Average Number Of Pills Research Articles

Usability and effectiveness of adherence monitoring of a mobile app designed to monitor and improve adherence to event-driven and daily HIV pre-exposure prophylaxis among men who have sex with men in Taiwan.

ObjectiveThe UPrEPU mobile app is a self-monitoring system to enable men who have sex with men to optimize their pre-exposure prophylaxis adherence for HIV prevention. The app was designed to accommodate a rather complicated event-driven dosing schedule. We aim to evaluate the usability of the UPrEPU app and its effectiveness in improving adherence monitoring.MethodsFrom May to October 2020, 35 participants were enrolled for the usability study and followed up for 4 months. Blood samples for the drug concentration in the dried blood spots were obtained once during the second to fourth follow-up visits. The effectiveness of adherence monitoring was analyzed using Cohen's kappa statistic to calculate the concordance between the average number of pills taken and drug concentration in the dried blood spots.ResultsOverall retention was 91.4% (32 participants) at the end of the study. Participants used the app for a mean of 29 days and made 2565 data entries in total, with an average of 76 data entries. The average systematic usability scale score for the app was 71.5, indicating acceptable usability. Slight agreement was reached between the dried blood spots measurement and the number of pills taken and recorded in the app (weighted kappa: 0.21).ConclusionsOur user-centered UPrEPU app demonstrated that it could accommodate both daily and event-driven dosing schedules for men who have sex with men clients with acceptable usability scores. We confirmed that complex behaviors such as different drug-dosing regimens that are contingent on sexual behaviors could be incorporated into the design of a mobile app.

System-wide opioid prescription reduction after shoulder arthroplasty

BackgroundThe nonmedical use of prescription opioids is currently one of the greatest public health issues. This phenomenon was largely driven by the increase in opioid prescriptions in the past few decades. Across specialties, orthopedic surgeons are among the highest prescribers of opioids for pain control. To help individual physicians within healthcare systems adopt and maintain safe prescribing habits, system-wide policies and guidance are needed. The purpose of this study was to determine if the implementation of system-wide changes in prescription practices could result in overall reductions in opioid prescriptions after shoulder arthroplasty. MethodsAn ecological study of opioid prescriptions after shoulder arthroplasty from Q1 2016 to Q3 2018 in a closed healthcare system was conducted. The number of pills and morphine milligram equivalents (MMEs) prescribed in the 28 days immediately after surgery were collected for each patient. A multipronged systemic opioid reduction strategy was adopted over this period, which included (1) an elimination of historical physician prescribing presets in the electronic medical record, (2) a new limitation to a maximum of 20 pills per preset prescription, (3) consistent education and leadership reminders of opioid stewardship using emails, and (4) overlay of a state-mandated prescribing physician review of historical use of controlled substance use in individual patients. Univariable linear regressions were used to determine the trend in average number of pills and MMEs prescribed over the study period, and independent sample Student t-tests were used to compare prescriptions in Q1 2016 to those in Q3 2018. ResultsOver the study period, there were 872 shoulder arthroplasties performed on 840 patients. Univariable linear regression demonstrated a decrease of an average of 1.96 pills (P < .001) and 2.67 MMEs (P < .001) for each progressive quarter. The number of pills prescribed in the first 28 days after surgery decreased 18.7% from an average of 86.1 pills in Q1 2016 to 67.4 pills in Q3 2018 (P < .001). MMEs decreased 24.1% from an average of 103.3 MMEs in Q1 2016 to 78.3 MMEs in Q3 2018 (P < .001). ConclusionThis study demonstrates that it is possible to systematically reduce opioid prescriptions after shoulder arthroplasty using electronic health record changes coupled with physician guidance and state-mandated review. Although opioid needs for pain control vary per patient, system-wide policies can meaningfully reduce opioid prescriptions and help to maintain safe prescribing habits. Level of evidenceLevel III, Retrospective Cohort Designm Prognostic Study

Opiate prescribing patterns in the adolescent population following anterior cruciate ligament reconstruction.

We sought to determine prescribing patterns for opioid analgesia following anterior cruciate ligament (ACL) reconstruction among age- and gender-stratified adolescents in a nationally representative database. A retrospective study. PearlDiver Patient Records. Outpatient opioid claims within 30 days of surgery were extracted. The patients were defined into age groups 10-14 ("younger") and 15-19 ("older"). A total of 1,139 patients were included in this study (536 female and 603 males) with 108 patients in the 10-14 age category and 1,034 patients in the 15-19 category. The primary study outcome measures the average number of opioid pills administered, average total morphine milligram equivalents (MMEs) prescribed, and the average prescription strength (MMEs/pill). No difference was found in the average number of pills (p = 0.26) or normalized total MMEs (p = 0.312) prescribed by age group. Normalized total morphine equivalents per prescription was significantly lower in females than males (p = 0.005). Multivariate linear regression analysis demonstrated that increasing patient age was predictive of fewer total pills (p = 0.017), after accounting for gender. There are age- and gender-based disparities in prescription patterns for adolescent ACL reconstruction. Our findings indicate that patients in the older age group on average received fewer pills than the younger age group, which consequently trended toward receiving higher total MMEs prescribed. This suggests that surgeons may be inadvertently overprescribing in the younger cohort. Additional studies that account for concurrent factors should be conducted to observe potentially similar trends.

Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial.

ABSTRACTMounting evidence implicates bariatric surgery as a cause of increased skeletal fragility and fracture risk. Bisphosphonate therapy reduces osteoporotic fracture risk and may be effective in minimizing bone loss associated with bariatric surgery. The main objective of this pilot randomized controlled trial (RCT; Clinical Trial No. NCT03411902) was to determine the feasibility of recruiting, treating, and following 24 older patients who had undergone sleeve gastrectomy in a 6 month RCT examining the efficacy of 150‐mg once‐monthly risedronate (versus placebo) in the prevention of surgical weight‐loss–associated bone loss. Feasibility was defined as: (i) >30% recruitment yield, (ii) >80% retention, (iii) >80% pills taken, (iv) <20% adverse events (AEs), and (v) >80% participant satisfaction. Study recruitment occurred over 17 months. Seventy participants were referred, with 24 randomized (34% yield) to risedronate (n = 11) or placebo (n = 13). Average age was 56 ± 7 years, 83% were female (63% postmenopausal), and 21% were black. The risedronate group had a higher baseline BMI than the placebo group (48.1 ± 7.2 versus 41.9 ± 3.8 kg/m2). The 10‐year fracture risk was low (6.0% major osteoporotic fracture, 0.4% hip fracture); however, three individuals (12.5%, all risedronate group) were osteopenic at baseline. Twenty‐one participants returned for 6‐month follow‐up testing (88% retention) with all (n = 3) loss to follow‐up occurring in the risedronate group. Average number of pills taken among completers was 5.9 ± 0.4 and 6.0 ± 0.0 in the risedronate and placebo groups, respectively (p = 0.21), with active participants taking >80% of allotted pills. Five AEs (3.7% AE rate) were reported; one definitely related, four not related, and none serious. All participants reported high satisfaction with participation in the study. Use of bisphosphonates as a novel therapeutic to preserve bone density in patients who had undergone a sleeve gastrectomy appears feasible and well‐tolerated. Knowledge gained from this pilot RCT will be used to inform the design of an appropriately powered trial.Clinical Trial Registration http://clinicaltrials.gov/show/NCT03411902. Weight Loss With Risedronate for Bone Health. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law

Category:Ankle, TraumaIntroduction/Purpose:The use of prescription opioids has risen sharply over the last few decades as pain management has become increasingly recognized as an essential aspect of patient care. In August 2017, Ohio implemented a law limiting the quantity of opioid medications a provider could prescribe for the treatment of acute pain. Specifically, a prescriber may not prescribe more than 7 days of opioids in the first prescription for an acute pain episode and the total morphine equivalent dose (MED) cannot exceed an average of 30 MEDs a day. The purpose of this study is to report patterns of opioid prescription for patients treated operatively for ankle fractures after implementation of the 2017 Ohio Opioid Prescriber Law in comparison to the previous year.Methods:A total of 152 patients operatively treated for isolated ankle fractures during two six-month periods, January 2017 to July 2017 (n=73) and January 2018 to July 2018 (n=79), were retrospectively identified using CPT codes. The earlier time period includes patients treated before implementation of the Ohio Opioid Prescriber Law, and the later time period represents patients treated after implementation of the law. Preoperative and postoperative patient narcotic use was reviewed using a legal prescriber database. The prescription search was limited to prescriptions prescribed within one year prior to surgery and 6 months postoperatively. Total number of prescriptions, quantity of pills, and milligrams of morphine per patient prescribed during the 90- day postoperative period were compared between those treated before and those treated after implementation of the law. Average number of pills and average milligrams per morphine per prescription were also compared. Statistical analysis was conducted using t-tests and fisher exact tests.Results:The average number of opioid prescriptions prescribed per patient in the 90-day postoperative period was 2.3 in the pre-law group and 1.95 in the post-law group (p=0.35). The average milligrams of morphine prescribed per patient dropped from 942.41 mg pre-law to 645.25 mg post-law (p=0.18). Differences in the average number of pills per prescription pre- and post-law (49.72 vs. 36.06) and average milligrams of morphine per prescription (383.11 mg vs. 277.56 mg) were statistically significant (p=0.002 and p=0.014, respectively). Differences in age, gender, Charlson Comorbidity Index, BMI, preoperative narcotic use, and postoperative narcotic use exceeding 90 days were not statistically significant between groups (p>0.05).Conclusion:Following the implementation of the 2017 Ohio Opioid Prescriber Law, there was a significant decline in the number of pills per prescription and milligrams of morphine per prescription in patients operatively treated for isolated ankle fractures. The presence of a downward trend in the quantity of opioids prescribed in this patient cohort suggests the effectiveness of the state prescriber law and is promising in the setting of the current opioid epidemic in the United States.

Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law.

Background:The purpose of this study was to report patterns of opioid prescription for patients treated operatively for ankle fractures after implementation of the 2017 Ohio Opioid Prescriber Law in comparison to the previous year.Methods:A total of 144 patients operatively treated for isolated ankle fractures during two 6-month periods, January 2017 to July 2017 (pre-law) and January 2018 to July 2018 (post-law), were retrospectively identified. Preoperative and postoperative patient narcotic use was reviewed using a legal prescriber database. Total number of prescriptions, quantity of pills, and morphine milligram equivalents (MMEs) per patient prescribed during the 90-day postoperative period were compared between those treated before and those treated after implementation of the Ohio prescriber law.Results:The average number of opioid prescriptions prescribed per patient in the 90-day postoperative period was 2.3 in the pre-law group and 2.1 in the post-law group (P = .625). The average MMEs prescribed per patient dropped from 942.4 MME pre-law to 700.5 MME post-law (P = .295). Differences in the average number of pills per prescription pre- and post-law (49.7 vs 36.2) and average MME per prescription (382.1 mg vs 275.2 mg) were statistically significant (P < .001 and P = .016, respectively).Conclusion:Following the implementation of the 2017 Ohio Opioid Prescriber Law, there was a downward trend in the number of pills per prescription and MMEs per prescription in patients operatively treated for isolated ankle fractures. The presence of a downward trend in the quantity of opioids prescribed in this patient cohort suggests the effectiveness of the state law.Level of Evidence:Level III, comparative study.

The Annual Direct and Indirect Health Care Costs for Patients with Chronic Pruritus and their Determining Factors

The Annual Direct and Indirect Health Care Costs for Patients with Chronic Pruritus and their Determining Factors

Analysis of Pill Box Geometrical Shapes for Kinetics and Pilling of Textile Materials

Abstract Pill boxes with various geometrical shapes, such as triangular, cubical, hexagonal, octagonal, and cylindrical shapes, have been theoretically analyzed for their kinetics and compared with the experimental trials using cotton, viscose, linen, polyester/cotton (P/C) (80/20), P/C (65/35), and polyester/viscose (P/V) (70/30) woven fabrics for pilling behavior. Theoretical analysis revealed that as the number of polygon sides increases, the total sample tube movement increases, which leads to continuous motion; however, in the cylindrical box, the single impact force decreases, while the total impact force of the sample remains the same. As the sliding angle increases, an increase in the total impact force and tube travel time at a decreasing rate is observed; the sliding angle is the inclination angle of the polygon side at which the sample tube starts moving horizontally. Experimental trials have revealed that the hexagonal box is more efficient in the pilling of textiles than the other boxes. These trials have also shown the average pills/in2 to be 3.2, 4.3, 2.7, 4.3, 2.8, and 2.4 for cotton, viscose, P/C (80/20), P/C (65/35), P/V (70/30), and linen, respectively, with the total average number of pills for all materials being 79. Various mechanisms and statistical analyses have been attributed. The overall ranking of the pill boxes has shown that the order of pilling is hexagonal, cubical, octagonal, triangular, and cylindrical.

Clinical Outcomes Following the Use of Archived HIV-1 DNA Sequencing to Guide Antiretroviral Therapy Regimen Adjustment and Simplification

Abstract Background While favorable new antiretroviral therapy (ART) options are available for HIV disease, the Department of Health and Human Services guidelines recommend against switching suppressive regimens unless there is evidence that the new regimen will be fully active. A new assay analyzes archived HIV pro-viral DNA and can detect resistance mutations when HIV RNA is below the limit of detection, when standard genotyping (GT) is not possible. Small studies have correlated archived DNA GT to historical plasma RNA GT, but there is minimal available data on treatment outcomes when using this assay to determine antiretroviral therapy switch strategies. We evaluated clinical outcomes following ART adjustment based upon results of archived DNA GT testing. Methods A retrospective review of electronic medical records was performed at our medical center from October 2014 to October 2016. Inclusion criteria included age ≥ 18 years, archived DNA GT result available, ART changed after archived GT result, and follow up HIV RNA available after ART switch. Data was collected prior to and after ART switching. McNemar’s test was used for categorical variables and paired t-test for continuous variables. Results A total of 38 patients were included. Most patients were male (89%), Caucasian (66%), had a history of AIDS diagnosis (45%), had HIV for &amp;gt;10 years (74%), and had baseline ART resistance (24% resistant to 1 class, 37% resistant to ≥ 2 classes). Median baseline CD4 was 532 cells/mm3. At baseline, 31 (82%) patients had HIV RNA &amp;lt; 50 copies/mL. Compared with baseline, 35 (92%) patients were undetectable at furthest follow up (P = 0.22). Median time to furthest follow up was 146.5 days (range 12–485). Overall, 36 (95%) patients had at least one undetectable HIV RNA after switching. None of the patients with an initial undetectable HIV RNA became detectable after switching ART. Average number of pills per day and administrations per day decreased from 3.84 to 1.97 (P &amp;lt; 0.001) and 1.47 to 1.05 (P &amp;lt; 0.001) respectively. The number of patients on protease inhibitors (PIs) decreased from 66% to 21% (P &amp;lt; 0.001). Conclusion The use of archived DNA GT to guide ART adjustment may result in maintained viral suppression while allowing for regimens with optimized long-term safety and decreased pill burden. Disclosures All authors: No reported disclosures.

Content Analysis of Single-dose Analgesics Dispensed by Attendants in Retail Drug Outlets in Obiaruku ,Delta State , Nigeria : A Surrogate-type Approach

Abstract&#x0D; &#x0D; Background&#x0D; Medicines can be potentially dangerous when used wrongly. This work examined drug combinations in pain management among attendants in retail drug outlets in Obiaruku, Delta State, Nigeria. &#x0D; Objectives&#x0D; The objective of this study was to describe drug combination in the management of pains by attendants working in community pharmacies and patent medicine shops (PMSs) &#x0D; Method &#x0D; This was a cross-sectional descriptive study using the ‘’surrogate shopper’’ approach to explore the real day-to-day practices and extract required information in twelve retail drug outlets located in the study area. Conversations were tape recorded and thereafter composition of single doses of pain relievers recommended by attendants were analyzed.&#x0D; Results&#x0D; A total of 12 retail outlets were visited. The average number of pills contained in a single dose pain reliever was 6.80±2.35 (for pharmacy outlets) and 5.33±1.32 (for PMSs), p&gt;0.05. Piroxicam (14, 73.7%) was most frequently used NSAID. More than half, 63.2% of the attendants included single tablet of Prednisolone, 5mg in their pain relief combination. Other drugs not indicated for analgesia were included in the single dose combo. This includes Vitamin B complex (2, 10.5%), cod liver oil, Sulfadoxine – pyrimetamine (1, 5.3%), Salbutamol and Ferrous sulphate (1, 5.3%) and multivitamin (12, 63.2%).There was no significant difference in pain management practices between Pharmacies and Patent medicine stores (PMSs) (p&gt;0.05).&#x0D; Conclusion&#x0D; Polypharmacy and irrational use of NSAIDs was a common practice among shop attendants in retail drug outlets, resulting in avoidable drug therapy problems and posing serious risk to public health.

Effect of an emergency department opioid prescription policy on prescribing patterns

BackgroundStaten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here. MethodsA retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed. Dates chosen for analysis was November 1, 2012 through January 31, 2013 and November 1, 2013 through January 31, 2014; these time periods were used to serve as a seasonally comparative group pre and post clinical practice policy implementation. Opioids written for the treatment of cough, and for children under eighteen were excluded from analysis. Patient age, sex, diagnoses, and prescription formulation, strength, and pill number was recorded for each patient receiving an opioid prescription. ResultsThere was a drop in the total prescriptions from 1756 to 1128 without a change in the average number of pills (12.78 vs 12.44) or average total dose prescribed (69.39 vs 68.98) mg of morphine equivalent per prescription. Additionally, there were sizable reductions in opioid prescriptions written for arthralgias/myalgias, dental pain, soft tissue injuries, and headaches. ConclusionThe opioid clinical policy had a clear effect in decreasing the number of patients prescribed opioids. Such policies may be the key to reducing the epidemic and saving lives from unintentional opioid overdoses.

Opioid Prescriptions by Specialty in Ohio, 2010-2014.

The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532 mg, N = 1,680,579), anesthesiology/pain (89.3 pills, 1,484 mg, N = 3,261,449), hematology/oncology (88.2 pills, 1,534 mg, N = 516,596), and neurology (84.4 pills, 1,230 mg, N = 573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone.

PMH49 - The Economic Consequences of the use of Antidepressants in Belgium

Antidepressants use is increasing worldwide but is particularly high in Belgium compared to other EU countries whereas suicide-rates in Belgium are among the highest. This could reflect misuse of antidepressants resulting in an important economic burden. The former is part of a separate abstract. The aim here was to evaluate potential savings that could be realized in case prescriptions behavior in Belgium would be similar to neighbor countries. Current spending levels for antidepressants and mood stabilizer prescriptions were determined in Belgium, France and the Netherlands. Volume and value sales were determined per country (average number of pills sold/capita) based on IMS Health Belgian National Retail Database available to IMS Health in both countries via the IMS MIDAS platform (2013 data). The potential country-level prescription cost in Belgium was estimated by multiplying average number of pills/person in France and the Netherlands, with the cost/pill in Belgium and extrapolating the result to the total population in Belgium, assuming that prescribing levels in Belgium were equal to those in France and the Netherlands and using Belgian prices. In Belgium the number of pills per capita is respectively 45% and 48% higher compared to France and the Netherlands (34.17 vs. 23.62 vs. 23.15 pills/person). With a 30% smaller population than the Netherlands, spending in Belgium is 4 times higher. In France, having a 6 times larger population compared to Belgium, spending is only 3 times higher. The estimated savings for the Belgian payer applying the usage (pill/person) of respectively France and the Netherlands and current cost/pill in Belgium were €67 and €70 Mn, meaning around 30% of current spending in Belgium. By comparing Belgium’s prescription patterns to France and the Netherlands, we estimated important potential savings due to antidepressant mis-use/over-use that could be re-invested in for example mental health prevention.

Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area

BackgroundMalaria chemoprophylaxis compliance is suboptimal among French soldiers despite the availability of free malaria chemoprophylaxis and repeated health education before, during and after deployment to malaria endemic areas.MethodsIn 2007, a randomized controlled study was performed among a cohort of French soldiers returning from Côte d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Malaria chemoprophylaxis consisted of a daily dose of 100 mg doxycycline monohydrate, which began upon arrival in Côte d'Ivoire and was to be continued for 28 days following return to France. Feasibility and acceptability were assessed by questionnaire. Cohort members were followed for a 28 day period, with compliance assessed by use of an electronic medication monitoring device, from which several indicators were developed: daily proportion of compliant individuals, average number of pills taken, and early discontinuation.ResultsAmong 424 volunteers randomized to the study, 47.6% were assigned to the SMS group and 52.3% to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators.ConclusionSMS did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. So the reminder by SMS was noted by all subjects of the study. Another study should be done to confirm these results on soldiers going on holidays from employment after return or with individual travellers.

Incidence of Polypharmacy in a Long‐Term Care Facility

The incidence of polypharmacy was investigated in a 200-bed long-term care facility. One hundred residents were drawn at random for the study. The average number of drugs prescribed per patient was 3.33, and the average number of pills was 6.34 daily. The most frequently prescribed drugs were the analgesics, followed in order by antihypertensive agents, cardiotonic preparations and antimicrobials. The literature is reviewed with respect to the incidence, causes and end-results of polypharmacy. It is recommended that long-term care facilities develop enlightened and aggressive pharmacy committees to monitor and evaluate drug use routinely in an institutional setting.