as 11.2%. Conclusion: the use of antibiotics in fracture surgery patients is classified as rational use of antibiotics but the use of antibiotics still exceeds WHO standards. Furthermore, it is necessary to conduct a similar study with prospective data collection so that it can observe the incidence of surgical wound infection.

PENGARUH KONSENTRASI DAN INTERVAL WAKTU PEMBERIAN POC LIDAH BUAYA TERHADAP PERTUMBUHAN DAN HASIL TANAMAN MENTIMUN (Cucumis sativus L.)

This study aims to obtain the best concentration of aloe vera POC on the growth and yield of cucumber plants, to determine the time interval of giving the best aloe vera POC to the growth and yield of cucumber plants, and to determine the effect of the interaction of concentration and frequency of aloe vera POC on the growth and yield of cucumber plants. . This research was carried out from March 2022 to April 2022 in Hamlet Kepoh, Tohudan Village, Colomadu District, Karanganyar Regency. This study used the Completely Randomized Block Design (RAKL) method which consisted of two factors. The first factor is the time interval of giving aloe vera POC (I) which consists of 3 levels. The second factor is the concentration of aloe vera POC solution (K) which consists of 4 levels of analysis of variance analysis with the F test or diversity test at the level of 5% and 1%. If each treatment was significantly different, it was continued with the Duncan Multiple Range Test (DMRT) at 5% level. The results of this study indicate that the time interval treatment of aloe vera POC (I) showed the best effect on the parameters of observing the number of fruits (2.42), fruit length (20.83 cm), dry bean weight (38.33 g), weight fresh chestnut (254.17 g) and root length (43.84 cm). The treatment of aloe vera POC concentration (K) showed the best effect on the parameters of the fresh weight (261.11 g). The interaction between concentration and time interval of aloe vera POC administration (I X K) showed the best effect on the observed parameters of root length (50 cm).

Drug-Related Problems in Pulmonary Hypertension with Valvular Heart Disease.

The occurrence of drug-related problems (DRPs) and their causes specifically among pulmonary hypertension (PH) with valvular heart disease (VHD) has not been evaluated and is unknown. Therefore, this study aimed to determine the percentage of occurrence, types, and causes of DRPs among PH with VHD patients. An observational retrospective study was conducted at Cardiology Centre, Hospital Serdang, from 1st January to 30th April 2021. Data were collected from medication charts, medical progress notes, laboratory and operative charts through electronic Health Information System (eHIS). The types and causes of DRPs were identified and classified based on Pharmaceutical Care Network of Europe's (PCNE) classification system V9.02. The data were analyzed using descriptive statistics. All patients (100%) experienced at least one DRP. Total number of DRPs identified was 120 encounters which were associated with 503 causes. The majority of problems were related to treatment effectiveness (59.1%) and treatment safety (33.4%). The causes of DRPs are mainly related to inappropriate monitoring including therapeutic drug monitoring (18.6%), inappropriate combination of drugs, or drugs and dietary/herbal supplement (10.3%), drug dose was too high (8.9%), drug dose was too low (8.2%) and inappropriate timing of administration or dosing intervals (7.7%). The percentage of DRP occurrence was high in the studied population. Treatment effectiveness and treatment safety issues were the main DRPs identified with various preventable causes. The findings may be useful to guide the planning of measures to prevent and solve future DRPs in the population.

Population Pharmacokinetic Modeling for Ceftazidime-Avibactam Renal Dose Adjustments in Pediatric Patients 3 months and Older.

Ceftazidime-avibactam is a novel β-lactam/β-lactamase inhibitor combination developed to treat serious Gram-negative bacterial infections; approved indications include complicated urinary tract infection, complicated intra-abdominal infection, and hospital-acquired pneumonia including ventilator-associated pneumonia in patients ≥ 3 months old. Because of the predominantly renal clearance of ceftazidime and avibactam, dose adjustments (reductions) are required for patients with estimated creatinine clearance (CrCL) ≤ 50 mL/min. We describe the application of combined adult and pediatric population pharmacokinetic models in developing ceftazidime-avibactam dose recommendations for pediatric patients ≥ 2 to < 18 years old with body surface area-normalized CrCL ≤ 50 mL/min/1.73 m2 , including moderate, severe, or very severe renal impairment, or end-stage renal disease requiring hemodialysis, and for patients ≥ 3 months to < 2 years old with mild, moderate, or severe renal impairment. Models included allometric scaling for all subjects and simulations (1,000 subjects per age group, renal function group, and indication) were performed nonparametrically using post hoc random effects. Doses were selected based on simulated pediatric patients achieving steady-state exposures similar to adults and high probability of target attainment (using a simultaneous joint target for both ceftazidime and avibactam). Because there were few children with renal impairment in the ceftazidime-avibactam clinical trials, selected pediatric doses were guided by extrapolation and matching of adult exposures associated with efficacy and within established safety margins. The recommended doses for pediatric patients with estimated CrCL ≤ 50 mL/min/1.73 m2 use equivalent adjustments in dose quantity and/or administration interval (vs. the corresponding age group with normal renal function) as those for adults.

Insights on attenuating autophagy cellular and molecular pathways versus methotrexate-induced toxicity via liposomal turmeric therapy

BackgroundMethotrexate (MX), a competitive inhibitor of dihydrofolate reductase, can inhibit DNA and RNA production and is a powerful anticancer agent widely utilized in clinical practice for treating nonneoplastic maladies, as psoriasis and rheumatoid arthritis; meanwhile, its probable prescription dose and interval of administration are strictly limited due to dose-related organ damage. Former studies verified that kidney, brain, liver, and lung harms are prospective obstacles of methotrexate administration. To understand the machinery of methotrexate-prompt toxicity, various mechanisms were investigated. The former is an autophagy defense mechanism; autophagy is a self-digesting mechanism responsible for the removal of damaged organelles and malformed proteins by lysosome. The contemporary article hypothesized that turmeric or its liposomal analog could defeat autophagy of MX-induced acute toxicity. Methotrexate, in a dose of 1.5 mg/kg, was administered intravenously followed by turmeric and liposomal turmeric treatment in a dose of 5 mg/kg for 30 days in rats. ResultsIncrement in autophagy (AUTP) consent by MX administration was attenuated by concurrent treatment via turmeric and liposomal turmeric that was reliable on the alteration in apoptotic markers. The assembly of FOXO-3 in serum post methotrexate administration was suppressed by concurrent treatment via liposomal turmeric. Apoptosis/autophagic marker investigation was evaluated through the gene expression of Bax (BCL2-associated X protein)/Bcl2 (B-cell lymphoma 2)/P53 (tumor protein P53)/SiRT-1 (sirtuin silent mating-type information regulation 2 homolog 1) and FOXO-3 (forkhead box transcription factor-3)/ERDJ-4 (endoplasmic reticulum localized DnaJ homologs)/BNP (brain natriuretic peptide B) signaling. The cell death of all cells was categorized to achieve autophagy. Interestingly, Bax/Bcl2/P53/SiRT-1 signaling pathways were downregulated, contributing to inhibiting the initiation of autophagy. Meanwhile, FOXO-3/BNP/ERDJ-4 reduction-implicated noncanonical autophagy pathways were involved in methotrexate-induced autophagy, whereas this change was suppressed when turmeric was administered in liposomal form. ConclusionThese outcomes recommended that liposomal turmeric prevents MX-induced acute toxicity through its autophagy, antioxidant, and antiapoptotic properties.

Immune Persistence against SARS-CoV-2 after Primary and Booster Immunization in Humans: A Large-Scale Prospective Cohort Study.

Amid the ongoing global COVID-19 pandemic, limited literature exists on immune persistence after primary immunization and the immunogenic features of booster vaccines administered at different time intervals. Therefore, this study aimed to determine the immune attenuation of neutralizing antibodies against the SARS-CoV-2 wild-type strain, and Delta and Omicron variants 12 months after the primary administration of the COVID-19 inactivated vaccine and evaluate the immune response after a booster administration at different time intervals. A total of 514 individuals were followed up after primary immunization and were vaccinated with a booster. Neutralizing antibodies against the wild-type strain and Delta and Omicron variant spike proteins were measured using pseudovirus neutralization assays. The geometric mean titers (GMTs) after the primary and booster immunizations were 12.09 and 61.48 for the wild-type strain, 11.67 and 40.33 for the Delta variant, and 8.51 and 29.31 for the Omicron variant, respectively. The GMTs against the wild-type strain declined gradually during the 12 months after the primary immunization, and were lower against the two variants. After implementing a booster immunization with a 6 month interval, the GMTs against the wild-type strain were higher than those obtained beyond the 7 month interval; however, the GMTs against the two variants were not statistically different across 3–12 month intervals. Overall, SARS-CoV-2 variants showed remarkable declines in immune persistence, especially against the Omicron variant. The booster administration interval could be shortened to 3 months in endemic areas of the Omicron variant, whereas an appropriate prolonging of the booster administration interval did not affect the booster immunization effect.

Studi Rasionalitas Penggunaan Obat Favipiravir pada Pasien Covid-19 di RSUD Harapan Insan Sendawar Kabupaten Kutai Barat Tahun 2021

Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by the SARS COV-2 virus. One of the antiviral groups that are often used worldwide for the treatment of COVID-19 is Favipiravir. Favipiravir use should be monitored because the accuracy of the drug will maximize the effect of therapy on the patient. Evaluation of Drug Use (EPO) of Favipiravir in terms of rationality needs to be done. Drugs that are not used rationally can cause side effects, the length of treatment will be longer, and even cause death effects in patients. The purpose of this study was to describe the characteristics of COVID-19 patients based on age, gender, and comorbidities and to find out the rationale for using Favipiravir inpatients at the HIS Hospital based on the criteria for the right diagnosis, the right patient, the right drug, the right dose, the right time interval for administration, appropriate duration of administration and clinical outcomes of COVID-19 patients (PCR, TCM, and antigen). This research is a type of nonexperimental research, the research was carried out in a descriptive evaluative way, and the data was collected retrospectively by looking at the medical record data. Determination of the rationale for using Favipiravir was carried out using the literature of the Indonesian COVID-19 Drug Informatorium edition 3, 100% correct patient, 100% correct drug, 100% correct diagnosis, correct dose 50.84%, correct duration of administration 61.01%, correct time interval administration of 81.35% and clinical outcomes (PCR (-) 74.57% %, TCM (-) 16.94%, and Antigen (-) 6.77%.

Evaluating the measures in patient-reported outcomes, values and experiences (EMPROVE study): a collaborative audit of PROMs practice in orthopaedic care in the United Kingdom.

All national orthopaedic societies advocate the use of patient reported outcome measures (PROMs), but clear guidance on their use is limited. We utilised a collaborative methodology to perform a national audit aiming to assess the perceived variability in PROMs practice in orthopaedic surgery in the United Kingdom. A multicentre collaborative audit of practice was performed extracting PROMs data on 21 commonly performed orthopaedic procedures. For each procedure, data were collected for frequency of PROM collection, type of PROM chosen, administration intervals, method and reason for collection. Compliance with national society recommendations was undertaken. Sixty-three trusts enrolled to participate in the study with a completion rate of 60% (38 trusts). The most frequently reported PROMs were those associated with best practice tariffs (83.3% and 80.6% for hip and knee replacements, respectively). Outside incentivised programmes we observed a higher rate of variation in PROMs practice which failed to meet our audit standard. Across all procedures evaluated, 69% (221/318) of respondents to the study used paper as the primary method of PROM collection. This is the first national audit of PROMs collection in orthopaedics. The integration of PROMs within best practice tariff platforms positively influences the frequency and standardisation of collection. Outside this initiative, PROMS collection is infrequent and highly varied despite the presence of several registries. Because PROMs collection is a recommendation across all procedures using implantable devices, the success of this will depend on the adequacy of funding, resource delivery and the presence of clearer recommendations.

Patient-centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis.

At present, no real-world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a patient-centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers. Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient-centered dosing regimen. Group A (n=30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B (n=30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C (n=30) prolonged dupilumab interval with 66%-75% (300 mg/6-8 weeks). AD severity score, patient-reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time. Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)-pruritus temporarily significantly increased after interval prolongation but remained low (median NRS-pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR=17.1-45.6); 12.5 mg/L (IQR=1.7-22.3)) compared with the levels during the standard dosage (88.2 mg/L [IQR=67.1-123.0, p < .001]). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period. This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient-centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time.

Clinical Features of the Course of Musculoskeletal Infection after Local Administration of Glucocorticoids

Summary. In the treatment of patients with inflammatory and degenerative-dystrophic lesions of the joints, soft tissues and ligaments, local administration of drugs is often used in practice, usually (mainly) glucocorticoids.&#x0D; Objective: to determine the place and role of local administration of glucocorticoids in the occurrence and development of musculoskeletal infection.&#x0D; Materials and Methods. The peculiarities of the occurrence and development of infectious complications, their clinical manifestations, laboratory and anamnestic data after local administration of glucocorticoids in 56 patients aged 24 to 78 years were analyzed.&#x0D; Results. 44 patients had moderate and severe subcompensated comorbidities. Betamethasone was the most commonly used for injections (32 patients, 57.2%). Glucocorticoids were administered intra-articularly to 43 (76.8%) patients: knee joint (37.5%), shoulder (25.0%), ankle (7.1%), hip (3.6%), elbow and 1st metatarsophalangeal (1 case each). In other cases (bursitis, enthesitis, etc.), glucocorticoids were administered paraarticularly. It was a single injection only in 32%; the rest of patients were injected 2 – 20 times. In 96% of cases, monocultures were microbiologically isolated (S.aureus in 52%). At the time of hospitalization, the acute stage of the infectious process was detected in 22 (39.3%) patients, subacute in 16 (28.6%), and chronic active fistula phase in 18 (32.1%). All cases of clinically similar manifestations are systematized into groups of symptom complexes – clinical variants: 1) abscess and/or phlegmon of paraarticular soft tissues, necrotizing fasciitis; 2) septic bursitis; 3) septic arthritis (synovitis); 4) septic destructive arthritis; 5) osteomyelitis.&#x0D; Conclusions. We found no clinical differences depending on the drugs used. The most important reasons for the development of infectious complications are ignoring the principles of dosing, multiplicity and time intervals of administration, unreasonable repeated use, and the presence of serious subcompensated comorbidities, which should be considered as a relative contraindication and as a risk factor.

Tingkat Keberhasilan Penggunaan Pupuk Hayati Bioboost dan Interval Pemberian terhadap Pertumbuhan dan Produksi Tanaman Mentimun (Cucumis sativus L.)

This research was conducted in Timoro Village, Tabulahan Subdistrict, Mamasa Regency, which was conducted in April to July 2019. The aim was to determine the level of success in using Bioboost biofertilizers and the interval of administration of growth and production of cucumber plants. The design method used in the implementation of this study was in the form of a Randomized Group Design with a Separate Plot Design (RPT) pattern. Main plot of Bioboost (W) biological fertilizer time interval treatment includes two levels, namely: W1 = Bioboost Biofertilizer Giving biweekly W2 = Bioboost Biofertilizer giving once every three weeks Whereas Child Plot (AP) is a dose of Bioboost (F) consisting of bioboost fertilizer (F) consisting of the three levels, namely: F0 = without administration of Bioboost Biofertilizer F1 = dose of Bioboost Biofertilizer 20 ml + 1000 ml of water. F2 = dosage of Bioboost 40 ml + 1000 ml water.The results showed that the interaction of the time interval of administration with the dose of bioboost biofertilizer (Z x F) had no effect on the growth and production of cucumber plants on all parameters. Keywords: Bioboost Biofertilizer, Giving and Cucumber Intervals

Clinical observation of different doses of rituximab for the treatment of severe pemphigus: A single-center prospective cohort study

To the Editor: Rituximab has been recommended as a first-line treatment for pemphigus, an autoimmune mucocutaneous disease.1 The conventional protocols of rituximab in pemphigus are commonly followed, including rituximab 1000 mg administered intravenously on days 1 and 15 or rituximab 375 mg/m2 administered intravenously once a week for 4 weeks, whereas small studies have proposed a low-dose protocol with rituximab 500 mg administered intravenously on days 1 and 15.2 Nevertheless, a lack of consensus on the dose and administration interval of rituximab in pemphigus remains.

Advancing Nursing Science Through Site-Based Clinical Inquiry: Designing Problem Pyramids.

Advancing Nursing Science Through Site-Based Clinical Inquiry: Designing Problem Pyramids.

Silk Fabric Decorated with Thermo-Sensitive Hydrogel for Sustained Release of Paracetamol.

Paracetamol is a safe and widely used antipyretic and analgesic drug, however, with the drawbacks of gastrointestinal first-pass effect and short intervals of administration. Transdermal drug delivery system can effectively avoid the liver metabolism caused by excess oral ingestion of paracetamol. Herein, a silk fabric-based medical dressing decorated by a thermo-responsive hydrogel for sustained release of paracetamol is proposed. Genipin as a bio-safe cross-linker is applied to assist gelation of a thermo-responsive hydrogel system coupled with chitosan and glycerol-phosphate disodium salt around body temperature (37°C), as well as densifying the microporous gel to improve mechanical strength. The in situ sol-gel transition enabled hydrogel well penetrate and coat the silk fabric, forming a hierarchical hydrogel structure capable of prolonging the sustained release of drug to 12h, twice as long as a blank fabric. The silk fabric with a thin gel coating maintains a good water vapor transmission rate, compatible for skin contact application. The drug release properties can be tuned by regulating the genipin content and fabric braiding structure. The silk fabric dressing exhibits temperature-dependent instant release behavior within the first 2h. The sustained release mechanism of paracetamol well matches with the Korsmeyer-Peppas model in a non-Fickian diffusion.

Cost analysis comparison of rurioctocog alfa pegol compared to turoctocog alfa pegol in the prophylaxis of Haemophilia A in Italy

Background: Hemophilia-A is an X-linked genetic disorder arising from a mutation to the X chromosome and causing either a quantitative or qualitative deficiency in blood clotting factor-VIII (FVIII). Several recombinant extended half-life FVIII products (rFVIII-EHL) are in use in Italy for the treatment of hemophilia-A. Objective: To estimate the annual average cost of the prophylactic treatment of a patient with hemophilia-A in Italy with rurioctocog alfa pegol or turoctocog alfa pegol, with particular regard to potential dose adjustments as provided in the SPCs. Methods: The comparison between the two rFVIII-EHL, expressed in terms of average annual cost per patient treated, was conducted from the NHS perspective. The average annual consumption (IU/kg) of the two rFVIII-EHL was derived from the clinical trial of reference for in label prophylactic treatment. Adjustments of doses and administration intervals allowed in the SPCs were considered on the basis of the literature. The published ex-factory price considered for both rFVIII-EHL was € 0.72. A scenario analysis focused on possible dosing adjustments was conducted. Results: With regard to the average consumption associated with the posology in label, the average annual treatment cost is almost the same between the two rFVIII-EHL. Whereas taking into account the possible dose adjustments based on once-weekly administration, rurioctocog alfa pegol shows a considerably lower average annual treatment cost compared to turoctocog alfa pegol (– € 42,719). Conclusions: Rurioctocog alfa pegol would be the more sustainable option, based on the annual average cost, for the NHS in the prophylactic treatment of hemophilia-A.

Regenerative medicine in aesthetics

Regenerative medicine refers to the restoration of the form and function of damaged and diseased tissues by upregulation of natural regenerative processes present in the human body. Applications of regenerative medicine in dermatology are numerous, ranging from the acceleration of wound healing, hair restoration, mesenchymal stem cell augmented fat transfer, skin rejuvenation, enhancing results, and reducing downtime postprocedure and postlaser, etc. In modern aesthetic practice, the most prominent among current regenerative treatments are platelet-rich plasma (PRP), stem cells, growth factors, and most recently, exosomes. Most of the modalities available at present lack high-quality evidence supporting their use and good quality clinical trials are required for the optimization of cellular source, dose, and administration intervals before these modalities are deemed acceptable for use at a wider scale.

Sustainable Prescribing in Secure Services – a Quality Improvement Initiative

AimsIn 2021 The Department of Health published a report into the safer use of medicines in health and justice mental health services, advocating sustainable prescribing as a way of improving patient care and reducing carbon emissions. Improving prescribing behaviour could lead to a reduction of 170,000 kg CO2e per year across England, along with cost savings which contribute to higher value service provision and improved service user experience. We aim to evaluate and improve the prescribing of antipsychotic depot and ‘as required’ (PRN) medication in a male secure unit.MethodsBaseline data were gathered from the patient population in a male secure unit (1 low and 2 medium secure wards, total 50 beds) in December 2021. This included the number of patients prescribed a depot, the type of depot prescribed and whether or not these were administered at the longest evidence-based interval. As part of a wider trust initiative “prn” medication was moved to a fortnightly review cycle to ensure medication was used for as short a duration as necessary. Over a six-week period medication rationale was analysed and discussed with the Responsible Clinician for the service user to optimise prescribing. Data collected following this intervention was compared with baseline results.ResultsThe project found that 26 patients in the service were prescribed an antipsychotic depot in December 2021. In this group 17 (65%) were prescribed their medication at the longest evidence-based interval. Of the 9 (35%) that were not, 5 had clinical reasons why a change would not be appropriate at present, however it was agreed this could be considered later in their pathway. Of the remaining service users, two had their dose of medication reduced and their prescribing interval increased. “As needed” (PRN) medications of 15 patients were evaluated; 9 (60%) had medications prescribed which were not in use (4 patients had 3 or more prescribed not used within 2 weeks). Following intervention this reduced to 2 patients, both of which had only 1 PRN medication which required review.ConclusionDeprescribing can have a significant impact on patient care and safety and can reduce the environmental impact of a service. This project demonstrated the advantages gained from regular medication reviews and taking into consideration dose and administration interval when prescribing antipsychotic depots. Using protocols for prescribing as needed medications, a structure for reviewing prescriptions, collaboration with patients and utilising patient group directions where appropriate can all aid in improving prescribing sustainability.