Appropriate Use Of Medications Research Articles

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Impact of federal antipsychotic use policy in nursing homes on new diagnoses for approved indications in dementia residents.

Federal policies targeting antipsychotic use among nursing home (NH) residents may have increased reporting of diagnoses for approved uses, including schizophrenia, Tourette's syndrome, and Huntington's Disease (called "exclusionary diagnoses" because they exclude residents from the antipsychotic quality metric). We assessed changes in new exclusionary diagnoses among long-stay NH admissions specifically with dementia following federal policies. Retrospective, quarterly, interrupted time-series analysis (2009-2018) of new long-stay NH residents with dementia and no exclusionary diagnoses reported before NH admission. The National Partnership and the addition of facility level antipsychotic use to the Five Star Quality Rating system were key time exposures. Outcome was quarterly facility level predicted percentage of exclusionary diagnoses within 2 years of admission stratified by NH characteristics. For 264,095 long-stay admissions, mean percentage of new exclusionary diagnoses was 2.2% before the Partnership. After the Partnership, there was an unadjusted increase in the percentage over time (slope change, 0.044, p = 0.018), but the percentage never exceeded 2.9%. The Partnership contributed to a one-time decrease in diagnoses in NHs with an intermediate percentage of Black residents (-1.29%, p = 0.004). Before the Partnership, diagnoses were increasing among not-for-profit relative to for-profit NHs (0.044; p = 0.012), but after the Partnership, the pattern reversed. For-profit NHs saw an increase (+0.034, p = 0.002); not-for-profit NHs experienced a decrease (-0.014, p = 0.039). Quality Rating modifications had no significant effect. Exclusionary diagnosis reporting among long-stay NH residents with dementia, the group most at risk from antipsychotics, did not increase in response to federal policies. Evaluation of reasons for the observed increase in exclusionary diagnoses among non-dementia NH residents is warranted along with continued attention to how to incentivize the appropriate use of medications in residents with dementia that is crucial for high-quality NH care.

Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial.

After traumatic brachial plexus injuries, despite treatment with appropriate medications, some patients experience uncontrollable pain, which can be devastating. Cannabis-based medicine is considered to have pain-relieving benefits in this situation, but the evidence is limited. Is cannabis-based medicine effective compared with the placebo in (1) reducing pain (measured by the VAS for pain) and neuropathic pain (measured by the DN4 questionnaire), and (2) improving sleep quality (measured by the VAS for sleep quality) in patients with traumatic brachial plexus injury? This prospective, triple-blinded (the researcher administering the substance, the patients, and the evaluator were all blinded to the substance used), two-period crossover, placebo-controlled, randomized controlled trial was conducted at a single center. Between January 2020 and January 2022, we treated 147 patients for neuropathic pain related to a traumatic brachial plexus injury. Our inclusion criteria were age between 20 and 60 years and moderate-to-severe pain (VAS for pain equal to or greater than 4 of 10 for more than 6 months), even with the use of appropriate medications. Based on these criteria, 20% (30) of patients were eligible. They were randomly allocated to receive either cannabis-based medicine followed by the placebo or vice versa. Fifteen patients received cannabis-based medicine first, and 15 patients received the placebo first. The groups did not differ at baseline in terms of demographic parameters. Participants received both the cannabis-based medicine and the placebo; they started with 10 days of the initial intervention, followed by a 14-day washout period, and then a 10-day period with the second intervention. The dosage regimen adhered strictly to the protocol. The outcomes were the (1) VAS for pain, which ranges from 0 to 10 and where 0 represents no pain and 10 signifies the worst pain; (2) the DN4 questionnaire which ranges from 1 to 10 and where a score of 4 or higher indicates a positive result for neuropathic pain; and (3) VAS for sleep quality, from 0 (worst) to 10 (best). The minimum clinically important difference of VAS for pain was defined as a 2-point improvement. After enrollment, 7% (2 of 30) of patients (one patient received the cannabis-based medicine first and another received the placebo first) were lost before the minimum study follow-up, leaving 93% (28 of 30) for analysis. With 28 patients in each group, the study was powered a priori at 90% to detect a clinically important difference of 2 points in the VAS for pain. No carryover or period effects were observed in the study. Four patients experienced mild dizziness during the cannabis-based medicine period but were able to continue the intervention. When comparing the use of cannabis-based medicine alongside pain control medications with the combination of placebo and pain control medications, the reduction in pain VAS from the preintervention resulted in a mean difference of 1 (99% CI -0.03 to 2.1; p = 0.01). Neuropathic pain was reported by 75% (21 of 28) of patients in both interventions (OR 1 [99% CI 0.07 to 14.1]; p > 0.99). The VAS for sleep quality favored cannabis-based medicine with a mean difference of 1.5 (99% CI 0.7 to 2.4; p < 0.001). Our study findings indicate that cannabis-based medicine did not improve pain by a clinically important margin. Consequently, our study advises against the addition of cannabis-based medicine to the standard medication treatment for pain in patients with traumatic brachial plexus injury. Level 1, therapeutic study.

Knowledge, attitudes, and practices regarding self-medication for acne among medical students in Beni-Suef University.

To evaluate medical students' knowledge, attitudes, and self-medication practices for acne vulgaris. An analytical cross-sectional study was conducted at Beni-Suef University's Faculty of Medicine from January 2023 to June 2023. A pre-structured questionnaire was used for the study. A total of 297 students (85.1 %) used self-medications for acne without a prescription. The total knowledge score of self-medication among the study participants was 3.81 ± 2.23. About 71.4 % knew about precautions, and 72.7 % of the participants reported that self-medication is part of self-care. There was a statistical significance between the total mean knowledge score and age (p=0.007), gender (p=0.013), and academic year (p=0.001). A significant portion of students self-medicate about acne. The total knowledge score of self-medication was to some extent not relatively high. Educational programs can be developed to increase medical students' awareness of the risks and benefits of self-medication, information on appropriate use of medications, and when to seek medical attention.

Appropriate use of medication among home care adult cancer patients at end of life: a retrospective observational study

BackgroundMedications are commonly used for symptom control in cancer patients at the end of life. This study aimed to evaluate medication utilization among home care palliative patients with cancer at the end of life and assess the appropriateness of these medications.MethodThis retrospective observational study included adult cancer patients who received home care in 2020. Medications taken during the last month of the patient’s life were reviewed and classified into three major categories: potentially avoidable, defined as medications that usually have no place at the end of life because the time to benefit is shorter than life expectancy; medications of uncertain appropriateness, defined as medications that need case-by-case evaluation because they could have a role at the end of life; and potentially appropriate, defined as medications that provide symptomatic relief.ResultsIn our study, we enrolled 353 patients, and 2707 medications were analyzed for appropriateness. Among those, 1712 (63.2%) were classified as potentially appropriate, 755 (27.9%) as potentially avoidable, and 240 (8.9%) as medications with uncertain appropriateness. The most common potentially avoidable medications were medications for peptic ulcers and gastroesophageal reflux disease (30.5%), vitamins (14.6%), beta-blockers (9.8%), anticoagulants (7.9%), oral antidiabetics (5.4%) and insulin products (5.3%). Among the potentially appropriate medications, opioid analgesics were the most frequently utilized medications (19.5%), followed by laxatives (19%), nonopioid analgesics (14.4%), gamma-aminobutyric acid analog analgesics (7.7%) and systemic corticosteroids (6%).ConclusionIn home care cancer patients, approximately one-third of prescribed medications were considered potentially avoidable. Future measures to optimize medication use in this patient population are essential.

Reach and effectiveness of a non-university cardio-obstetrics program

Background Current guidelines recommend multidisciplinary cardiovascular obstetric programs (CVOB) to manage complex pregnant patients with cardiovascular disease. Minimal evaluation of these programs exists, with most of these programs offered at university-based centers. Methods A cohort of 113 patients managed by a CVOB team at a non-university health system (2018–2019) were compared to 338 patients seen by cardiology prior to the program (2016–2017). CVOB patients were matched with comparison patients (controls) on modified World Health Organization (mWHO) category classification, yielding a cohort of 102 CVOB and 102 controls. Results CVOB patients were more ethnically diverse and cardiovascular risk was higher compared to controls based on mWHO ≥ II-III (57% vs 17%) and. After matching, CVOB patients had more cardiology tests during pregnancy (median of 8 tests vs 5, p < .001) and were more likely to receive telemetry care (32% vs 19%, p = .025). The median number of perinatology visits was significantly higher in the CVOB group (8 vs 2, p < .001). Length of stay was a half day longer for vaginal delivery patients in the CVOB group (median 2.66 vs 2.13, p = .006). Conclusion Implementation of a CVOB program resulted in a more diverse patient population than previously referred to cardiology. The CVOB program participants also experienced a higher level of care in terms of increased cardiovascular testing, monitoring, care from specialists, and appropriate use of medications during pregnancy.

EFFECTIVENESS OF BEHAVIORAL COGNITIVE THERAPY ON ANXIETY IN PATIENTS WITH DIABETES MELLITUS

Diabetes mellitus is a chronic disease characterized by high blood glucose levels and disturbances in the metabolism of carbohydrates, fats, and proteins due to insufficient insulin hormone. Anxiety in DM sufferers affects fluctuations in blood glucose which causes unstable blood sugar levels, even though diet, physical exercise, and drug use have been attempted appropriately. DM sufferers have three times the risk of anxiety compared to the general population, diabetes complications can make daily life activities more difficult to carry out, resulting in prolonged sadness. Anxiety in Diabetes Mellitus sufferers affects blood glucose fluctuations which cause unstable blood sugar levels, even though diet, physical exercise and appropriate use of medication have been made. Cognitive behavioral group counseling emphasizes how emotional and behavioral problems can be overcome effectively through cognitive restructuring and shows how irrational beliefs interfere and how they can change inaccurate thoughts with a variety of methods. The purpose of this study was to determine the effectiveness of cognitive behavioral therapy for anxiety in people with diabetes mellitus. Methods To electronic data based Pubmed and Google Scholar with keywords in English and Indonesian, which are published nationally and internationally. This literature study uses The Joanna Briggs Institute guideline is used for assess quality and the Prisma checklist to guide this review. from the search for articles found results that have identified as many as 279 articles with the number of results entered as many as 5 articles. This literature study shows that Cognitive Behavior Therapy for anxiety in patients with diabetes mellitus is effective in reducing anxiety in patients with diabetes mellitus.&#x0D; &#x0D; Keywords: Cognitive Behavior Therapy, Anxiety, Diabetes Mellitus

CARING FOR PATIENTS IN ACUTE CARE LIVING WITH DEMENTIA: WHERE WE ARE AND WHERE WE NEED TO GO

Abstract There are many challenges to caring for older adults living with dementia when hospitalized including medication management, pain identification and management, behavioral symptoms associated with dementia, and sedentary behavior. To help staff, particularly the nurses providing care to these patients, we developed Function Focused Care for Acute Care using the Evidence Integration Triangle (FFC-AC-EIT) to best address increasing physical activity, pain assessment and management, appropriate use of medications and management of behavioral symptoms associated with dementia. FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. The testing of FFC-AC-EIT is ongoing as a cluster randomized controlled trial that to date has included 365 patients from 10 hospitals randomized to FFC-AC-EIT or FFC-AC-Education only. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reason excluding COVID-19, and demonstrating evidence of dementia. This symposium will address the care and changes that occur during the hospital stay for these participants. Specifically, the following areas will be addressed: psychotropic medication use, participation in function focused care, the impact of physical activity on behavioral symptoms associated with dementia, and treatment of pain. The findings can be used to help guide researchers and clinicians in optimal ways to address the common challenges to care of hospitalized patients living with dementia. Presenters will provide information about future work needed to improve care across each of these areas.

Investigation on the accumulation of background and pregnancy outcome information on cases consulted by the Japan Drug Information Institute in Pregnancy.

Since pregnant women are excluded from clinical trials, it is essential to accumulate post-marketing information to evaluate the effects on the fetus of medication use during pregnancy. The Japan Drug Information Institute in Pregnancy (JDIIP) was established at the National Center for Child Health and Development as a Ministry of Health, Labour, and Welfare project to provide patients with information and conduct follow-up surveys. In this study, we investigated the status of the accumulation of JDIIP consultation cases to identify issues for enhancing clinical information appropriate for use during pregnancy and to examine how information should be collected and provided. In addition, the status of descriptions of Japanese package inserts, which are representative of those used by healthcare professionals as a source of information, was confirmed for medications used by JDIIP consultation cases. The characteristics of the JDIIP consultation cases information were that the contents that needed to be adjusted when evaluating the effects on the fetus of medication use during pregnancy were obtained. In addition, the follow-up rate was 83.1%. However, although the number of consultation facilities has increased, the number of consultations has not, indicating the need to further increase the number. It was found that there is limited information on epidemiological studies of clinical use in Japanese package inserts. To improve clinical information on the appropriate use of medications during pregnancy, it is necessary to accumulate more information in the future, and it is considered necessary to consider new approaches utilizing the JDIIP system.

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study.

Nonmedical use of prescription drugs can cause overdose; this represents a serious public health crisis globally. In this digital era, social networking services serve as viable platforms for illegal acquisition of excessive amounts of medications, including prescription medications. In Japan, such illegal drug transactions have been conducted through popular flea market applications, social media, and auction websites, with most of the trades being over-the-counter (OTC) medications. Recently, an emerging unique black market, where individuals trade prescription medications-predominantly nervous system drugs-using a specific keyword ("Okusuri Mogu Mogu"), has emerged on X (formerly Twitter). Hence, these dynamic methods of illicit trading should routinely be monitored to encourage the appropriate use of medications. This study aimed to specify the characteristics of medications traded on X using the search term "Okusuri Mogu Mogu" and analyze individual behaviors associated with X posts, including the types of medications traded and hashtag usage. We conducted a cross-sectional study with publicly available posts on X between September 18 and October 1, 2022. Posts that included the term "Okusuri Mogu Mogu" during this period were scrutinized. Posts were categorized on the basis of their contents: buying, selling, self-administration, heads-up, and others. Among posts categorized as buying, selling, and self-administration, medication names were systematically enumerated and categorized using the Anatomical Therapeutic Chemical (ATC) classification. Additionally, hashtags in all the analyzed posts were counted and classified into 6 categories: medication name, mental disorder, self-harm, buying and selling, community formation, and others. Out of 961 identified posts, 549 were included for analysis. Of these posts, 119 (21.7%) referenced self-administration, and 237 (43.2%; buying: n=67, 12.2%; selling: n=170, 31.0%) referenced transactions. Among these 237 posts, 1041 medication names were mentioned, exhibiting a >5-fold increase from the study in March 2021. Categorization based on the ATC classification predominantly revealed nervous system drugs, representing 82.1% (n=855) of the mentioned medications, consistent with the previous survey. Of note, the diversity of medications has expanded to include medications that have not been approved by the Japanese government. Interestingly, OTC medications were frequently mentioned in self-administration posts (odds ratio 23.6, 95% CI 6.93-80.15). Analysis of hashtags (n=866) revealed efforts to foster community connections among users. This study highlighted the escalating complexity of trading of illegal prescription medication facilitated by X posts. Regulatory measures to enhance public awareness should be considered to prevent illegal transactions, which may ultimately lead to misuse or abuse such as overdose. Along with such pharmacovigilance measures, social approaches that could direct individuals to appropriate medical or psychiatric resources would also be beneficial as our hashtag analysis shed light on the formation of a cohesive or closed community among users.

A study of clinical profile and outcome in children with dilated cardiomyopathy

Background: Objective was to analyse the clinical profile of children diagnosed with Dilated cardiomyopathy and to correlate the same with the severity and functional status on 2-D echocardiography. Methods: It was a prospective, retrospective and observational study. A total of 150 subjects were selected from patients visiting the cardiology OPD, admitted in medical wards, paediatric Intensive Care Unit of a tertiary care referral centre. The demographic profile, symptomatology, heart functions and compliance were recorded. The cases were evaluated by detailed history, general and cardiovascular examination and laboratory investigations along with 2D echocardiography. Results: The demographic profile is significant as the age at diagnosis predicts the risk of mortality with older children having the worst outcome. A significant association observed between decreasing ejection fraction and increasing mortality with a p value (p=0.02). Signs of pedal edema and hepatomegaly are associated with unfavourable outcome with a significant p value of (p=0.03). The overall prognosis of children with Dilated cardiomyopathy steadily improved with timely use of appropriate medications. Only 1 patient in this study had undergone orthotopic heart transplant at the age of 15 years (case of chemotherapy induced Dilated cardiomyopathy). Conclusions: Dilated cardiomyopathy is a difficult entity to treat in children as most cases are idiopathic and the therapy remains mostly supportive. Hypovitaminosis-D and hypocalcemia are common treatable causes of dilated cardiomyopathy in children and must be ruled out in all cases of dilated cardiomyopathy. Patients refractory to medical therapy should be considered for ventricular assist devices and orthotopic heart transplantation.

Evaluation of oral medications in the geriatric medical care ward based on the Guidelines for Appropriate Use of Medications for the Elderly (2018), and an analysis of the number of oral medicines in relation to the nutritional route and activities of daily living (ADL) categories

This study aimed to evaluate the use of potentially inappropriate medications (PIMs) and to examine the number of oral medicines based on the swallowing function and activities of daily living (ADL) categories in a geriatric medical care ward. A prospective investigation of oral medication use of 124 consecutive patients (male, n=58; female, n=66) admitted to a geriatric medical care ward was conducted from November 2019 to October 2020. Nutritional routes and ADL categories were quantitatively assessed, and the respective medication quantities were subjected to a statistical analysis. The average number of oral medications was 5.8 at acute care admission, 4.4 upon transfer to the geriatric medical care ward and 4.8 at discharge. Approximately 30% of oral medications were classified as PIMs, including antithrombotic agents, diuretics, antidiabetic drugs, magnesium oxide, sleep and anxiolytic medications, and antipsychotic drugs. Magnesium oxide, antipsychotic drugs, sleep and anxiolytic medications were frequently discontinued during the patient's stay at the geriatric medical care ward. The proportion of PIMs significantly decreased from 35.1% at admission, to 28.8% at ward transfer, and 24.3% at discharge (P<0.01). The number of oral medicines at discharge varied based on the nutritional route, with averages of 5.5 for oral intake, 3.6 for enteral nutrition, and 0.7 for venous nutrition. It also varied based on ADL categories, with averages of 6.0 for ADL 1, 5.8 for ADL 2, and 3.8 for ADL 3. The use of PIMs decreased in the geriatric medical care ward. A reduced swallowing function and lower ADL were associated with a decrease in the quantity of oral medicines.

Prevalence of Overweight and Obesity, Its Complications, and Progression in a 10-Year Follow-Up in the Gutenberg Health Study (GHS)

Introduction: Overweight and obesity lead to numerous complications and their treatment. The associated costs represent a health and sociopolitical burden. Therefore, the development of overweight and obesity is of great importance for health policy. Methods: The Gutenberg Health Study (GHS), a population-based observational study of individuals aged 35–74 years in the city of Mainz and the district of Mainz-Bingen, examined current data on the prevalence and development of overweight and obesity and their association with concomitant diseases and medication use. Results: Among men, 48.1% were overweight and 26.3% had obesity. Among women, these proportions were 32.1% and 24.1%, respectively. Elevated body mass index (BMI) was associated with numerous complications, particularly insulin resistance and type 2 diabetes, arterial hypertension, elevated triglycerides and low HDL cholesterol, and cardiovascular disease. Accordingly, medications to treat these conditions were used significantly more often in individuals with elevated BMI. During the 10-year observation period, mean weight increased in the population. Both men and women had a moderate but significant increase in BMI compared to men and women of the same age at baseline. Individual weight changes over the 10-year observation period, on the other hand, were age-dependent. In the two younger age decades, weight gain was observed, while in the oldest age decade, mean body weight decreased. Conclusion: These current data confirm that overweight and obesity are associated with relevant complications and that these complications lead to significant use of appropriate medications. The study also suggests that there is a significant trend toward increased prevalence of obesity (BMI ≥30) over the 10-year period.

Descriptive survey of pharmacy students’ self-evaluation of Advanced Pharmacy Practice Experiences (APPE) and practice readiness using entrustable professional activities

Objective: To evaluate pharmacy students’ self-identified levels of entrustability before and after their advanced pharmacy practice experiences (APPE). Methods: Third and fourth-year pharmacy students completed a Qualtrics survey where they were asked to self-identify their entrustability level (scale of I–V) on each of the fifteen core entrustable professional activities (EPAs) for pharmacy graduates. Results: A total of 249 third-year students completed the APPE-readiness survey in the Fall of 2017–2019, and 106 fourth-year students completed the practice-readiness survey in the Spring of 2018. The highest entrustability level in both surveys was “create a written plan for continuous professional development”. The lowest reported entrustability levels in both surveys were: “Oversee the pharmacy operations…”, “Maximise the appropriate use of medications…,” and “Establish patient-centred goals and create a plan…”. The largest area of change from pre-APPE to post-APPE was overseeing pharmacy operations, with an increase of 26%. The average pre-APPE entrustment level was 3.72, increasing to 4.2 in the practice readiness portion. The percentage of students self-reporting below an entrustment level of 3 in the practice-readiness survey ranged from 0–0.99%. Conclusion: Pharmacy students increased their self-reported level of entrustability over all 15 EPA domains from pre-APPE to post-APPE year.

A Study of Drug Use in the Outpatient Pediatric Department of a Tertiary Care Hospital in Jammu and Kashmir

BACKGROUND&#x0D; The health care system around the world is concerned about rational drug use. To achieve this goal, the more vulnerable pediatric population necessitates additional attention. The study's objectives were to determine the most prevalent diseases and medications administered, as per WHO recommendations, by looking at prescription trends and the ailments for which they were prescribed.&#x0D; Objective&#x0D; The objective of this study was to find drug use in the outpatient pediatric department of a tertiary care hospital in Jammu and Kashmir.&#x0D; METHODS&#x0D; This four-month prospective study was undertaken in the paediatrics department of a tertiary care hospital in Jammu and Kashmir. The Institutional Ethical Committee gave its nod to the investigation, which was then carried out. The parent's or guardian's consent was obtained after discussion and explanation. The patient's and the prescriber's privacy were protected. Every pediatric prescription (from newborn to 12 years old) from the outpatient, inpatient, and critical care units was included in the research.&#x0D; RESULTS&#x0D; There were 498 prescriptions in total that were randomly collected and studied. There were a total of 1895 prescriptions, with an average of 4.01 per encounter. Prescriptions from the WHO's essential drug list (666) accounted for 35.14 percent of all prescriptions. There were 397 prescriptions written for antibiotics in total. A total of 79.72 percent of patient encounters involved an antibiotic prescription. The prescribed injections were used in 26.2% of the encounters.&#x0D; CONCLUSION&#x0D; With all the indicators, this study gives a positive outlook on drug use, especially for those on the EDL (Essential Drug List). It is possible to improve health care through regular auditing, continuous medical education, and evidence-based medicine (EBM). Drug prescribing patterns in a pediatric outpatient department have been analyzed in this research. To summarize, the role of the clinical pharmacist is critical in pediatrics, both as an integral part of the care team and in clearing up any confusion about the appropriate use of medications. As a pediatric patient, proper drug management is even more critical than for an adult. The prescribing patterns were improved, substantial issues with patients' or caretakers' grasp of consultant instructions were found, and even the financial burden on the patient was lessened with the aid of the WHO core indicators.

An evaluation of the Australian Community Pharmacy Agreement from a public policy perspective: industry policy cloaked as health policy?

BackgroundA series of Community Pharmacy Agreements (Agreements) between the Federal government and a pharmacy-owners’ body, the Pharmacy Guild of Australia (PGA) have been influential policy in Australian community pharmacy (CP) since 1990. While ostensibly to support the public’s access and use of medicines, the core elements of the Agreements have been remuneration for dispensing and rules that limit the establishment of new pharmacies. Criticism has focused on the self-interest of pharmacy owners, the exclusion of other pharmacy stakeholders from the Agreement negotiations, the lack of transparency, and the impact on competition. The objective of this paper is to determine the true nature of the policy by examining the evolution of the CPA from a policy theory perspective.MethodsA qualitative evaluation of all seven Agreement documents and their impact was undertaken using policy theories including a linear policy development model, Multiple Streams Framework, Incremental Theory, the Advocacy Coalition Framework, the Theory of Economic Regulation, the Punctuated Equilibrium Framework, and Elite Theory. The Agreements were evaluated using four lenses: their objectives, evidentiary base, stakeholders and beneficiaries.ResultsThe PGA has acted as an elite organisation with long-standing influence on the policy’s development and implementation. Notable has been the failure of other pharmacy stakeholders to establish broad-based advocacy coalitions in order to influence the Agreements. The incremental changes negotiated every 5 years to the core elements of the Agreements have supported the publics’ access to medication, provided stability for the government, and security for existing pharmacy owners. Their impact on the evolution of pharmacists’ scope of practice and through that, on the public’s safe and appropriate use of medication, has been less clear.ConclusionsThe Agreements can be characterised predominantly as industry policy benefiting pharmacy owners, rather than health policy. An emerging issue is whether incremental change will continue to be an adequate policy response to the social, political, and technological changes that are affecting health care, or whether policy disruption is likely to arise.

Requirement for Discharge in the Care of a Responsible Adult in Procedural Sedation in the Emergency Department: Necessity or Potential Barrier to Health Equity?

BackgroundProcedural sedation is commonly practiced by emergency physicians to facilitate patient care in the emergency department (ED). Although various guidelines have modernized our approach to procedural sedation, many procedural sedation guidelines and practices still often require that patients be discharged into the care of a responsible adult. DiscussionSuch requirement for discharge often cannot be met by underserved and undomiciled patients. Benzodiazepines, opioids, propofol, ketamine, “ketofol,” etomidate, and methohexital have all been utilized for procedural sedation in the ED. For patients who may require discharge without the presence of an accompanying responsible adult, ketamine, propofol, methohexital, “ketofol,” and etomidate are ideal agents for procedural sedation given rapid onsets, short durations of action, and rapid recovery times in patients without renal or hepatic impairment. Proper pre- and postprocedure protocols should be utilized when performing procedural sedation to ensure patient safety. Through the use of appropriate medications and observation protocols, patients can safely be discharged 2 to 4 h postprocedure. ConclusionThere is no pharmacodynamic or pharmacokinetic basis to require discharge in the care of a responsible adult after procedural sedation. Thoughtful medication selection and the use of evidence-based pre- and postprocedure protocols in the ED can help circumvent this requirement, which likely disproportionally impacts patients who are of low socioeconomic status or undomiciled.

The Success of a New Protocol for Early Diagnosis and Management of Congenital Atrioventricular Block: A Follow-up Study of 15 Fetuses from November 2007 to August 2022

Background: Congenital atrioventricular heart block (CAVB) is a relatively rare condition that can lead to long-term complications. Early diagnosis and management of CAVB is currently the ideal goal, particularly in high-risk pregnancies. Methods: The Fetal Heart Center at Kurdistan University serves as the primary referral center for pregnant mothers residing in the western region of Iran. Fifteen fetuses with CAVB were admitted between November 2007 and August 2022. They were referred for one or more of the following reasons: Fetal bradycardia or arrhythmia, abnormal ultrasound findings, and previous maternal or fetal risk factors. After obtaining a complete medical history, we conducted fetal echocardiography and ordered testing for maternal Lo/Ra autoantibodies. Our therapeutic approach was based on the type of atrioventricular block (AVB), serum titer of Lo/Ra antibodies, and specific risk factors associated with each type of AVB. Consequently, we used a combination of different medications, including dexamethasone, Hydroxychloroquine (HCQ), IVIG, beta-agonists, and inotropes. Results: We admitted 15 fetuses with CAVB, including seven females (47%) and eight males (53%). Most of our cases had positive tests for Lo and Ra autoantibodies, with varying degrees of AVB. A previous fetal death was common in our case series, accounting for 47% of cases. Moderate and high antibody titers were present in 80% of our cases. Mild bradycardia was a relatively common finding in our cases of first and second-degree atrioventricular block (AVB), occurring in 33% of patients. All of the above-mentioned findings, commonly referred to as major risk factors, were used for either early evaluation or therapeutic goals. No cases with first-degree AVB developed a higher grade of AVB after our therapeutic approach. One fetus with second-degree AVB developed CCHB, and another with mixed second/third-degree AVB reverted to second-degree AVB with the use of appropriate medications. Conclusions: Our therapeutic approach for the current cases yielded satisfactory results. Subsequently, we attempted to develop a rudimentary approach for early managing and treating fetuses with various types of CAVB. We are looking forward to future multicenter studies.

Immunoglobulin A nephropathy in remission: a case report.

A 33-year-old military male presented with complaints of fever, headache, myalgia, chills, and haematuria for 10 years. His lab results showed elevated serum creatinine levels and proteinuria. A renal biopsy was done which was consistent with a diagnosis of immunoglobulin A nephropathy. He was managed with antihypertensive, including angiotensin-converting enzyme inhibitors, steroids and immunosuppressants, and Omega-3 fatty acids. There was remission of the symptoms and the patient's serum creatinine and sonogram findings returned to baseline. Routine follow-up along with the appropriate use of medications can limit disease complications and progression.

EPH98 Cutaneous Adverse Drug Reactions of COVID-19 Vaccines: A Cross-Sectional Study of the Largest Healthcare System in Taiwan

Potential cutaneous adverse drug reactions (cADRs) associated with COVID-19 vaccinations are well-known. However, comprehensive evaluation including detailed patient characteristics, vaccine types, signs and symptoms, treatments and outcomes from such cADRs are still lacking in Taiwan. A cross-sectional study was conducted from December 2019 to October 2022 to analyze spontaneous ADR reporting data from Taiwan’s largest multi-institutional healthcare system. Physicians and pharmacists initially ensured the data quality and completeness of the reported ADR records. Subsequently, we applied descriptive statistics to analyze the patient cohort based on demographic characteristics, administered COVID-19 vaccines, clinical manifestations, and patient management. We identified 242 cADRs from 759 reported COVID-19 vaccine-related ADRs, 88.3% of which were judged as “possible” using the Naranjo Scale. The mean age of patients with cADRs was 48.1±17.5 years, with the majority (44.2%) of cADRs reported in the 40-64yr old age group. cADRs were more common in women (68.2%) and most of the patients had no history of allergy to vaccines (99.6%). Oxford/AstraZeneca (58.6%) accounted for the most reported brand of COVID-19 vaccines. Patients developed cADRs within 1 to 198 days (median = 5.5 days), and mostly after first-dose vaccination (77.8%). The most frequently reported cADR was rash/eruption (18.7%), followed by itchiness/pruritus (11.7%) and urticaria (9.2%), mainly affecting the lower limbs (23.8%) and upper limbs (22.6%). Medications were prescribed for 65.1% of the cADRs, and signs and symptoms were resolved within 1 to 167 days (median = 7 days) after treatment with oral antihistamines (23.0%), topical corticosteroids (14.6%) or oral corticosteroids (14.4%). Our findings provide comprehensive details regarding COVID-19 vaccine-related cADRs in Taiwan. Certain groups, especially women and the middle-aged, who reported a relatively higher rate of cADRs, may benefit from pre-vaccination counseling about the risks of cADRs and the use of appropriate medications.