Future Prescribing Research Articles

A cross-sectional study to compare knowledge and perception of generic medicine among medical students at a tertiary care center

Background: Prescribing generic medicine is still a debatable issue among prescribers and the issues of bioequivalence, quality, and safety remain problem areas. The perception that generic medicines are inferior to brand medicine can be eradicated by educating medical students who are the future prescribers. Aim and Objective: The correct knowledge of generic medicine among students will enhance the prescribing of low cost and effective medicines. Therefore, this study was conducted to analyze the knowledge and perception of generic medicines among undergraduates (UG), interns, and postgraduate (PG) students in a medical teaching institute. Materials and Methods: A questionnaire-based cross-sectional study was conducted among 230 medical students (145 UG, 50 interns, and 35 PG) in Uttar Pradesh University of Medical Sciences, Saifai, to assess knowledge and attitude of students for generic medicines. Chi-square test was used to analyze results. Results: About 98% of UG and interns and 100% of PG students were aware of generic medicines. Awareness of Jan Aushadhi Scheme is substantially poor in UG students as compared to interns and PG (P < 0.001). About 86% of student considered generic medicine of low cost, less effective (30%), poor quality (34%), and having more side effects (38%) as compared to branded medicine. Students believe product bonuses (28%) and advertisement (38%) by pharmaceuticals will alter their prescribing patterns in the future. About 71% of students (P < 0.001) consider that it is easier to remember a generic name and 89% of students (P < 0.001) wish to have further information regarding generic medicine in their medical curriculum. Conclusion: Medical students lack comprehensive knowledge and carry erroneous impressions for generic medicine. There is a need for more emphasis regarding generic medicine in UG medical curriculum. This will augment rational prescribing and cost-effective use of generic medicine in the future.

Prevalence of Self Medication Practice among Dental Undergraduates in a Dental college

Self-medication practice among future prescribers can cause a serious threat to the health care profession. There has been an increasing trend among medical and dental students for self-medication. The objective of our study was to find the prevalence and practice of self-medication among dental undergraduates in Kantipur Dental College and Teaching Hospital. A descriptive cross-sectional study was conducted among all the dental undergraduate students of Kantipur Dental College, Kathmandu, from July to September 2018. Ethical clearance was obtained from the institutional review board. A convenience sampling method was used. A prevalidated questionnaire was handed to the students in their classroom to collect the data. The data were analyzed using Statistical Package for the Social Sciences version 16 and Microsoft Excel 2010 and presented as frequency and percentage. The prevalence of self-medication among dental undergraduates was found to be in 150 (83.3%) out of a total of 180 students who participated in the study. Self-medication was commonly practiced by dental students. Self-medication should be considered as a serious threat, especially among the students with inadequate knowledge of drug, dose, and duration of treatment.

Antimicrobial stewardship: Perception and familiarity of future prescribers in a tertiary health institution in Northern Nigeria

Background: Antimicrobial stewardship (AMS) is a coordinated program that promotes the appropriate use of antimicrobials. According to the World Health Organization, education of medical students on AMS is an integral part of antimicrobial resistance containment activities. The perception of undergraduate clinical medical students on AMS has not been studied in Nigeria recently. This study aims to identify the perception of AMS among medical students in Ahmadu Bello University (ABU) Zaria. Methodology: We conducted a cross-sectional survey on medical students in the 4th, 5th, and 6th years of study. A stratified sampling technique was employed. Open Data Kit for android was used to administer the questionnaire. Information on sociodemographics, perception of AMS, perception of the usefulness of AMS education as well as familiarity with the term AMS were collected from study respondents. Data were presented in frequency and percentages for categorical variables, while descriptive summary statistics were used for numeric variables. Results: Most of the respondents (96.2%) belonged to the age group of 20–29 years. The mean age (±standard deviation) of our respondents was 25.75 (±2.47) years. Only 34.6% were “very familiar“/”familiar” with the term “AMS.” Majority (89.2%) of the respondents did not have any knowledge about antimicrobials before entering medical school. The perception of AMS among medical students was generally good. Conclusion: Our respondents recognized the importance of judicious antibiotic use and would like more instructions on how to make rational use of antimicrobials. There is a need by authorities of the ABU medical school to revamp our clinical medical curriculum to include more AMS teaching so as to better equip our “future prescribers” on the appropriate use of antimicrobials.

Students' Practices and Knowledge on Antimicrobial Usage and Resistance in Split, Croatia: The Education of Future Prescribers.

Aims: To evaluate the effect of biomedical students' ongoing education, we assessed their knowledge and attitudes toward antimicrobial use. Study Design: A cross-sectional study was carried out among the students of four study programs: Medicine in Croatian, Medicine in English, Dental medicine, and Pharmacy. The anonymous questionnaire was distributed to students who attended classes from April to May 2018. Results: A total of 947 (86%) out of 1,107 students enrolled at the University of Split School of Medicine participated in this study. A third of dental students (51/159) and a quarter of medical (113/458) and pharmacy students (32/130) believed that paracetamol was an antibiotic that reduces pain. However, the percentage significantly decreased from the first to the final years. Only 31% of the final year dental medicine students (5/16) named a correct guideline for the usage of antimicrobial drugs, 23% of medical students (18/78), and none in the English program. Pharmacy students were the most informed, since 76% of the final year students (16/21) named Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance (ISKRA) guidelines. Conclusion: The students showed poor knowledge on the use of guidelines for antibiotic use, highlighting the need for changes in the existing curricula, including a more effective course on antimicrobial prescribing.

Influence of Future Prescribers' Personal and Clinical Experiences With Opioids on Plans to Treat Patients With Opioid Use Disorder.

Recreational use of opioids is a growing problem in the United States, particularly in the Midwest. Educators have called for inclusion of pain- and opioid-specific courses in health professional school curricula, yet more research is needed to address future prescribers' beliefs, experiences, and postgraduate plans related to opioids. To examine health professional students' perceived severity of the opioid crisis and opioid-related beliefs, experiences, and postgraduate plans. Using a descriptive, cross-sectional design, researchers evaluated health professional students from 3 academic programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]) using a 25-item survey that assessed perceived opioid crisis severity and opioid-related beliefs, experiences, and postgraduate plans. Demographics of respondents were assessed using descriptive statistics and frequencies. Responses were compared between academic programs with 1-way analysis of variance or Kruskal-Wallis tests, and relationships between students' experiences and postgraduate plans were assessed. A total of 491 students (mean [SD] age, 27.2 [5.4] years; 62.7% female; 68.2% DO students) participated in the survey (response rate, 40.4%). The opioid crisis was perceived to be severely impacting the health care system (mean [SD] score, 79.7 [16.8] out of 100), and most respondents (415 [84.5%]) reported that opioid use affected their communities. Clinical experience varied by program, with NP students (75 [81.5%]) reporting the most experience treating acute overdose. Most respondents (317 [64.6%]) agreed that their postgraduate practice would involve caring for patients addicted to opioids; however, only 232 students (47.3%) felt confident in their ability to treat patients with addiction. Experiences managing acute overdose and handling drug-seeking behavior were positively associated with a belief that postgraduate work would involve working with patients with addiction (U=38,275.5, Z=5.92, P<.001; U=25,346.0, Z=4.94, P<.001) and confidence in treating patients with opioid addictions (U=36,806.5, Z=4.96, P<.001; U=23,765.5, Z=3.66, P<.001). Although health professional students had similar beliefs and perceptions regarding the opioid crisis, there were notable differences between academic programs. Students with clinical opioid experiences were more likely to plan on working with patients addicted to opioids and be confident in treating these patients. Thus, the inclusion of experiential learning in the medical curricula may be beneficial for both students and their future patients.

Knowledge of Antimicrobial Resistance among Veterinary Students and Their Personal Antibiotic Use Practices: A National Cross-Sectional Survey

The challenge of antimicrobial resistance (AMR) is grave in developing countries. Antimicrobials are misused yet stakeholders’ contribution to antimicrobial stewardship is low. Veterinary students are future prescribers and their knowledge could influence progress in combating AMR; hence, there is a need to assess their knowledge, attitude, and awareness of AMR. A multi-institutional questionnaire was administered to undergraduates in Nigerian veterinary schools. It comprised demographics, own personal antibiotic usage, and knowledge, attitude, and awareness of AMR in humans and animals. Descriptive statistics and logistic regression were used for analyses. Of the 426 respondents, 39.2% reported personal antimicrobial use in the previous six months. Over 60% received knowledge scores lower than average and >87% requested more education on clinical use and prescriptions pre-graduation, monitored dispensing of antimicrobials, conducting AMR research, and confirmed link among human, animal, and environmental health. Less than 25% of respondents were aware of antimicrobial stewardship and global efforts/organizations for AMR. Final year students have 9-fold and 14-fold more satisfactory knowledge on antimicrobials in humans and animals compared with other students, respectively (p = 0.001). Final year students also have more knowledge (13×) and awareness of contributory factors (3×) on AMR (p = 0.001) than other students. Unsatisfactory knowledge on AMR issues exists among veterinary students yet willingness to improve was observed. Identified knowledge, attitude, and gaps in AMR awareness should be targeted by veterinary schools in Nigeria.

Rational prescribing practice assessment among resident doctors in a tertiary care teaching hospital: a questionnaire based observational study

Background: One of the important factors in health policy is recognised to be rational use of medicines (RUM). Physicians can influence the health and well-being of patients by prescribing appropriate drug in right doses and they should be taught to prescribe rationally at the earliest of their professional carrier.Methods: This cross-sectional, questionnaire-based study was carried out in SMHS hospital which is a tertiary-care teaching hospital associated with Government Medical College, Srinagar, Jammu and Kashmir, India.Results: Out of 106 resident doctors enrolled in the study, 96.2% respondents were aware about the term essential medicines of India, and 47.6% had National List of Essential Medicines of India available at their work place. When the participants were questioned about the term RUM only 17% of them responded positively, but majority of the resident doctors (88.67%) were aware about the ingredients of the drugs they use to prescribe. Though only 3.7% of our participating doctors always use essential medicines during their prescription writing but majority of them (96.22%) would always use to inform the patient regarding disease, drug therapy and monitoring of drug therapy.Conclusions: Considering the fact that respondents are future prescribers they should be aware of all aspects about RUM and improper knowledge in certain areas of RUM is a matter of concern that needs to be addressed.

Finding the Sweet Spot: An Interactive Workshop on Diabetes Management in Older Adults.

Intensive glucose lowering in older adults with diabetes leads to increased risks with minimal benefits. Surveys indicate that clinician confidence for individualizing glycemic goals and regimens remains low. We created an interactive workshop and clinical tool kit to improve clinician knowledge of safe diabetes management in older adults. Finding the Sweet Spot was a 1-hour workshop taught by pharmacists to medical and pharmacy learners that introduced a five-step framework for diabetes management in older adults. The interactive presentation included cases and a clinical tool kit based on current recommendations from the American Diabetes Association and American Geriatrics Society. Pilot workshops were held for 6 months, allowing for real-time revisions based on feedback; final implementation occurred for 6 months thereafter. We evaluated learner self-efficacy (via a 5-point Likert scale) and knowledge (via multiple-choice questions) of diabetes management in older adults before and after the workshop. Thirty learners participated in Finding the Sweet Spot (70% medicine, 30% pharmacy). The percentage of confident learners increased from 55% to 97% (p < .05) after the workshop. All learners demonstrated improvements in knowledge, with the mean score on the knowledge assessment increasing from 61% to 80% (p < .05). Via open-ended feedback, learners expressed satisfaction and found the clinical tool kit especially helpful. Our Finding the Sweet Spot workshop demonstrated statistically significant changes in self-efficacy and knowledge among learners, indicating that this interactive workshop improves medical and pharmacy provider confidence and skills in caring for older adults with diabetes.

Implication of the knowledge and perceptions of veterinary students of antimicrobial resistance for future prescription of antimicrobials in animal health, South Africa.

Understanding the knowledge and perceptions of veterinary students of antimicrobial resistance (AMR) as potential future prescribers of antimicrobials may serve as an opportunity to improve stewardship of AMR. Pre-final (n = 42) and final (n = 29) year veterinary students of the University of Pretoria completed questionnaires to determine their knowledge and perceptions of AMR. Of the 71 respondents, mixed practice (48%) and small animal practice (45%) were the most preferred career choices post-graduation, with the field of gross pathology being the least preferred. Over 80% of the respondents believed that veterinary practitioners’ misuse of antimicrobials contributes to AMR and a higher percentage (98.6%) believed that farmers’ misuse of antimicrobials encourages the development of AMR, in particular, in food animals (60.6%) compared to companion animals (50.7%). Agreement in the ranking of abuse of antimicrobials between pre-final and final year students was fair (36.4%; kappa 0.3), and the most abused antimicrobials in descending order listed by the students were tetracyclines, penicillins, sulphonamides and aminoglycosides. There was wide disparity between training and potential field application, as well as variations in the correct matching of antimicrobials to their respective antibiotic classes. Responses to the clinical application of antimicrobials also varied widely. Despite the apparent teaching of AMR to veterinary students, gaps may exist in the translation of theoretical concepts to clinical applications, hence the need for focused and targeted antimicrobial prescription and stewardship training to bridge these potential identified gaps.

Prescribing patterns of physicians working in both the direct and indirect treatment sectors in Iran; findings and implications

Objective: There can be different incentives in the private versus public healthcare systems across countries influencing the delivery of health care. The implementation of regulations along with financial incentives and quality targets are key initiatives to improve rational prescribing. However, there are concerns in Iran that the different incentives in the Direct versus Indirect sectors can influence the delivery of care even among the same physicians. Consequently, the objective of this study was to evaluate the effect of Social Security Organization (SSO) rules and regulations on the prescribing patterns of physicians working simultaneously in both sectors of the SSO in Iran. Subsequently use the findings to suggest initiatives to improve future prescribing if needed. Methods: Retrospective cross-sectional study on claims data. All prescriptions written by general practitioners, internists, gynaecologists and paediatricians that had at least 100 claims and working in both sectors were collected. Non-parametric tests were undertaken to compare prescribing patterns. Key findings: 455 549 prescriptions were analysed. The average number of medicine items per prescription was 4 in the direct treatment setting versus 2 in the indirect treatment setting, while the proportion of prescriptions including at least one antibiotic, injectable, corticosteroid and injectable corticosteroid, were 31.5, 16.1, 8.7 and 3% respectively in the indirect treatment setting versus 28.7,13.7, 7.7 and 3.2% in the direct treatment setting. Except for antibiotic prescribing, all other differences were significant. Conclusions: There are a number of areas of potential concern with physician prescribing in this study. These include the high use of antibiotics in both sectors, potentially inappropriate polypharmacy in the Direct sector, as well as possibly the overuse of injections especially in the Indirect sector, increasing costs and potentially patient harm. These will be the subject of future research projects.

M32 THE COMPARISON OF GWAS RESULT BETWEEN DEPRESSION AND SCHIZOPHRENIA

Drug hypersensitivity reactions (DHR) are heterogeneous in their pathomechanisms, clinical presentation, severity, and outcomes. Novel DHR mechanisms, phenotypes, and endotypes have been described. The key to prevention from further exposure to the culprit drugs involves correct identification of the putative drug through a combination of in vitro and/or in vivo tests, accurate drug allergy labeling and reporting, and electronic decision support systems within electronic medical records to prevent future accidental prescribing. Prescreening and premedication, the focus of this review, may be a useful adjunct to preventive measures in certain situations. After an index immediate drug hypersensitivity reaction, prescreening may be useful in perioperative anaphylaxis, and iodinated (ICM) and gadolinium-based contrast media (GCM) where the culprit and potential alternative agents are skin tested. In certain nonimmediate DHR, pharmacogenomic prescreening may be used before prescribing high-risk drugs (eg, carbamazepine and allopurinol) where specific human-leukocyte antigen genotypes are associated with severe cutaneous adverse reactions. Premedication with antihistamine and systemic corticosteroids is another therapeutic strategy to prevent infusion reactions for certain biologicals and chemotherapeutic agents, in cases of perioperative anaphylaxis, ICM and GCM DHR, and clonal mast cell disorders. Rapid drug desensitization may also be used to induce temporary tolerance in situations where there are limited alternative drugs.

A cross-sectional questionnaire-based study of knowledge, attitude and practice of antibiotic usage among the undergraduate students of a tertiary care teaching rural hospital: with an emphasis of WHO fact-sheets

Background: Awareness regarding the antibiotic usage forms vital way to overcome the quickly deepening problem of antibiotic resistance. Hence, all the medical students should be made aware of the current emerging health related issues as future clinicians. It is in this regards that this study was undertaken among undergraduate (UG) students, in order to assess their knowledge, attitude &amp; practice concerning antibiotic use.Methods: The present observational study was conducted over a period of four months starting from May 2018 till August 2018 among undergraduates. A total of 250 structured questionnaires were distributed. Data collected was further entered in Microsoft excel sheet and further analysed.Results: Total 250 students participated in this present study. Out of them, nearly 75.6% had heard about antibiotic resistance while 24.4% denied. Regarding the improper use of antibiotics that can cause antibiotic resistance 70% was aware. Moreover, nearly 40.4% attended a CME about rational use of antibiotics. The belief that the antibiotics are safe drugs hence they can be commonly used was reported by 48%. The results were grouped into knowledge, attitude and practice regarding the antibiotic use.Conclusions: Thus, the result gives us useful insight regarding KAP of the undergraduate students who will be future prescribers of antibiotics. This can be further applied to plan desirable educational informative interventions that focus on improving the knowledge for prescribing antibiotics in future clinicians, which can further help in reducing the development of antibiotic resistance.

Antimicrobial prescribing and determinants of antimicrobial resistance: a qualitative study among physicians in Pakistan.

Background Understanding physicians' perception about antimicrobial use and resistance is essential to ensure that the objectives of the Pakistan national action plan on antimicrobial resistance are met. Little is currently known about physicians' perceptions in Pakistan. Objective Assess physicians' perception surrounding antibiotic use and resistance, factors influencing antibiotic prescribing and potential interventions to improve future antibiotic prescribing. Settings The study was conducted in Lahore, the capital of the province of Punjab, which is the second largest and most populous city of Pakistan. Method Qualitative study was conducted with a semi-structured interview guide involving in-depth face-to-face interviews with purposively selected physicians. Audiorecorded interviews were transcribed verbatim and transcripts analyzed by thematic content analysis. Main outcome measures Themes surrounding the perspectives of physicians on issues of antimicrobial use and resistance. Results Five major themes emerged: (1) knowledge and perception of physicians about antimicrobials, (2) antimicrobial prescribing behaviors of physicians, (3) factors influencing prescribing, (4) determinants of antimicrobial resistance, (5) and potential interventions to reduce antimicrobial resistance. The main challenges and issues associated with antibiotic prescribing were the improvement of knowledge, implementation of hygienic measures, access to and clarity of treatment recommendations and minimizing external factors influencing prescribing including pharmaceutical company activities. Suggestions for the future included stricter regulations for prescribing, improved diagnosis, availability of local guidelines and monitoring of prescribing and resistance patterns. Conclusion Identification of concerns regarding inappropriate antimicrobial prescribing will enable specific initiatives and approaches to improve future antimicrobial use and reduce antimicrobial resistance in Pakistan.

Study on knowledge, attitude and practices with respect to antibiotic use among medical students

Background: Antibiotic resistance has emerged as a serious global problem. Irrational prescribing of antibiotics is one of the key factors responsible for the development of antibiotic resistance. As today’s medical students will be the future prescribers their awareness regarding antibiotic resistance and rational prescribing of antibiotics is very much important. The main objective of the study was to evaluate the knowledge, attitude and practices of the medical students towards antibiotic use.Methods: A cross-sectional questionnaire-based study was conducted involving the medical students from all the semesters. A predesigned questionnaire was used to evaluate the knowledge, attitude and practices of the respondents. The response options were ‘yes’ or ‘no’ for some questions, and a 5 point Likert scale used to assess some questions. The data was analyzed using MS office Excel.Results: A total of 457 fully completed questionnaires from the respondents were evaluated. Majority of the respondents (70%) were females, and 91% of the respondents were aware of antibiotic resistance as a global problem. On analysis of score of questions assessing knowledge, 91% of respondents had attained a score in the range of 5-7. Majority (83%) of the respondents used antibiotics only on doctor’s prescription and 74% of the respondents had completed the prescribed course.Conclusions: The present study gives an insight on the knowledge, attitude and practices of medical students on antibiotic use, and can be used as a tool to plan educational strategies to improve the knowledge of the students regarding rational use of antibiotics.

Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and Treatment.

To examine whether inappropriate antibiotic treatment for an initial bout of acute bronchitis in childhood affects patterns of future healthcare utilization and antibiotic prescribing. We conducted a retrospective analysis of children with at least 1 acute bronchitis episode, defined as the 14-day period after an acute bronchitis visit, born in 2008 and followed through 2015 in a nationally representative commercial claims database. We predicted the likelihood of returning for a subsequent acute bronchitis episode, and being prescribed an antibiotic as part of that episode, as a function of whether or not the child was prescribed an antibiotic as part of the first acute bronchitis episode controlling for patient, provider and practice characteristics. Children prescribed an antibiotic as part of their initial acute bronchitis episode were more likely both to have a subsequent acute bronchitis episode (hazard ratio = 1.23; 95% confidence interval: 1.17-1.30) and to be prescribed an antibiotic as part of that second episode (hazard ratio = 2.13; 95% confidence interval: 1.99-2.28) compared with children who were not prescribed as part of their first episode. Children diagnosed with asthma were more likely to experience a second visit for acute bronchitis, but less likely to receive an antibiotic as part of that second episode. Inappropriate antibiotic prescribing for a child's initial acute bronchitis episode of care predicted likelihood of subsequent acute bronchitis episodes and antibiotic prescriptions. Providers should consider the downstream effect of inappropriate antibiotic prescribing for acute bronchitis in childhood.

Cost-Effectiveness of Panel Tests for Multiple Pharmacogenes Associated With Adverse Drug Reactions: An Evaluation Framework.

The cost-effectiveness of testing for multiple genes implicated in adverse drug reactions requires the simultaneous assessment of all actionable information, including future prescribing decisions based on incidental findings. We developed methodology for determining the value of pharmacogenetic panel tests, illustrated with a multigene panel, including HLA-A*31:01, HLA-B*15:02, HLA-B*57:01, HLA-B*58:01, HLA-B (158T), and HLA-DQB1 (126Q). If the findings for all alleles are acted upon, regardless of their individual cost-effectiveness, the HLA panel resulted in cost savings of £378 (US $491), and a quality-adjusted life year gain of 0.0069. Based on a stratified analysis and compared with no testing, initial use of the panel was cost-effective in patients eligible for abacavir (HLA-B*57:01), carbamazepine (HLA-A*31:01), and clozapine (HLA-B (158T) and HLA-DQB1 (126Q)), but not for carbamazepine (HLA-B*15:02) or allopurinol (HLA-B*58:01). The methods presented allow for the assessment of the cost-effectiveness of multiple-gene panels.

Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India.

Context:To reduce the magnitude of antimicrobial resistance, there is a need to strengthen the knowledge for future prescribers regarding use and prescription of antibiotics. Before that, it is required to have a conclusive evidence about knowledge, attitude, and practices of that group.Aim:To assess the knowledge, attitudes, and the practices of medical students in India with respect to antibiotic resistance and usage.Settings and Design:It was a cross-sectional study which was done online through Google forms for a period of 4 months from July to October 2018.Materials and Methods:A structured questionnaire containing a five-point Likert scale was sent to medical students across India by sharing link through contacts of Medical Students Association of India. Respondent-driven sampling technique was also adopted for the study.Statistical Analysis Used:Descriptive statistics, parametric (Chi-square), and nonparametric (Kruskal--Wallis and Mann--Whitney U) tests.Results:A total of 474 responses were received from 103 medical colleges across 22 states of India. The mean score of knowledge was 4.36 ± 0.39. As compared to first year students, knowledge was significantly higher among students of all the years. As much as 83.3% students have consumed antibiotics in previous year of the survey. Around 45% of medical students accepted that they buy antibiotics without a medical prescription.Conclusion:The knowledge level of medical students was quite satisfactory. As far as attitude and practices are concerned, there is a substantial need for improvements.

A prescription for better opioid prescribing?

Informing physicians who prescribe opioids about opioid-linked deaths in their practice reduces future opioid prescribing.

PUK26 - IMPACT OF EMERGING HIF-PH INHIBITORS ON RENAL ANEMIA TREATMENT

Renal anemia (RA) is currently managed using iron supplements and erythropoiesis-stimulating agents (ESAs). ESAs are extremely efficacious, but concerns remain around their association with serious adverse cardiovascular events, including stroke. In addition to these safety concerns, nephrologists frequently lament the need for more convenient and cost-effective therapies. This research explores how the emergence of novel oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHi) will change the RA treatment paradigm and how reimbursement decisions will impact the prescribing and uptake of HIF-PHi in both chronic kidney disease-nondialysis (CKD-ND) and dialysis patients. Interviews with 20 thought-leading nephrologists in seven major pharmaceutical markets. 100 US nephrologists were also surveyed regarding their current and expected prescribing of iron supplements and ESAs, and future prescribing of HIF-PHi for treating RA. Interviewed nephrologists anticipate that HIF-PHi will be used in a variety of ways to treat RA in CKD-ND and dialysis patients, such as a direct alternative to ESAs in patients unable to tolerate ESAs or for whom ESAs are contraindicated. The majority of surveyed nephrologists indicate that oral administration of HIF-PHi will provide the greatest benefit to CKD-ND patients. Therefore, we expect HIF-PHi will garner significantly more patient share in CKD-ND than in dialysis populations. The gain in share for HIF-PHi will come primarily at the expense of ESAs in both the CKD-ND and dialysis markets. Assuming availability, nephrologists expect HIF-PHi to be prescribed in over a third of their RA patients. However, the anticipated high price of HIF-PHi will likely drive payers to adopt prior authorization requirements leading to use in later lines of therapy. Overall, nephrologists view HIF-PHi with excitement but express concerns regarding pricing, and access. Securing favorable reimbursement is critical for uptake of HIF-PHi, given the long-standing history of ESAs and availability of biosimilar ESAs.

Veterinary Medical Students’ Perceptions, Attitude and Knowledge about Antibiotic Resistance and Stewardship: How Prepared Are Our Future Prescribers?

A cross sectional, multicentre survey utilizing a questionnaire was used to assess 6th- (final-) year veterinary medical students’ perceptions, attitude and knowledge about antibiotic resistance (ABR) and stewardship (ABS) in 5 conveniently-selected veterinary schools in Nigeria. Data obtained were analyzed by Fischer’s exact and χ2 tests at a significance level of P &lt; 0.05. Out of 175 final-year veterinary students, 95 (54.3% i.e., response rate) completed the survey. Of the 95, 17% have heard about ABS and 7% knew the meaning of ABS. Less than 10% knew the core principles and goals of ABS and less than 20% of the respondents knew the ideal members of an ABS team. All the respondents rightly knew that no antibiotic stewardship programme (ASP) exist in veterinary hospitals in Nigeria, nearly all of them (97%) reported that antibiograms are rarely used during antibiotic (AB) prescription in their institutional veterinary teaching hospital (VTH) and about two-third (65%) believed that ABs are overused in most veterinary hospitals in Nigeria. Most of the respondents believed that ABR is of greater concern at national level than in their institutional VTHs and majority of them (92%) believed that ABR is a global problem (P = 0.009). Minority of the respondents knew that inadequate personal hygiene, use of substandard ABs, prescription of ABs by non-veterinarians/professionals, poor infection control practices, treating self-limiting infections with ABs, suboptimal and incomplete AB doses (P = 0.017), are factors that promote ABR. Minority of the respondents knew that education on AB therapy (44%), development of antibiotic usage policies (35%), reduction of AB use (14%), establishment of national AB resistance surveillance (28%) and development of institutional guidelines for AB use (29%), are critical interventions to curb ABR. Only 17% of the respondents felt that their education on ABR is adequate for their veterinary career. Most of the respondents believed that strong knowledge of ABs is important for their future veterinary career and would like more education about ABR and ABS. Overall mean correct score of 29% on clinical knowledge vignettes with similar scores across the schools in all the areas, was recorded. This survey has shown that Nigerian veterinary students’ perception and knowledge about ABR and ABS are poor and therefore creates doubt about their preparedness to practice ABS. There is urgent need for improved ABS education in Nigerian veterinary schools.