Frequency Of Prescription Research Articles

NCOG-08. BEVACIZUMAB ALONE VERSUS BEVACIZUMAB PLUS IRINOTECAN IN PATIENTS WITH RECURRENT GLIOBLASTOMA: A NATIONWIDE POPULATION-BASED STUDY

Abstract INTRODUCTION There is no established treatment for recurrent glioblastoma. For the treatment of recurrent glioblastoma, the antiangiogenic antibody, bevacizumab, is used either alone or in combination with Irinotecan. This study aimed to compare the survival of patients receiving bevacizumab monotherapy (BEV) and those receiving bevacizumab plus irinotecan combination therapy (B+I) in recurrent glioblastoma (GBM), using a nationwide population-based dataset. METHODS Patients matching the ICD code C71.x were screened from the national database. From January 2008 to November 2021, 846 patients who had undergone surgery or biopsy and received concurrent chemoradiotherapy with Temozolomide were included. Of these, 450 received BEV, while 396 received B+I. The patients' demographic characteristics, inpatient stay duration, prescription frequency, and survival outcomes were compared between the two groups. RESULTS The BEV group was older and had a higher percentage of females compared to the B+I group. The survival analysis revealed no significant difference in survival times between the two groups in the univariate and multivariate analysis. Younger age, female gender, and having surgery rather than biopsy were associated with better prognosis. CONCLUSION This study found no significant difference in overall survival between bevacizumab monotherapy and bevacizumab plus irinotecan combination therapy in patients with recurrent GBM. Considering the additional potential toxicity associated with irinotecan, bevacizumab monotherapy may be a suitable treatment option.

Trends in the multiple prescriptions of hypnotic drugs in a university outpatient in Japan.

In Japan, the daily dosage of hypnotic drugs for insomnia treatment is increasing year by year, and over-dependence on treatment with hypnotic drugs is a major problem. This study aimed to examine the factors related to the elimination of prescriptions of three or more hypnotic drugs within 1 year in our clinic. We conducted two surveys. Survey ① assessed the frequency of prescriptions of three or more hypnotic drugs by retrospectively reviewing the medical records of all patients who visited general and psychiatric outpatient clinics from January 2013 to March 2019. Survey ② assessed changes in prescriptions of hypnotic and psychotropic drugs within the subsequent year by retrospectively reviewing the medical records of all patients prescribed three or more hypnotic drugs who visited neuropsychiatric outpatient clinics multiple times between April 2013 and March 2019. The frequency of prescribing three or more hypnotic drugs was six to nine times higher in psychiatry than in other departments. Flunitrazepam and brotizolam were the most common drugs prescribed and had the second lowest discontinuation rate after zolpidem. Conversely, eszopiclone, zopiclone, and suvorexant had the highest discontinuation rates. The success factors for drug reduction were age (odds ratio [OR]: 0.97, p < 0.0037), trazodone addition (OR: 12.86, p < 0.0194) and number of years of psychiatric experience. The characteristics and success factors in relation to drug reduction in patients with multiple prescriptions of hypnotic drugs identified in this study may contribute to solving the problem of multiple prescriptions of hypnotic drugs.

Albuminuria as a marker of atherosclerosis burden and a possible predictor of adverse events in patients with polyvascular disease

The role of albuminuria as a marker of the atherosclerosis burden and a predictor of prognosis in patients with polyvascular disease (PD) has been little studied. To evaluate the prevalence, association with atherosclerosis burden, and prognostic value of albuminuria in relation to cardiovascular and bleeding complications in patients with PD. The data was obtained from the prospective registry REGATA-1 (NCT04347200). Seventy four patients (75.7% males, median age 67 [61-69] years) with PD (CAD and peripheral arterial disease) were enrolled. All patients received aspirin and rivaroxaban 2.5 mg. The albumin-creatinine ratio in a single morning urine sample, estimated glomerular filtration rate (eGFR), and von Willebrand factor levels were determined. Mild albuminuria (10-29 mg/g) was detected in 45.9% of patients, moderate and severe (≥30 mg/g) - in 29.7%; eGFR<60 ml/min - in 21.7%, chronic kidney disease (CKD) according to the full KDIGO criteria (eGFR and/or albuminuria ≥30 mg/g) - twice as often (39.2%). The frequency of nephroprotective therapy prescription was insufficient. The level of albuminuria did not correlate with von Willebrand factor (endothelial dysfunction marker), but was associated with affecting of 4-5 vascular beds (ROC AUC 0.775; p=0.011). During the follow-up (12 [8-18] months) 3 patients developed MACE, 11 - BARC 2-3 bleedings. Neither albuminuria nor eGFR were predictors of MACE, bleeding, or net clinical benefit. CKD (KDIGO) was also not associated with bleedings. CKD (KDIGO) was independent predictor of MACE (in significant multiple regression model beta - coefficient for CKD was 0.097; p=0.042), however, the small number of end points allows us to speak only of a hypothesis-generating trend. The implementation of CKD (KDIGO) has increased the predictive value of the REACH score. Albuminuria is highly prevalent in patients with PD. It is a marker of atherosclerosis burden. CKD, diagnosed taking into account the level of albuminuria, can be used in a comprehensive assessment of cardiovascular risk in this category of patients.

Frequency of anti-resorptive therapy prescription and skeletal disease screening in patients diagnosed with multiple myeloma.

398 Background: Patients with multiple myeloma (MM) who have evidence of myeloma-related osseous disease should receive anti-resorptive therapy. However, there are often many delays in initiating therapy and some patients are never initiated on treatment despite best practice recommendations. In this study, we examined rates of anti-resorptive therapy for patients with lytic bone lesions seen on imaging and potential barriers for starting therapy. Methods: A retrospective chart review of patients diagnosed with MM between January &amp; November 2022 at our institution was conducted. All patients diagnosed with MM were included in our analysis. Patient demographics and medical information were collected from the electronic medical record. Data was analyzed using descriptive statistics (mean, standard deviation, median, frequency, interquartile range (IQR)) &amp; inferential statistics (t test, chi squared, ANOVA, Kruskal Wallis analyses). A p-value level of &lt; 0.05 was considered significant. Results: Out of a cohort of 68 patients, 39 (57.4%) demonstrated lytic lesions on imaging. 23 (59%) of these patients were prescribed anti-resorptive therapy. The median time from diagnosis of MM to anti-resorptive prescription was 18 days (IQR=188.5) for a bisphosphonate and 57 days (IQR=190) for denosumab. For those who did receive anti-resorptive therapy, median time to prescription by insurance type, in days, was 23.5 for state, 36 for private, 48 for traditional Medicare, 144.5 for Medicaid expansion, and 175 for Medicare advantage (p=0.21). Insurance type, race, and sex were found to be unrelated to the lack of administration of anti-resorptive therapy. Our analysis demonstrates that factors, other than those studied, account for low administration rates of anti-resorptive therapy. Conclusions: There is a critical under-prescription of anti-resorptive therapy for patients with myeloma-related skeletal disease. While not significant, in this limited sample, large variation in time to therapy based on insurance type warrants further investigation in a larger cohort of patients to better understand how it might lead to disparities in care. Although limited to a single institution, our study reveals a prominent gap in the care of newly diagnosed MM patients that may be applicable to many institutions. Ongoing efforts are currently underway to improve the prescription &amp; time to therapy of anti-resorptive agents.[Table: see text]

Association between seasonal influenza vaccination and antimicrobial use in Japan from the 2015-16 to 2020-21 seasons: from the VENUS study.

Seasonal influenza vaccination might be considered an antimicrobial resistance (AMR) countermeasure because it can reduce unnecessary antimicrobial use for acute respiratory infection by mitigating the burden of such diseases. To examine the association between seasonal influenza vaccination and antimicrobial use (AMU) in Japan at the community level and to examine the impact of influenza vaccination on the frequency of unnecessary antimicrobial prescription for upper respiratory infection. For patients who visited any healthcare facility in one of the 23 wards of Tokyo, Japan, due to upper respiratory infection and who were aged 65 years or older, we extracted data from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study database, which includes all claims data and vaccination records from the 2015-16 to 2020-21 seasons. We used the average treatment effect (ATE) with 1:1 propensity score matching to examine the association of vaccination status with frequency of antibiotic prescription, frequency of healthcare facility consultation, risk of admission and risk of death in the follow-up period of the same season (from 1 January to 31 March). In total, 244 642 people were enrolled. Matched data included 101 734 people in each of the unvaccinated and vaccinated groups. The ATE of vaccination was -0.004 (95% CI -0.006 to -0.002) for the frequency of antibiotic prescription, -0.005 (-0.007 to -0.004) for the frequency of healthcare facility consultation, -0.001 (-0.002 to -0.001) for the risk of admission and 0.00 (0.00 to 0.00) for the risk of death. Our results suggest that seasonal influenza vaccination is associated with lower frequencies of unnecessary antibiotic prescription and of healthcare facility consultation.

Assessing mental health from registry data: what is the best proxy?

Abstract Background Medical registries frequently underestimate the prevalence of health problems compared with surveys. This study aimed to determine the registry variables that can serve as a proxy for variables studied in a mental health survey. Methods Prevalences of depressive symptoms and antidepressant use from the 2018 Belgian Health Interview Survey (HIS), stratified by sex and age, were compared with same-year prevalences from INTEGO, a Belgian primary care registry. Participants aged 15 and above were included. We assessed correlation and agreement using Spearman's rho (SR), the intraclass correlation coefficient (ICC) and the limits of agreement (LOAs). Results HIS questions about depressive symptoms were compared with the following variables from INTEGO: symptom codes (SR 0.763, ICC 0.026), diagnosis codes (SR 0.653, ICC 0.195), free text (SR 0.653, ICC 0.322), antidepressant prescriptions (SR 0.793, ICC 0.391) and the combinations symptom + diagnosis codes (SR 0.640, ICC 0.270) and symptom + diagnosis codes + free text (SR 0.653, ICC 0.386). LOAs varied from [-0.120, 0.021] for antidepressants to [-0.015, 0.061] for the full combination. HIS questions about antidepressant use were compared with prescription frequencies in INTEGO of at least once (SR 0.899, ICC 0.586) and at least three times yearly (SR 0.895, ICC 0.835). Corresponding LOAs were [-0.093, -0.008] and [-0.053, 0.007]. Conclusions Correlation between the HIS and INTEGO was high, agreement fair to poor. Agreement increased by combining certain variables, by including free text, or by increasing the prescription frequency to resemble chronic use. Prevalences from INTEGO were mostly underestimates. A considerate choice of variables and prescription chronicity is needed to accurately use a registry as a surveillance tool for mental health. Key messages • The external validity of medical registries can be poor, especially compared with survey data. • Researchers should be aware of the choice of variables when using registry data as a proxy for population measures.

Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)

BACKGROUND: Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients.AIMS: To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology.MATERIALS AND METHODS: We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022.RESULTS: The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a longer duration of diabetes, in clinical practice the problem remains of untimely detection of CKD with impaired renal function at advanced stages. The progressive nature of the course and the negative impact of kidney damage on the risks of premature mortality in patients determine the priority of preventive diagnostic and therapeutic strategies aimed at compliance with the standard of examination, detection of pathology in the early stages and a multifactorial approach to nephroprotection, according to clinical recommendations.

Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021

INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study.&#x0D; AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 20162021 for MI.&#x0D; MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 20162017 104 patients, in 20182019 256 patients, in 20202021 239 patients. The median and interquartile range of age of patients hospitalized in 20162017 were 70 (61.0; 78.0) years, in 20182019 71 (65.0; 79.3) years, in 20202021 72 (65.0; 80.0) years, p = 0.09.&#x0D; RESULTS: In 20162017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% as part of triple ATT, in 8.7% as part of double ATT (OACs + antiplatelet agent), in 1.0% as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 20182019, DAPT was used in 37.9% of cases; therapy with OACs in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 20202021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% triple АТТ, in 14.2% double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed.&#x0D; CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 20202021 increased 1.3 times as compared to 20182019, and 8.9 times as compared to 20162017 and made 59.8% (p 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 20182019 and 4.6 times as compared to 20162017 and made 74.5% (p 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.

Prescribing trends of amoxicillin, ceftriaxone, and moxifloxacin across different districts of Karachi, Pakistan

Antibiotic resistance is a major public health concern worldwide due to misuse and overuse of antibiotics. This study aimed to evaluate the dispensing trends of three frequently prescribed antibiotics including Amoxicillin, Ceftriaxone, and Moxifloxacin in various districts of Karachi. A cross-sectional study was conducted using a questionnaire distributed in pharmacies across different districts of Karachi, Pakistan. Data was analyzed to determine the dispensing trend of these three antibiotics. The results indicated that Amoxicillin was the most commonly prescribed antibiotic, followed by Ceftriaxone and then Moxifloxacin. District-wise analysis showed that Amoxicillin was the most commonly prescribed antibiotic in the south district. The frequent prescribing of these antibiotics has contributed to the antibiotic resistance. This study highlights the need for interventions to ensure rational prescribing practices so that antibiotic resistance can be prevented.

The effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children

Background. Recurrent and prolonged course of respiratory infections leads to the formation of chronic foci of inflammation, the persistence of viruses, impaired physical and psychomotor development, and a decrease in the child’s immunity. Given the participation of vitamin D (VD) in the regulation of the body’s immune response, the study of its role in the development and course of recurrent respiratory diseases in children remains re­levant. The purpose is to study the effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children. Materials and methods. We examined 52 children with recurrent respiratory infections aged 4 to 10 years. Children were examined before and after VD supplementation according to the study criteria: the average frequency of acute respiratory infection (ARI) episodes per year, the severity of the clinical manifestations of ARI episode, its average duration, the frequency of antibiotic prescriptions and outpatient visits to the doctor. Results. It was found that at the beginning of the exa­mination, the level of 25(OH)D in the blood serum ranged from 11.1 to 29.9 ng/ml, 22 (42.3 %) children had VD deficiency. An analysis of the frequency of ARI episodes per year showed that children with VD deficiency were ill more often than children with a sufficient level of VD (p &lt; 0.001). According to the results of the study, it was found that VD supplementation contributes to a decrease in the frequency of ARI episodes from 8.7 ± 1.7 to 6.8 ± 1.2 times a year (p &lt; 0.001), a decrease in the average number of symptoms of an episode of acute respiratory infections per year from 5.5 ± 0.5 to 4.5 ± 0.5 and their manifestations from 9.2 to 7.41 points (p &lt; 0.001), a decrease in the duration of ARI episode from 6.0 ± 1.7 to 5.7 ± 1.5 days (p = 0.003), as well as a decrease in the number of outpatient visits from 5 to 4 (p = 0.004) and antibiotic prescriptions from 61 to 38 (p &lt; 0.001). Conclusions. VD supplementation improves the course of respiratory diseases in children. The study was carried out in accordance with the Declaration of Helsinki principles. The study protocol was adopted by the ethics committee of the institution indicated in the work. The informed consent of the children’s parents was obtained.

Effects of a homework implementation method (MITCA) on school engagement

MITCA (homework implementation method) was born with the purpose of turning homework into an educational resource capable of improving the self-regulation of learning and the school engagement of students. In this article, following the current theoretical framework, we evaluate the impact of the MITCA method on school engagement in students in the 5th and 6th years of Primary Education. While the control group of students who did not participate in the 12 weeks of MITCA (N = 431; 61% of 5th grade) worsened significantly in emotional, behavioral, and cognitive engagement, these pre-post differences do not reach significance for the group that has participated in MITCA, even observing a tendency to improve. After the intervention, the students who participated in MITCA (N = 533; 50.6% of 5th grade) reported greater emotional and behavioral engagement than the students in the control group. MITCA students showed positive emotions, were happier in school and were more interested in the classroom, paid more attention in class, and were more attentive to school rules. The conditions of the tasks’ prescription proposed by MITCA would not only restrain the lack of engagement but would also improve students’ emotional and behavioral engagement in school found in the last years of Primary Education. In the light of the results, a series of educational strategies related to the characteristics of these tasks, such as the frequency of prescription and the type of correction are proposed.

Levosimendán ambulatorio repetitivo como puente al trasplante cardiaco

Introduction and objectivesRepetitive ambulatory doses of levosimendan are an option as a bridge to heart transplantation (HT), but evidence regarding the safety and efficacy of this treatment is scarce. The objective of the LEVO-T Registry is to describe the profile of patients on the HT list receiving levosimendan, prescription patterns, and clinical outcomes compared with patients not on levosimendan. MethodsWe retrospectively reviewed all patients listed for elective HT from 2015 to 2020 from 14 centers in Spain. ResultsA total of 1015 consecutive patients were included, of whom 238 patients (23.4%) received levosimendan. Patients treated with levosimendan had more heart failure (HF) admissions in the previous year and a worse clinical profile. The most frequent prescription pattern were fixed doses triggered by the patients’ clinical needs. Nonfatal ventricular arrhythmias occurred in 2 patients (0.8%). No differences in HF hospitalizations were found between patients who started levosimendan in the first 30 days after listing and those who did not (33.6% vs 34.5%; P=.848). Among those who did not, 102 patients (32.9%) crossed over to levosimendan after an HF admission. These patients had a rate of 0.57 HF admissions per month before starting levosimendan and 0.21 afterwards. Propensity score matching analysis showed no differences in survival at 1 year after listing between patients receiving levosimendan and those who did not (HR, 1.03; 95%CI, 0.36-2.97; P=.958) or in survival after HT (HR, 0.97; 95%CI, 0.60-1.56; P=.958). ConclusionsRepetitive levosimendan in an ambulatory setting as a bridge to heart transplantation is commonly used, is safe, and may reduce HF hospitalizations.

Analysis of the current status of quantitative literature evidence for the prescription of 56 herbal medicines covered by health insurance

Objectives: The purpose of this study is to analyze the current state of quantitative literature evidence for the prescription of 56 herbal medicines covered by health insurance that have been studied in Korea for the past 30 years, to evaluate the reliability of the evidence, and to find out the research direction of herbal medicine prescription in the future.Methods: 56 kinds of herbal medicine prescriptions were searched in domestic literature search databases OASIS, DBpia, and overseas PubMed, classified into chemistry, toxicity, cells, animals, clinical cases, and clinical trial studies, and built into an EBM pyramid structure.Results: When classified according to research contents, there were 61 cases (7.5%) of physicochemical analysis to identify constituent substances, 80 cases (9.8%) of toxicity evaluation, and 672 cases (82.7%) of efficacy evaluation. The efficacy evidence was classified according to the evidence-based medical pyramid structure: 196 cell trials (29.1%), 372 animal trials (55.4%), 89 case and case reporting series (13.3%), 7 comparative case studies (1.1%), and 8 randomized control clinical trials (1.2%). In the pyramid composition, the basis for the validity of 56 kinds of herbal medicines prescribed was 568 cases (84.5%) in cell and animal units, which could not be said to be highly reliable. There was no relationship between the ranking of quantitative literature evidence for herbal medicine prescriptions and the ranking of salary administration.Conclusions: In an era that continues to require scientific evidence for herbal medicine, traditional herbal medicine should secure the basis for safety validity even for the 10th most frequent prescription among 56 herbal medicine prescriptions for consumers. In particular, traditional herbal medicine should increase the quantitative and qualitative level of case reports on related herbal medicine prescriptions, focusing on each clinical society, and move toward comparative case studies and randomized clinical trial so that traditional herbal medicine is positioned as Evidence-based medicine.

Opioid Prescription Clusters Associated With Early or Unplanned Military Separation.

Early/unplanned military separation in Active Component U.S. service members can result in reduced readiness during periods of high-tempo combat and increased demand for health care services within the Military Health System and Veterans Administration. Although current assessment tools leverage prescription data to determine deployment-limiting medication receipt and the need for interventions or waivers, there is a lack of understanding regarding opioid prescription patterns and subsequent early/unplanned military separation after return from deployment. As such, understanding these relationships could support future tool development and strategic resourcing. Therefore, the goal of the present study was to identify unique 12-month opioid prescription patterns and evaluate their relationship with early/unplanned military separation in Active Component service members who returned from deployment. This retrospective, IRB-approved cohort study included data from 137,654 Active Component Army service members who returned from deployment between 2007 and 2013, received a post-deployment (index) opioid prescription, and had at least 1 year of Active Component service post-opioid initiation. A k-means clustering analysis identified clusters using opioid prescription frequency, median dose, median days supply, and prescription breaks (≥30 days) over the 12-month post-initiation (monitoring) period. A generalized additive model examined whether cluster membership and additional covariates were associated with early/unplanned separation. In addition to the single opioid prescription (38%), the cluster analysis identified five clusters: brief/moderate dose (25%), recurrent breaks (16%), brief/high dose (11%), long/few prescriptions (8%), and high prescription frequency (2%). In the generalized additive model, the probability of early/unplanned military separation was higher for the high prescription frequency cluster (74%), followed by recurrent breaks (45%), long/few prescriptions (37%), brief/moderate dose (30%), and brief/high dose (29%) clusters, relative to the single prescription (21%) cluster. The probability of early/unplanned separation was significantly higher for service members with documented substance use disorders, mental health conditions, or traumatic brain injuries during the monitoring periods. Service members assigned male were more likely to have an early/unplanned separation relative to service members assigned female. Latinx service members and service members whose race was listed as Other were less likely to experience early/unplanned separation relative to white service members. Relative to Junior Officers, Junior Enlisted and Senior Enlisted service members were more likely to experience early/unplanned separation, but Senior Officers were less likely. Further evaluation to support the integration of longitudinal opioid prescription patterns into existing tools (e.g., a screening tool for deployment-limiting prescriptions) may enable more timely intervention and support service delivery to mitigate the probability and impact of early/unplanned separation.

The association between patients' frailty status, multimorbidity, and demographic characteristics and changes in primary care for chronic conditions during the COVID-19 pandemic: a pre-post study.

The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty. A research database from a sub-set of McMaster University Sentinel and Information Collaboration family practices was used to identify patients ≥65 years of age with a frailty assessment and 1 or more of the conditions. Patient demographics, chronic conditions, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since the pandemic were described and associations between patient characteristics and changes in monitoring, prescriptions, and test results were analysed using regression models. The mean age of the 658 patients was 75 years. While the frequency of monitoring activities and prescriptions related to chronic conditions decreased overall, there were no clear trends across sub-groups of age, sex, frailty level, neighbourhood income, or number of conditions. The mean values of disease monitoring parameters (e.g. blood pressure) did not considerably change. The only significant regression model demonstrated that when controlling for all other variables, patients with 2 chronic conditions and those with 4 or more conditions were twice as likely to have reduced numbers of eGFR (Estimated glomerular filtration rate) measures compared to those with only 1 condition ((OR (odds ratio) = 2.40, 95% CI [1.19, 4.87]); (OR = 2.19, 95% CI [1.12, 4.25]), respectively). In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.

Profil peresepan dan analisis risiko racikan antidepresan di sebuah apotek di Yogyakarta

In Yogyakarta, the number of patients suffering from depression reached 5.5%. To enhance the therapeutic benefit, psychiatrists frequently prescribe a combination of antidepressants to their patients. To identify the risk for incompatibility, the prescription profile of antidepressant medicines that are compounded together must be examined. The purpose of this study is to examine the prescribing patterns of compounded medications designated as antidepressants in a Yogyakarta pharmacy. The prescription is the research subject in this descriptive exploratory study. Prescriptions that satisfied the inclusion criteria were gathered, and the frequency of prescriptions was calculated. Two medications with the greatest prescribing frequency were then examined for potential interactions and incompatibility. Folic acid is the most commonly prescribed medicine when combined with another. It was formerly used with sertraline HCl, maprotiline HCl, trifluoperazine HCl, and diazepam. The psychiatrist was used to mixing three to four active drugs administered in capsules. The drug combination has various interactions that must be properly monitored. These findings can be used by the doctor to choose the best medicine combination.

Frequency and Pattern of Antibiotic Prescription for Common Infections Presented in Five Primary Healthcare Centers, Cairo, Egypt

Abstract Background rationale antibiotic prescription is a key strategy to control antibacterial resistance. Objectives to measure the antibiotic prescription rate, and to identify the most commonly prescribed antibiotic, and to explore the reasons for irrational antibiotic prescription in five primary healthcare (PHC) settings in Egypt. Method A Cross-sectional study was conducted on 535 prescriptions collected from five primary healthcare centres; and checklists about symptoms and signs of common health problems of respiratory tract, gastrointestinal tract and urinary tract for antibiotic prescription was fulfilled. Results Antibiotic prescription rate was (33.8%) and the most commonly prescribed antibiotic was Amoxil (Penicillin) (31.5%). Only (26.4%) of antibiotic prescriptions were adherence to the guidelines of Ministry of health of Egypt. Only (31.3%) of patients had upper respiratory tract infection were treated according to the guidelines where Tonsillitis was the most common URT diagnosis (43%), where only (34.3%) of them took Amoxil, followed by bronchitis (67.2%), where (46.3%) of them took Amoxil (adherent to guidelines). Only (31.2%) of patients had lower respiratory tract infection were treated according to the guidelines. Most of urinary tract infections were found among females (86.8%) and cipro was the most commonly prescribed antibiotic (39.5%). Conclusion Antibiotics are frequently prescribed in primary health care centers in Egypt, and most of these prescriptions are inappropriate. Training sessions for physicians is mandatory to improve their awareness, attitude and practice towards antibiotics prescription.

Patterns of Prescription Medication Use Before Diagnosis of Early Age-Onset Colorectal Cancer: Population-Based Descriptive Study.

Colorectal cancer (CRC) is estimated to be the fourth most common cancer diagnosis in Canada (except for nonmelanoma skin cancers) and the second and third leading cause of cancer-related death in male and female individuals, respectively. The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis. We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as "cases"), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older). We included 1001 EAO-CRC cases (n=450, 45% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95% CI 13.1-18.6). We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC.

Comprehensive analysis of biosecurity practices and antimicrobial use in broiler chicken production by integrated operations in Korea

Integrated broiler operations that allow producers to combine various biosecurity and sanitation practices account for approximately 97.6% of chicken meat production in Korea, but it is not well known about the biosecurity level or compliance with regulations for each operation. Therefore, the objective this study was to analyze the current adoption of biosecurity practices and trends in antimicrobial use in 74 farms from 5 major integrated broiler chicken operations (A-E). The highest stock densities of more than 65 birds per 3.3 m2 (0.5 birds/ft2) showed in 66.7 and 33.3% of the farms in operations A and C, respectively. Also, the livability rate of 98% or less was observed in 73.3 and 93.4% of the farms, in operation A and C, respectively, which lower than other operations. Moreover, it was observed that 60.0 and 40.0% of farms in operations B and C reused litter 3 or more times. Among the 74 farms, the most common antimicrobials prescription frequency was 2 times (39.2%), and the prescription to β-lactams antibiotics (45.3%) showed the significantly highest (P < 0.05). The highest administration of antimicrobials was at 15 to 22-days old (42.7%), and most of them were recommended by veterinarian (80.7%). Footbath disinfectant and spraying outside the poultry house were performed in most of the farms (64.9 and 83.8%, respectively), but the use of quicklime (36.5%) and drinking water disinfectant (18.9%) was low in farms. Most of the farms washed vehicles for transportation of poultry (87.8%) and feed (100%) before arriving at the farms, however, 40.5% of the farms used little or no disinfectants when washing the transport vehicles. Moreover, wild birds, and cats and dogs were well controlled on most of the farms (each 94.6%), but only 74.3% of farms offered rodent control programs. Also, only 27.0% of the farms used farm-specific shoes and clothing as well as footbath disinfection for entrance. These findings can be useful in developing policies and guidelines for sustainable and responsible broiler chicken production and reduction of antimicrobial use in Korea.

Combining the Real-Time Vial Sharing Strategy with Daily-Rate Charge Mode for Antimicrobial Drugs of Inpatients: An Economical and Practical Method for Patients and Hospitals.

Antimicrobial agents' wastage is a huge problem, especially for pediatric patients, resulting in excessive drug expenditure and increasing the economic burden on patients' families. Moreover, the cost of disposing of antimicrobial agents' waste and the risk of environmental and occupational exposure also increased. This study aimed to explore the cost-effectiveness of the vial-sharing strategy combined with the daily-rate charge mode for pediatric inpatients to provide a strategy for reducing patients' expenditures, saving medical costs, and reducing drug proportion. This retrospective study was conducted at Pharmacy Intravenous Admixture Service (PIVAS), Shenzhen Children's Hospital, Guangdong Province, China, in 2022. Data on prescription drugs were collected from the PIVAS system. Ten antimicrobial drugs with a frequency of prescriptions no less than twice once daily were selected, and the drug costs, drug weight, and drug saved were further analyzed according to the combination of real-time vial sharing strategy and daily-rate charge mode. Traditional single vial charge mode without vial sharing was set as a control strategy. The actual expenditure of the hospital was also calculated and analyzed. During 2022, ¥ 4,122,099 (34.4%) was saved for inpatients by applying a vial-sharing strategy on ten antibacterial agents, and more than 46,343,750 mg (24.6%) of drugs were totally saved. The top 5 drugs saved by the real-time vial-sharing strategy were cefoperazone-sulbactam, vancomycin, amoxicillin-sulbactam, ceftazidime, and meropenem. Taken the price into consideration, the top five payment-saved drugs were vancomycin (¥ 1,522,385), meropenem (¥ 1,311,475), cefoperazone-sulbactam (¥ 736,697), imipenem-cilastatin (¥ 406,092), and amoxicillin-sulbactam (¥ 51,394). Moreover, the account balance of the hospital was up to ¥ 426,499. The real-time vial sharing strategy combined with the daily-rate charge mode greatly reduces drug wastage and patients' payments. It may be useful for hospitals with PIVAS to achieve vial-sharing while protecting the best interest of inpatients.