Prescribing Research Articles

Prescription of commonly used drugs in patients with functional bowel disorders. A cross-sectional comparison with the general population.

Comorbidity with other conditions is common in functional bowel disorders. We aimed to investigate the prescription patterns of commonly used drugs in patients with irritable bowel syndrome (IBS) and functional unspecific bowel disorder, compared to the general population. Prescriptions of commonly used drugs in 2022 were compared between patients and the general population from the same age group and region in Sweden. Of 526 patients, 317 were followed up in 2022 (219 women and 98 men) and were compared to 51,001 women and 55,571 men in the general population. The median follow-up time from the first visit to 2022 was 8 years (25th-75th percentile 6-11 years). Female patients were significantly more likely than controls to be prescribed PPIs, antibiotics, NSAIDs, paracetamol, opioids, muscle relaxants, antimigraine drugs, antidepressants and asthma medications. Male patients were significantly more likely than controls to be prescribed PPIs, opioids, antidepressants, and asthma medications. In the year prior diagnosis and through 2022, female patients showed a significant decline in the use of PPIs (38% vs.10%; p < 0.001), antibiotics (27.5% vs. 20.1%; p = 0.0426), NSAIDs (23.3% vs.14.6%; p = 0.012), opioids (20.6% vs. 7.5%; p < 0.001), and a significantly increase in the use of asthma medications (15.5% vs. 24.2%; p = 0.0088). Male patients showed a significant decline in the use of PPIs and NSAIDs. Patients with functional bowel disorders are more likely to be prescribed medications for conditions other than IBS. Over time, there was a decline in the prescriptions of most drugs, except for antidepressants and asthma medications.

Many strategies enabling us to optimize kidney care may also be planet-friendly.

Kidney replacement therapy (KRT) is one of the most energy-consuming and waste-producing medical treatments. Reducing the need of dialysis is therefore an environmentally friendly choice. However, preferring prevention, lifestyle-related interventions and patient education to drugs is time consuming and most physicians are already overburdened by the many demands of routine clinical practice. In this mini review, we discuss the role that could be played by prevention, diet and non-pharmacological interventions in reducing the impact of care of chronic kidney disease and KRT. Although evaluating the environmental impact of CKD and KRT is extremely complicated, the need for rethinking all the steps in current nephrology practice to preserve our planet's health is urgent, and shifting from a "drug prescription" model to a "time prescription" one would benefit both our patients and the environment.

Suspected Stonefish Envenomation in Reunion Island: 15 Years Later.

Although marine envenomations are a reason for consultation in tropical emergency departments, stonefish stings are particularly feared. Immediate management focuses on pain control, whereas late management addresses cutaneous complications. This study presents a new series and compares the management of these patients and their outcomes at our center over the past 20 years. This study presents a new series of 53 patients treated between 2016 and 2020 at the South Hospital of the University Hospital Center of Réunion following a sting attributed to the stonefish. We compared this new series with a previous series of patients treated at the same center for the same reason between 2001 and 2005. The series are comparable. Regarding early management, the use of regional anesthesia was more frequent (47 vs 3.5%). Half the patients received a strong opioid. Prescription of nonsteroidal anti-inflammatory drugs and corticosteroids persisted. Exposure to a heat source remained common. Prophylactic antibiotics were prescribed more frequently (64 vs 35%) and more uniformly with amoxicillin/clavulanate. Regarding late management, the average duration of hospitalization decreased (1.8 vs 2.6 d). Cutaneous complications were less frequent (9 vs 25%). No patient managed with regional anesthesia presented cutaneous complications. The management of patients in Réunion following Scorpaenidae stings has evolved over time. Regional anesthesia has become more widespread, and the prescription of probabilistic preventive antibiotic therapy is more homogeneous. These changes are associated with a shorter hospital stay and fewer cutaneous complications.

Analyses of Adverse Drug Reactions to Fluoroquinolones in Spontaneous Reports Before and After the Referral and in Clinical Routine Cases.

In November 2018, the European Medicines Agency (EMA) restricted the use of fluoroquinolones (used by mouth, injections or inhalation) in the context of a referral due to long-lasting and potentially irreversible adverse drug reactions (ADRs). Fluoroquinolones should no longer be used to treat mild or moderate bacterial infections unless other antibacterials cannot be used. The first aim of our study was to analyze whether in the period before compared with after the referral the characteristics of spontaneous ADR reports related to fluoroquinolones differed and whether specific ADRs were more frequently reported for fluoroquinolones compared with cotrimoxazole. Secondly, we analyzed whether the ADR profile differed between individual fluoroquinolones. Finally, the number of fluoroquinolone reports was considered in relation to the number of outpatient drug prescriptions. All spontaneous ADR reports from Germany received before the referral (01/2014-12/2019) and after the referral (01/2020-12/2022) for adults in which fluoroquinolones (n=2575; n=967) or cotrimoxazole (n=299, n=275) were reported as suspected/interacting were identified in the European ADR database, EudraVigilance. The ADR reports were descriptively analyzed concerning the reported characteristics. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression analyses, which were performed to investigate whether aortic aneurysms, retinal detachments, cardiac arrhythmias, peripheral polyneuropathies, nervous system disorders, toxic liver diseases and non-traumatic injuries of muscles, tendons and synovialis were more frequently reported for fluoroquinolones compared with cotrimoxazole. Stratified analyses between fluoroquinolones were conducted by calculating ORs and their 95% CIs by using two-by-two tables. Reporting rates were calculated by dividing the number of fluoroquinolone reports by the number of fluoroquinolone prescriptions. Reporting rates of fluoroquinolones clearly increased until 2019 and decreased afterward. Only minor differences in the characteristics of fluoroquinolone reports (e.g., regarding the indications) were observed in reports received before and after the referral. In both periods, peripheral neuropathies, nervous system, and muscle and tendon disorders were more often reported for fluoroquinolones than cotrimoxazole. In the pooled fluoroquinolone-stratified analyses, (i) peripheral neuropathies and nervous system disorders were more frequently reported for ciprofloxacin, (ii) non-traumatic injuries of muscle, tendon, and synovialis were more often reported for levofloxacin, and (iii) cardiac arrhythmias and toxic liver diseases were more frequently reported for moxifloxacin compared with the other fluoroquinolones. In accordance with a reminder sent by the EMA referring to prescribing trends for fluoroquinolones, our study showed that the characteristics of spontaneous ADR reports for fluoroquinolones after the referral were similar to those before the referral, underlining the importance of adhering to the recommended restrictions issued by the EMA. In addition, we observed individual differences between ciprofloxacin, levofloxacin, and moxifloxacin with regard to their ADR profile. Further studies are needed to confirm our results.

Effect of cardiac rehabilitation on progression to long-term care: A clinical and economic longitudinal study in Japan.

The social burden of nursing care is increasing with age, particularly for patients with heart failure who often require intensive care. This study aimed to clarify the relationship between nursing care needs and the clinical status of patients with a history of cardiovascular disease, focusing on the benefits of cardiac rehabilitation (CR) in reducing these needs. This single-gate, multicenter, retrospective observational study included patients of all ages with a history of hospitalization for cardiovascular diseases using government-administered insurance claims and health examination data. Data spanning a four-year period (April 2014 to March 2018) were analyzed, and the effects of CR on nursing care needs and associated factors were examined. Multivariate analysis and propensity score matching were used to adjust for confounding factors, ensuring a robust comparison between CR and nonCR groups. A total of 48,456 patients were enrolled, with an average follow-up of 36.1 months. After propensity score matching, patients who participated in CR demonstrated significantly lower mortality rates and reduced nursing care needs compared to those who did not (0.02 ± 0.13 vs. 0.04 ± 0.20, p < 0.01, 0.94 ± 0.27 vs. base: 1, p = 0.05). CR was associated with improved adherence to medications and increased generic drug prescriptions, contributing to better long-term health outcomes. The adjusted odds ratio for CR in reducing nursing care needs was 0.574 (95 % CI, 0.347-0.948, p < 0.05). This study confirms the potential critical role of CR in reducing mortality and nursing care needs in patients with cardiovascular disease. Although CR did not directly reduce nursing care costs, it contributed to improved health outcomes and reduced dependency on long-term care services. These findings highlight the benefits of CR as a preventive intervention, especially in aging populations. Further research is needed regarding its long-term economic benefits.

Antipsychotic Drug Prescribing in Children Previously Treated With Stimulants for ADHD: A Population-Based Longitudinal Study: La prescription d'antipsychotiques chez les enfants précédemment traités avec des stimulants pour le TDAH : une étude longitudinale basée sur la population.

Stimulant drug treatment in preschool-age children for attention-deficit hyperactivity disorder (ADHD) as well as the concomitant use of antipsychotic drugs is largely unstudied in terms of longitudinal outcomes. We characterized longitudinal patterns of stimulant drug use in children diagnosed for ADHD and analyzed the mental health disorders leading to add-on therapy with antipsychotics. The study population comprised of children and adolescents (age: 0-19 years) in the province of British Columbia (BC), Canada, with at least one dispensing for any psychotropic drug between 1997 and 2017 (N = 144,825). BC health administrative databases were used to identify children with diagnosis for ADHD and dispensings for stimulant and antipsychotic drugs. Longitudinal patterns of drug use and diagnostic codes proximal to the add-on of antipsychotics were assessed. We found that residence in rural regions and lack of child psychiatrists are significantly associated with higher rates of stimulant drug prescription in preschool and early school-age children. Residence in rural regions was also associated with a higher rate for the concomitant use of antipsychotics over the course of stimulant treatment. When comparing children starting stimulant therapy before the age of 6 with those starting therapy after 6 years, we found an 82% increase in the likelihood of antipsychotic add-on in those starting stimulants at younger ages (HR: 1.82, 95% CI [1.63-2.04]). Moreover, children starting stimulant therapy before the age of 6 years had 3.57-fold higher rates of diagnostic codes for specific delays in development (ICD-9 315) in close proximity to the antipsychotic add-on. The question remains whether the add-on of antipsychotics is a consequence of insufficient action of the stimulant in ADHD, or required to ameliorate the adverse effects of the stimulant drug. Our result suggests that care need to be taken in the diagnosis for ADHD in children at the age when entering elementary school.

Gender inequalities in prescribing and initiation patterns of guideline-recommended drugs after acute myocardial infarction

BackgroundEuropean guidelines recommend the prescription of certain drugs after acute myocardial infarction (AMI). The existence of gender differences in pharmacological treatment after an AMI has been described. This study aims to describe and analyse, using real-world data (RWD), whether there are gender differences in the prescribing patterns and initiation of treatment in secondary prevention after a first AMI, and which are the factors that explain these differences.MethodsA population-based observational study of RWD was conducted in the CARhES (CArdiovascular Risk factors for hEalth Services research) cohort. The study included subjects who had experienced a first episode of AMI between 2017 and 2022, had survived the event, and had a minimum follow-up of 180 days.Results3,975 subjects were followed 180 days after a first AMI. Women (27.8% of the study population) were older and had more comorbidities. Of the main guideline-recommended drugs, antiplatelets, lipid modifying agents and beta-blockers, were prescribed less often in women. Comedications such as rivaroxaban and calcium channel blockers were more likely to be prescribed in women. The proportion of subjects initiating treatment was similar in both genders.Overall, age and morbidity burden were the main contributors to differences in the prescribing patterns. Living in an urban area seemed to be a protective or mitigating factor. There were controversial results regarding socioeconomic level. ConclusionIn our study population, women are older, have greater comorbidities and lower socioeconomic status. Despite this, gender inequalities in the prescribing patterns after a first AMI remains, as women appear to experience less therapeutic effort. It is crucial to analyse them from an intersectional perspective, considering the influence of multiple axes of inequality on health, in order to develop gender-sensitive strategies with a multidisciplinary approach.

Association between triglyceride/high density lipoprotein ratio and incidence risk of Parkinson’s disease: a population-based cohort study

The association between insulin resistance and increased risk of Parkinson’s disease (PD) has rarely been investigated. Our study aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio (which represents insulin resistance), and the incidence risk of PD in the general population. This study was conducted using data from the National Health Insurance Service-Health Screening Cohort Database of South Korea (2002–2019). We enrolled 310,023 participants who had no previous PD history and who had undergone more than three repeated measurements for the TG/HDL cholesterol ratio. The diagnosis of PD was determined using the International Classification of Diseases, 10th Revision code G20, specific reimbursement codes for Rare Intractable Diseases of V124, and a history of anti-PD drug prescription. During a median of 9.64 years (interquartile range 8.72–10.53), 4,587 individuals (1.47%) had an incidence of PD. Considering the multivariable time-dependent Cox proportional hazard model with repeated measures of average TG/HDL cholesterol ratio, a per unit increase in TG/HDL cholesterol ratio significantly increased the risk of PD in the entire cohort (hazard ratio (HR), 1.010; 95% confidence interval (CI), 1.001–1.020). These repeated measures of the average TG/HDL cholesterol ratio were associated with the incidence risk of PD in a J-shaped pattern for the entire diabetes mellitus (DM) and non-DM cohorts in restricted cubic spline analysis. Compared to the lowest tertiles (T1), the highest tertiles (T3) were positively associated with the incidence risk of PD (HR: 1.149, 95% CI 1.065–1.239 in the entire cohort, p for trend < 0.001; HR: 1.175, 95% CI 1.075–1.285 in the non-DM cohort, p for trend < 0.001). In contrast, the lowest (T1) and highest tertiles (T3) were not associated with the incidence risk of PD in the DM cohort (HR: 1.128, 95% CI 0.909–1.348) in fully adjusted multivariable analysis. Our study provides information that TG/HDL ratio may be positively associated with PD incidence risk in a non-DM population in longitudinal setting of the general population.

Oral Antibacterial Drug Prescribing in Primary Care Out-of-Hours Services: A Scoping Review.

The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings.

Geriatrics. Focus on neurocognitive disorders

Neurocognitive disorders are a major public health challenge, affecting 55 million people, and are projected to triple by 2050. This year's research highlights pathological mechanisms such as mitochondrial dysfunction and brain inflammation. Modifiable risk factors, such as vision loss, underscore the importance of early prevention. A Swiss study reveals a high prevalence of inappropriate drug prescriptions in the elderly. Anti-amyloid treatments, such as lecanemab and donanemab, show promising results. Lastly, anticoagulation for atrial fibrillation may reduce the risk of dementia. An integrated approach is essential to alleviate the burden of neurocognitive disorders.

Exploring the Pharmacogenomic Map of Croatia: PGx Clustering of 522-Patient Cohort Based on UMAP + HDBSCAN Algorithm.

Pharmacogenetics is a branch of genomic medicine aiming to personalize drug prescription guidelines based on individual genetic information. This concept might lead to a reduction in adverse drug reactions, which place a heavy burden on individual patients' health and the economy of the healthcare system. The aim of this study was to present insights gained from the pharmacogenetics-based clustering of over 500 patients from the Croatian population. The data used in this article were obtained by the pharmacogenetic testing of 522 patients from the Croatian population. The patients were clustered based on the genotypes of 28 pharmacologically relevant genes. Dimensionality reduction was employed using the UMAP algorithm, after which clusters were defined using HDBSCAN. Validation of clustering was performed by decision tree analysis and predictive modeling using the RandomForest, XGBoost, and ExtraTrees classification algorithms. The clustering algorithm defined six clusters of patients based on two UMAP components (silhouette score = 0.782). Decision tree analysis demonstrated CYP2D6 and SLCO1B1 genotypes as the main points of cluster determination. Predictive modeling demonstrated an excellent ability to discern the cluster of each patient based on all genes (avg. ROC-AUC = 0.998), CYP2D6 and SLCO1B1 (avg. ROC-AUC = 1.000), and CYP2D6 alone (avg. ROC-AUC = 0.910). Membership in each cluster provided clinically relevant information, in the context of ruling out certain favorable or unfavorable phenotypes. However, this study's main limitation is its cohort size. Through further research and investigation of a larger number of patients, more accurate and clinically applicable associations between pharmacogenetic genotypes and phenotypes might be discovered.

A Prospective Study of Drug Utilization and Evaluation in Gastrointestinal Disorders at a Tertiary Care Teaching Hospital

Drug Utilization Evaluation (DUE) is a comprehensive study examining the marketing, distribution, prescription, and use of medications within a society. This evaluation encompasses a range of medical, social, and economic factors related to drug use, with the primary goal of ensuring that drug therapy adheres to current standards of care. This prospective observational study conducted at Navodaya Medical College Hospital and Research Centre (NMCH &amp; RC) from 15th February to 15th August 2024 aimed to evaluate prescription patterns for gastrointestinal disorders, focusing on drug utilization from the Essential Drug List (EDL) and adherence to WHO core prescribing indicators.150 prescriptions were analyzed, revealing that 64.66% of patients were male, with the majority aged 20-39 years. Acute gastroenteritis was the most common diagnosis (34%), and common symptoms included abdominal pain, loose stools, and vomiting. Antibiotics, particularly metronidazole, were the most prescribed drug class (25.35%). Of the prescribed drugs, 75.95% were from the EDL, but only 8.91% were prescribed by generic name, and 64.82% involved injections. The average number of drugs per prescription was 6.65, indicating polypharmacy and drug interactions were prevalent. The study highlighted concerns about moderate antibiotic use, high injection rates, low generic drug prescriptions, and polypharmacy, underscoring the need for improved rational prescribing practices to enhance patient safety and cost efficiency.

A Study on Drug Prescribing Pattern in Psychiatry Out-Patient Department from a Tertiary Care Teaching Hospital

Background: Conventional public health statistics, which concentrate on mortality rather than morbidity or dysfunction, severely underrepresent the massive burden of sickness caused by behavioral and psychiatric illnesses. Objective: To determine the prevalence of psychiatric disorders and the patterns of psychotropic drug prescriptions. Materials and Methods: It was a hospital-based prospective observational study was conducted in the Department of Pharmacology &amp; Therapeutics, Sir Salimullah Medical College &amp; Hospital during July’ 2022 to December’ 2022. A total of 765 prescriptions were selected. All patients attending the psychiatry OPD during the period of the study were included and analyzed as per the WHO drug indicators. Results: Clonazepam constitutes 119 (51.74%), Lorazepam 74 (32.17%), and Others 37 (16.09%) of the 230 anxiolytics listed in the table. In 195 antidepressant drugs, 76 (38.97%) were escitalopram, 33 (16.92%) were amitriptyline, 47 (24.10%) were imipramine, and 39 (20%) were other antidepressants. Antipsychotics were detected in 194 patients (21% of the cohort population). This includes Olanzapine (88.36%), Haloperidol (34.54%), Risperidone (14.22%), and Other Antipsychotics (12.89%). Trihexyphenidyl was prescribed to 75 of the 88 study participants, accounting for 85.23% of the total. Prescribing Indicators and it was observed that an average number of drugs per prescription were 2.59±1.37. Average number of Antipsychotics prescribed per prescription was 2.73±1.46. The number of antipsychotic drugs prescribed by generic name was 52.94%. Percentage of injectable drugs prescribed 2.48%, Percentage of the prescriptions containing psychotropic FDC 20.78%, Percentage of psychotropic drugs prescribed from essential drug list 42.75%, Percentage of psychotropic drugs prescribed from hospital pharmacy 62.22%. Conclusion: The most frequently prescribed antidepressant, antipsychotic, and BZD medications were escitalopram, olanzapine, and clonazepam, in that order. Carbamazepine was preferred over lithium as a mood stabilizer.

Adolescents with first-episode psychosis and clinical high risk in the Province of Ferrara: an audit on the implementation of a specialised early intervention program

Objective The first-episode psychosis (FEP) and clinical high-risk (CHR) team within the child and adolescent mental health (CAMH) service receives referrals by psychiatric units, CAMH service, schools, and general practitioners. This audit evaluated the implementation of the FEP-CHR team in Ferrara, Italy. Methods The FEP-CHR team provides standardised assessment and up to 2-year individualised treatment including pharmacological prescription, cognitive-behavioral psychotherapy, and vocational activities. Data regarding access and pathways to care, assessment, and outcome of all patients admitted to this service from January 2019 to June 2023 were analysed. Descriptive statistics were reported and discussed. Results The service admitted 29 patients (19 FEP, 10 CHR), mostly females. FEP referrals primarily came from families via general practitioners, while half of CHR patients were already receiving CAMH care. One in three in the total sample had psychiatric hospitalisation during treatment. At discharge, most transitioned to usual or specialised mental health care and five patients achieved full recovery. Conclusions The audit revealed a lower-than-expected incidence rate, a sub-optimal adherence to the standardised assessment, and a need for improved outcome monitoring. It promoted quality improvement initiatives including professional training to improve psychiatric differential diagnosis, drug prescribing, and transition to adult psychiatric services.

Association between urate-lowering therapy and kidney failure in patients with chronic kidney disease.

Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD. CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60mL/min/1.73 m2). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways). At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HRKRT 0.89, 95% CI 0.67-1.20). Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.

Cholinesterase inhibitors and reduced risk of hospitalization and mortality in patients with Alzheimer's dementia and heart failure.

Cholinesterase inhibitors (ChEIs) have beneficial effects on the heart. Associations between ChEI-use and reduced mortality and cardiovascular events in Alzheimer's disease (AD) have been shown. Whether these associations exist in those with both heart failure (HF) and AD is unknown. A propensity score (PS) matched cohort with patients with HF and AD was obtained through linking registers for cognitive/dementia disorders, comorbidities, drug prescription, and death, in Sweden, to analyze associations between ChEI-use and risk of mortality or hospitalization for HF, stroke, or myocardial infarction, were examined.In 455 patients with and 455 without ChEI treatment, ChEI use was associated with reductions of mortality and hospitalization due to HF by 21% (0,79; CI 0.66-0.96) and 47% (0,53; CI 0.38-0.75) respectively. Donepezil and galantamine but not rivastigmine were associated with lower risk of death compared to non-users. Donepezil was associated with a lower risk of hospitalization due to HF compared to non-users. There was no significant difference in hospitalization for bradycardia, AV block or implantation of pacemaker between ChEI use and non-use. This study suggests that in persons with HF and AD, treatment with ChEIs is associated with improved survival and a decreased risk of hospital care for HF but results due to type of ChEI vary.

Inappropriate prescribing of drugs for peptic ulcer and gastro-esophageal reflux disease remains a matter of concern: Results from the LAPTOP-PPI cluster randomized trial.

Proton pump inhibitors (PPIs) are among the most commonly and inappropriately prescribed drugs by general practitioners (GPs), resulting in increased risk of adverse outcomes for patients and in avoidable costs for Italy's National Health Service (NHS). This study aims to assess the effectiveness of a low-cost and easily implementable informative intervention directed at GPs to enhance the appropriate prescription of PPIs. The LAPTOP-PPI study is a pragmatic, cluster-randomized controlled trial designed to improve the appropriateness of PPI prescriptions among community-dwelling individuals aged ≥65years. In June 2021, GPs in the Local Health Units (LHUs) of Bergamo (Northern Italy) and Caserta (Southern Italy) were randomly allocated to either an intervention group (summary reports on prescribing habits, scientific documents on the Italian Medicine Agency's therapeutic indications, strategies for PPI de-prescribing, along with educational materials for patients), and a control group (standard practice). PPI appropriateness was assessed through an algorithm specifically designed and based on NHS prescription appropriateness and reimbursement criteria. Intervention efficacy was evaluated by comparing data from the baseline period (July 1 to 31 December 2019) with those from the follow-up period (July 1 to 31 December 2021), 6months after randomization. The analysis was performed on the intention-to-treat principle and according to GP level. To estimate the effectiveness of the intervention, we used a difference-in-differences (DID) approach. Overall, 942GPs (540 from Bergamo and 402 from Caserta LHUs) were included in the analysis. At baseline, 171,978 patients aged ≥65 received drug prescriptions for acid-related diseases and were assessable for evaluation of appropriateness. At follow-up, this number was 137,699. The overall inappropriateness rate at baseline among GPs included in the analysis was 57.4% (std.dev. 8.4%) in the intervention arm and 57.6% (std.dev. 8.8%) in the control arm; 6months after the intervention delivery, they were 59.2% (std.dev. 8.0%) and 58.5% (std.dev. 7.3%), respectively. Given their widespread use, improving the prescription quality of PPIs is a major concern. Educational interventions for GPs and patients are routine strategies to address inappropriateness, but they appear to be insufficient for independently improving prescribing practice, especially in a critical situation such as the post-pandemic period.

Identifying Drug Prescription in Newly Diagnosed Hypertension Patients in India.

This study evaluated initial antihypertensive drug prescription patterns in Indian healthcare settings. An observational, cross-sectional, prospective prescription registry analyzed prescriptions for 4723 newly diagnosed hypertension patients. Additionally, it investigated the extent to which physicians adhered to either European or Indian hypertension guidelines. Angiotensin receptor blockers (ARBs) were the most commonly prescribed drugs, given to 79% of patients, followed by calcium channel blockers (CCBs) at 55%. Diuretics and beta-blockers (BBs) were prescribed to 27% and 17% of patients, respectively. Monotherapy was administered to 35% of patients, while combination therapies were more prevalent, with dual therapy at 51% and regimens involving three or more drugs prescribed to 14%. Among multi-drug treatments (n=3082, 65%), 98% received fixed-dose combination tablets. The most common combinations were ARB+CCB (26%), ARB+diuretic (12%), and ARB+CCB+diuretic (8%). Key predictors for an increasing number of prescribed drugs included statin use/dyslipidemia, age, blood pressure level, and diabetes. Non-adherence to hypertension guidelines was evident as 1364 patients classified from moderate to very high risk received monotherapy. Of these, 496 patients had grade 2 or 3 hypertension. Additionally, 88 patients received the undesirable combination of ACEi+ARB, and 267 (15.9%) type 2 diabetes mellitus (T2DM) patients did not receive RAS-blockers (146 on monotherapy). The findings reveal a trend toward utilizing ARBs, CCBs, and combination tablets, indicating improved adherence to guidelines. However, a significant number of patients did not receive appropriate treatment, highlighting areas for improvement in prescription practices.

Mental illness and antibody responses after COVID-19 vaccination in a prospective population-based study in Catalonia.

The association between mental illness diagnoses (mood affective disorders, anxiety disorders, other) over ten years and psychotropic drug prescription based on electronic health records with antibody levels (IgG and IgA) post COVID-19 vaccination was assessed in 939 vaccinated adults from Catalonia, Spain. We employed linear regression models to assess associations between specific mental illnesses and psychotropic drugs with antibody levels, correcting for demographics, comorbidities and lifestyle factors. In a genotyped subset (n=247) we assessed the effect of polygenic risk scores (PRS) for mental illnesses and performed a two-sample mendelian randomization (MR) analysis to examine causality between mental illness and antibody responses. Mood affective disorders were associated with lower IgG to receptor binding domain (RBD) [percentage change=-26.37 (95% CI, -42.00, -6.54)]. Diagnosis of anxiety disorders was not associated with the outcome. The group of other diagnoses (mainly including insomnia and nicotine dependence) were associated with lower IgG RBD levels [percentage change: -21.53 (95% CI, -35.38, -4.71)] and recent onset cases (≤5years ago) showed greater decline in antibody levels. Participants on second-generation antipsychotics and multiple classes of psychotropic drugs in the last 6months exhibited lower antibody levels. In the genotyped population, higher genetic liability (higher PRS) to schizophrenia was associated with lower IgG RBD levels [percentage change=-35.49 (95% CI, -56.55, -4.23)]. MR analysis revealed a causal relationship between major depression genetic instrumental variables and lower IgG RBD and S levels. These findings raise concerns about the efficacy of COVID-19 vaccines and potentially of other vaccines as well, in individuals with mood affective disorders, current/recent insomnia and nicotine dependence and people on multiple psychotropic drugs. Whether these associations are translated into increased risk for breakthrough infections and immune mediated long-term sequels of the SARS-CoV-2 infection warrants further investigation.

The economic burden of post-endoscopic retrograde cholangiopancreatography (ERCP) procedure infections in Italy.

The infections of multidrug-resistant organisms (MDROs) associated with duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedure have become a significant cause for concern, especially in fragile patients. While the clinical impacts of these infections are well-documented, their economic implications remain underexplored. This study assesses the incidence and economic burden of post-ERCP infections in Italy using an administrative database. We conducted a retrospective observational study using administrative databases from A.O.U. Città della Salute e della Scienza di Torino. The study included all patients who underwent their first inpatient ERCP between 2018 and 2021. Infections were identified using ICD-9-CM codes for Pseudomonas aeruginosa, Clostridium difficile, Escherichia coli, Klebsiella spp., and Staphylococcus aureus. A 1-year follow-up was defined in order to estimate healthcare resource utilization and related costs, including readmissions, drug prescriptions, and outpatient specialist and laboratory services. The study included 686 inpatient ERCP cases, an overall infection rate of 4.2% was observed. Higher infection rates were observed in women (4.6%), patients over 70 years old (4.6%), emergency admissions (5.1%), and transplant patients (19.1%). The average hospital stay doubled for infected patients (24.3 vs. 11.3 days; p=0.001). Post-ERCP infections led to a 28% increase in average costs (€12,256 vs. €9,561; p=0.048). With an annual volume of 25,000 ERCP procedures, post-ERCP infections in Italy contribute approximately €2.9 million in additional direct costs per year. Post-ERCP infections impose substantial financial burdens on the healthcare system, underscoring the critical importance of implementing cost-effective prevention strategies to mitigate this public health threat in Italy.