Inappropriate Use Of Medicines Research Articles

Polypharmacy and potentially inappropriate medicine use in older adults with cancer: a multicenter cross-sectional study in Northwest Ethiopia oncologic centers.

Most patients with cancer have comorbid conditions that necessitate advanced medical treatment. Polypharmacy (PP) and potentially inappropriate medicine (PIM) use is common among older adult patients with cancer. Not much research has been conducted on PP and PIM use among older adult patients with cancer in Ethiopian oncology centers. Therefore, this study aimed to evaluate the prevalence and determinants of PP and PIM use among older adults with cancer in Northwest Ethiopia oncology centers using the American Geriatrics Society (AGS) 2019 updated Beers criteria. This multicenter cross-sectional study was conducted among older adult patients with cancer from July 15-December 30, 2023 in Northwest Ethiopian oncology centers. The use of at least one drug included in the 2019 Beers criteria revisions was classified as potentially inappropriate medication use. To identify the factors influencing PP and PIM use, logistic regression analysis was performed. Of the 310 samples aproched, 305(98.4% response rate) participated in the study. The prevalence of PP and PIM use were 70.2% (95% CI 64.9-75.1) and 63.0% (95% CI 57.4-68.8) respectively. Being female AOR:3.6; 95% CI:1.7-7.8; p = 0. 001, advanced age [(70-74 years) AOR:3.9; 95% CI:1.2-6.7; p = 0.046 and ≥75 years AOR:3.8; 95% CI:1.7-8.4; p = 0.0028], abnormal body weight (underweight AOR:5.5; 95% CI:1.5-9.6; p = 0.019, overweight AOR:5.1; 95% CI:1.5-7.3; p = 0.01 and obese AOR:5.6; 95% CI:1.5-9.3; p = 0.021) and comorbidities AOR:3.5; 95% CI:1.7-8.3; p = 0.0032 were statistically significant factors for PP. Advanced age [(70-74 years) AOR:5.5; 95% CI:1.4-9.8; p = 0.015 and ≥75 years AOR:3.3; 95% CI:1.5-7.1; p = 0.002)] and polypharmacy; AOR:7; 95% CI:3.4-9.4; p = 0.001 were statistically significant factors for PIM use. Polypharmacy and potentially inappropriate medicine use were prevalent among older adult patients with cancer. Ensuring safe medicines prescription practices for older patients with cancer requires understanding the issue, stopping unwarranted treatment, and replacing it with less toxic, age-appropriate medicines.

The influence of beliefs and health literacy on medication-related outcomes in older adults: A cross-sectional study

BackgroundOlder adults often manage multiple chronic diseases which necessitates the use of multiple medicines. Nevertheless, they also face an elevated risk of harm when medicines are used inappropriately. Studies indicate that socioeconomic disadvantage, beliefs, and health literacy may correlate with non-adherence and inappropriate medicine use. However, older adults are underrepresented in the current body of literature. ObjectiveTo investigate the influence of beliefs and health literacy on medication-related outcomes in older adults. MethodsParticipants ≥65 years living in the community were invited to complete a survey. Participants were asked to report demographics, medicines and complete three questionnaires: Self-Efficacy for Appropriate Medication use Scale (SEAMS), Beliefs about Medicines Questionnaire (BMQ) and Health Literacy Questionnaire (HLQ). Descriptive statistics, regressions and correlations were calculated. ResultsA total of 154 participants were included in the analysis (35.7 % male, age range 65–110 y). Mean SEAMS score was 33.2 out of 39 (standard deviation (SD) = 8.0), reflecting high self-efficacy for adherence. Mean HLQ scores were high across the four scales measured in the survey (scales 1, 5, 6, and 9). Sixty-two participants (44.0 %) were using five or more medicines (polypharmacy) and 18 (15.4 %) reported use of a potentially inappropriate medicine. Regarding beliefs, mean BMQ-specific scores were as follows: necessity score 17.5 (SD = 5.1) and concern score 12.0 (SD = 4.0), indicating strong beliefs in the necessity of medicines and few concerns. Results of the regression analysis indicated that where the BMQ-Necessity scores were employed as the independent variable, there was statistical significance with polypharmacy (p < 0.001). Additionally, moderate positive correlations were identified between (1) necessity beliefs and both polypharmacy (r = 0.401, p < 0.001) and adherence (r = 0.477, p < 0.001), and (2) adherence and HLQ scale 5 (r = 0.343, p < 0.001), scale 6 (r = 0.326, p < 0.001) and scale 9 (r = 0.320, p < 0.001). ConclusionOlder adults who perceive their medicines as necessary are more inclined to report use of multiple medicines, leading to polypharmacy. Additionally, older adults with stronger beliefs in the necessity of medicines and higher levels of health literacy demonstrate greater self-efficacy for adherence. Health professionals should consider evaluating necessity beliefs in older adults to manage potential non-adherence, reduce the risk of polypharmacy, and thereby mitigate the risk of suboptimal medicine use.

Synthesis, Characterization, and Biological Evaluation of Chitosan Nanoparticles Cross-Linked with Phytic Acid and Loaded with Colistin against Extensively Drug-Resistant Bacteria.

The natural evolution of microorganisms, as well as the inappropriate use of medicines, have accelerated the problem of drug resistance to many of the antibiotics employed today. Colistin, a lipopeptide antibiotic used as a last resort against multi-resistant strains, has also begun to present these challenges. Therefore, this study was focused on establishing whether colistin associated with chitosan nanoparticles could improve its antibiotic activity on an extremely resistant clinical isolate of Pseudomonas aeruginosa, which is a clinically relevant Gram-negative bacterium. For this aim, nanoparticulate systems based on phytic acid cross-linked chitosan and loaded with colistin were prepared by the ionic gelation method. The characterization included particle size, polydispersity index-PDI, and zeta potential measurements, as well as thermal (DSC) and spectrophotometric (FTIR) analysis. Encapsulation efficiency was assessed by the bicinchoninic acid (BCA) method, while the antimicrobial evaluation was made following the CLSI guidelines. The results showed that colistin-loaded nanoparticles were monodispersed (PDI = 0.196) with a particle size of around 266 nm and a positive zeta potential (+33.5 mV), and were able to associate with around 65.8% of colistin and decrease the minimum inhibitory concentration from 16 μg/mL to 4 μg/mL. These results suggest that the association of antibiotics with nanostructured systems could be an interesting alternative to recover the antimicrobial activity on resistant strains.

Actual Access and Usage of Antipyretic Analgesics before and after COVID-19 Vaccination: Pharmacist's Roles in Promoting Proper Use of Medicines during the Infodemic

An overwhelming surge of information regarding preparedness for postvaccination side effects had caused widespread confusion approximately since April 2021, when the coronavirus disease 2019 (COVID-19) vaccination had started for the general population in Japan. Notably, this resulted in a remarkably increased shortage of OTC acetaminophen formulations. The aim of this study was to elucidate the actual responses of the public in such an environment, how individuals acquired and understood information related to the management of postvaccination side effects, and how they obtained and used antipyretic analgesics before and after COVID-19 vaccination. We conducted a web-based survey in January 2022, targeting 400 individuals aged ≥20 years, who had received two COVID-19 vaccine doses, and excluded qualified professionals such as physicians and pharmacists. The results revealed that 67% of the respondents had obtained antipyretic analgesics in anticipation of adverse effects after vaccination, whereas 38% had taken these medicines before and/or after the second vaccination. Possible misappropriation of medicines from others, preventive administration, and lack of dosage and administration confirmation are the problems identified in medication acquisition and usage. Additionally, avoidance of antipyretic analgesics based on information without scientific evidence was observed. This study revealed no small amount of inappropriate use of medicines in situations, such as the COVID-19 pandemic, where there is an "infodemic" of mixed-quality information. Pharmacists, as experts in medication, should play a crucial role in promoting appropriate medication usage by consistently staying updated with the latest scientific evidence and proactively supporting OTC drug selection and counseling medication.

Phytochemical analysis and evaluation of the antibacterial and antibiotic potentiation activities of the aqueous extract of Cordia oncocalyx Allemão (Boraginaceae)

The global antibiotic resistance crisis highlights the inappropriate use of medicines by the population and the lack of development of new antimicrobial agents. According to various studies, natural products are promising alternatives for combating bacterial resistance and treating infectious diseases. Accordingly, the present study aimed to analyze the chemical composition and evaluate the antibacterial and antibiotic potential of an aqueous extract of Cordia oncocalyx Allemão (AECO). Phytochemical analyses were performed using high-performance liquid chromatography equipped with a diode array detector (HPLC-DAD). The minimum inhibitory concentration (MIC) was used to evaluate the antibacterial activity of C. oncocalyx against conventional and multidrug-resistant (MDR) bacterial strains (Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus). According to HPLC-DAD analysis, the following compounds could be identified in the aqueous extract of C. oncocalyx: luteolin (3.07 ± 0.04 mg/g), caffeic acid (1.05 ± 0.03 mg/g), ellagic acid (0.62 ± 0.05 mg/g), and quercetin (0.58 ± 0.01). AECO did not exhibit antibacterial activity when administered alone (MIC >512 μg/mL). However, when combined with gentamicin, ampicillin, and norfloxacin, AECO potentiated the action of these antibiotics against the multi-resistant strains of P. aeruginosa and S. aureus. Although clinical relevance was not revealed by the in vitro tests against pathogenic bacteria, AECO can combined with commercial antibiotics to improve their antibacterial effects. Future studies focusing on the mechanisms of action of the compounds isolated from C. oncocalyx and toxicological tests are fundamental.

The role of health surveillance in the face of self-medication in the context of Covid-19: A literature reviewha

The politicization of the disease led to misinformation and the use of unproven treatments, such as the “COVID Kit”. The National Health Surveillance Agency (ANVISA) took important measures, including management and planning, health risk control, regulation, monitoring of suspected and confirmed cases, as well as information, communication and health education. Therefore, the general objective of this research is to demonstrate how the National Health Surveillance Agency (ANVISA) acted in the face of self-medication in the context of COVID-19. To this end, a literature review was carried out over the last five years on self-medication, pandemics, health surveillance, using databases such as PubMed, Google Scholar, Scientific Electronic Library Online (SciELO), Manuals from the Ministry of Health and the World Health Organization Inclusion criteria were adopted, such as articles published in Portuguese or English, primary studies and literature reviews, while studies that did not meet the general objective of the work and publications prior to 2019 were excluded. Regarding the results, ANVISA played an important role in the control and regulation of medicines during the pandemic, classifying chloroquine as a special control medicine and carrying out more than 30 thousand inspections to ensure compliance with clinical protocols to combat the disease. Finally, the pandemic brought challenges for health surveillance professionals, in order to contain the spread of the coronavirus, especially regarding the inappropriate use of medicines and other products subject to health assessment.

Observational evidence linking psychotropic medicines to the dispensing of opioid agents in later life.

The use of opioid medicines is common in developed countries, particularly among older adults and those with mental health disorders. It is unclear if the association between mental disorders and opioid medicines is causal, or is due to reverse causality or confounding. We used a 10% random sample of the Australian Pharmaceutical Benefits Scheme (years 2012-2022) to examine the cross-sectional, case-control and longitudinal association between the dispensing of antidepressants, anxiolytics, hypnotics, antipsychotics and lithium, and opioid medicines. We used logistic regression, structural equation models (SEM), and Cox regression to analyze the data. Analyses were adjusted for age (years), sex, and number of non-psychotropic medicines dispensed during the year. The 2022 file contained 804 334 individuals aged 50 years or over (53.1% women), of whom 181 690 (22.6%) received an opioid medicine. The adjusted odds ratio of being dispensed opioid medicines was 1.44 (99% CI = 1.42-1.46) for antidepressants, 1.97 (99% CI = 1.92-2.03) for anxiolytics, 1.55 (99% CI = 1.51-1.60) for hypnotics, 1.32 (99% CI = 1.27-1.38) for antipsychotics, and 0.60 (99% CI = 0.53-0.69) for lithium. Similar associations were noticed when we compared participants who were or not dispensed opioid medicines in 2022 for exposure to psychotropic agents between 2012 and 2021. SEM confirmed that this association was not due to reverse causality. The dispensing of antidepressants was associated with increased adjusted hazard (HR) of subsequent dispensing of opioid medicines (HR = 1.29, 99% CI = 1.27-1.30). Similar associations were observed for anxiolytics, hypnotics and antipsychotics, but not lithium. The dispensing of opioid medicines is higher among older individuals exposed to antidepressants, anxiolytics, hypnotics and antipsychotics than those who are not. These associations are not due to reverse causality or study design. Preventive strategies seeking to minimise the risk of inappropriate use of opioid medicines in later life should consider targeting this high-risk population.

Transforming Diabetes Supplies in the Prison System: An Example of Environmental Social Innovation

Background: The disposal of plastic material has been gaining negative attention due to its impact on the environment and people’s health. Insulin pens used by people living with diabetes are disposed of through landfills or incineration, negatively impacting the environment and generating costs for the state. Methods: In an attempt to reduce the disposal of plastic in the environment and reduce disposal costs, the “Insulinadiamor” project was created, which uses handicrafts as a means of re-socializing women deprived of their liberty. In this project, female inmates in the state of Sergipe turn insulin pens into ballpoint pens. Results: During the year 2022, 2000 insulin pens were transformed into ballpoint pens. We estimate a loss of around USD 37,150.28 for the state due to the inappropriate use of medicines, which was reflected in the return of complete insulins. In addition, by avoiding landfill or incineration of the plastic content collected, we contributed to an estimated saving of almost USD 603.91 for the state and more than 80 kg of CO2-equivalent emissions. Conclusions: This project brings a sustainable and transformative approach involving financial savings, rehabilitation of inmates, and contribution to the environment. It also raises the importance of creating more sustainable initiatives to reduce plastic waste in the health sector and other areas.

Community Pharmacist's Awareness, Knowledge and Attitude Towards use of Vitamin Supplements in Pimpri-Chinchwad Municipal Corporation (PCMC) Area of Pune, India: A Descriptive Cross Sectional Study.

US FDA defines: dietary supplements is a product that intended to supplement a person's diet, it's generally consist of at least one or more of the following dietary ingredients, vitamin, minerals, a herb or other botanical and amino acid by increasing the daily consumptions of an extract metabolite concentration, constitute or combinations of these medication. Excessive and inappropriate use of medicines has been recognised as a public health problem resulting in increased likelihood of adverse drug event, drug interaction, and inappropriate drug prescribing and increased cost. This was the cross-sectional study conducted in year 2022 at Pimpri Chinchwad (Pune). The total 250 questionaires are distributed and from that 226 response were received. Target population consist of community pharmacists working in the drug store in this area (n=226). Data was represented in three domains of study i. e. awareness, knowledge and attitude. Correlation coefficient using Pearson's method were determined to evaluate strength of correlation between awareness-knowledge, Knowledge-attitude and awareness-attitude. Correlation coefficient were calculated by comparing most relevant and equal number of questions. The study demonstrated positive attitude among surveyed community pharmacists in Pune, India. There is lacuna in accurate and adequate awareness, knowledge and attitude of vitamin deficiency, efficiency, recommended daily allowance (RDA), toxicity and interactions among pharmacist as one of the stakeholders of healthcare in India. Few of the remedies viz. framing of guidelines, inclusion in formal education syllabus, continuous education, updation exams etc. may be of use.

Potentially inappropriate medicine use and predicting risk factors in hospitalized older adult patients: findings of a prospective observational study from Ethiopia

BackgroundOlder patients are fragile and more susceptible to medication-related problems requiring a strict assessment of their medicine list. The present study was conducted with the intention to assess the quality use of medicines in older adult patients by detecting potentially inappropriate medicine use and its predictive risk factors.MethodsThis prospective cross-sectional study involved 162 older medical patients admitted to Jimma Medical Center. A data abstraction format is employed to capture relevant information. Each patient was assessed for the presence of potentially inappropriate medicine using the 2019 American Geriatrics Associations Beers Criteria. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. A p value < 5% was considered a cutoff point for declaring statistical significance.ResultsOver the hospital stay, 103 (63.6%) participants were on polypharmacy (5–9 concurrent medicines per patient), while 16 (9.9%) were on hyper polypharmacy (≥ 10 concurrent medicines per patient). On medicine use assessment using the Beers criteria, at least one potentially inappropriate medicine was detected in 118 (73%) participants. Overall, 191 potentially inappropriate medicines (range, 0 to 4) were identified, and 27 (14.1%) of these were associated with avoiding recommendations. Furosemide [83 (43%)], tramadol [26 (14.5%)], and spironolactone [22 (11.4%)] were the top three most frequent potentially inappropriate medicines identified. In terms of mode of prescription, 187 (96.9%) potentially inappropriate medicines were prescribed on a scheduled basis. Older adult patients with thrombocytopenia had a lower probability of taking potentially inappropriate medicine, while the odds of potentially inappropriate medicine use were 7.35 times higher in patients diagnosed with heart failure.ConclusionsNearly three-fourths of the participants had potentially inappropriate medicine in their medicine list. Therefore, generating local evidence on the clinical, economic, and humanistic consequences may help in determining whether the Beers criteria should be taken into account when prescribing medicine to older adults. Interventions targeting older adult patients with heart failure might reduce inappropriate medicine use.

Preventing the Abuse and Misuse of Over-the-Counter Medicines: A Survey of Community Pharmacists in Finland

Background Over-the-counter (OTC) medicines intended for short-term use for self-care may be abused or misused. Aim To explore the experiences and perceptions of community pharmacists (dispensers, pharmacists, and pharmacy owners) of the use, abuse, and misuse of OTC medicines by pharmacy customers, and to identify their perceptions of the most appropriate methods to prevent inappropriate use of OTC medicines. Method A cross-sectional national online survey to community pharmacists in Finland. A previously validated structured questionnaire was modified. Three national pharmaceutical associations were contacted to help in recruitment of their members (n = 5594, calculated target sample size n = 360). Descriptive statistical analyses were conducted. Results In total, 442 responses were received. Most respondents strongly agreed (Md all = 5) that OTC medicines could be abused or misused; pharmacy owners were more likely to strongly agree than pharmacists (p = 0.012). Pharmacy owners were more likely to think that laxatives were liable for abuse than dispensers (p = 0.008), and that travel sickness medicines were liable for misuse than dispensers (p < 0.001) and pharmacists (p = 0.013). Patient counseling was the most commonly employed method to prevent the problem. Respondents perceived that providing training to staff about OTC medicines that can be abused (Md all = 5) was the most appropriate strategy to prevent OTC medicine abuse; pharmacy owners were more likely to strongly agree or agree of this (p = 0.005) than dispensers. Conclusion: Community pharmacists are aware of the liability of OTC medicines for the potential abuse and misuse. They employ various methods as advising and counseling the customer to support the rational use of OTC medicines.

Application of the waiting time distribution in a nationwide screening of real-world dermatology drug utilization for aberrant use patterns.

Inappropriate use of medicines may have critical consequences from individual, public health, and economic perspectives. Discovering wrongful medicine use may require intentional surveillance or screening. The objectives of this study were to: (i) apply and evaluate the waiting time distribution (WTD) method as a screening tool for identifying aberrant drug use and (ii) evaluate the nationwide use of Dermatology drugs in Denmark for signals of aberrant drug use. Dermatology drug use data from the Danish nationwide healthcare registries from 2018 to 2020 were used to produce WTDs that were analyzed for drug use patterns. The method provides estimates of the prevalence and incidence and enables estimation of mean treatment duration, drug relapse, and unexpected drug prescribing. The study included 2 027 889 individual drug users and analyzed 6 141 449 prescriptions. The analysis included approximately 100 dermatology drugs and drug categories and produced 56 WTD drug curves. The WTD patterns and epidemiological estimates confirmed that most drugs are used as intended and revealed few unexpected patterns for further investigation. Three unexpected findings were identified concerning (i) short-term use that would entail suboptimal clinical efficiency for minoxidil, (ii) sub-optimal use of topical tacrolimus, and (iii) potential undesirable increase in short-course doxycycline treatments. In Denmark, dermatology drugs are predominantly used as expected, with few unexpected use patterns identified. Targeted specific follow-up on the identified signals is necessary for conclusions about inappropriate use. The findings suggest that the WTD method is applicable for screening for aberrant drug use.

Family Medicine Residents Awareness of Rational Drug Use in Geriatric Patients and Their Need for a Web Application

The term polypharmacy is generally known as the simultaneous use of five or more medicines. An increase in polypharmacy is also observed with chronic diseases, which increases with age. The main complications of polypharmacy are medicine side effects, inappropriate medicine use, drug-drug interaction, and drug-disease interactions. Family physicians are the most effective physician group in coordinating medicine therapy, as they provide continuous, longitudinal, and comprehensive medical care to the individual. In this study, it was aimed to determine the need of an auxiliary web application regarding family medicine residents' awareness of polypharmacy side effects in geriatric population and to identify the barriers to rational drug use in their daily clinical practice. The research is a cross-sectional observational study, and all residents actively working in the Ankara City Hospital Family Medicine Clinic were planned to be included and were invited to the study. The study was conducted through survey application method under observation. It was determined that geriatric patients mostly referred to their "clinical experience" in rational drug use according to the participants. The obstacles faced by the participants in rational drug use were mostly in that of "not having enough knowledge" and "patient-centered medicine regulation to be difficult and time consuming". 75.3% of respondents (n=70) marked strongly agree and 18.3% marked agree (n=17) for the statement "I would like to have an easily accessible an artificial intelligence aided web application that I can use in my daily practice regarding polypharmacy side effects, such as drug-drug interactions, drug-chronic disease incompatibility, potentially inappropriate medicine (PIM) in the elderly" and the mean value of this proposition was determined as 4.65±0.7. This study showed that the resources used to detect polypharmacy and its complications were not used adequately and appropriately. Moreover, the study results present the need and demand for time-saving and facilitating auxiliary web applications to minimize PIM, drug-drug interaction, drug-chronic disease interaction in the elderly and to evaluate it in the light of current data to provide person-centered and comprehensive care in the clinician's practice.

Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service

BackgroundPolypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process.ObjectivesTo describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers.MethodAn implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge.ResultsOf 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. ConclusionImplementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862.

A retrospective analysis of therapeutic drug exposures in New Zealand National Poisons Centre data 2018–2020

ObjectiveThe New Zealand National Poisons Centre advises the general public and health professionals on management of exposures to various substances. The epidemiology of medicine exposures was used to characterise inappropriate use of medicines across age groups. MethodsData from contacts in 2018–2020 were analysed: patient demographics (age, gender), number of therapeutic substances, and advice given. The most frequent individual therapeutic substance exposures across age groups and the reasons for these occurring were determined. ResultsA total of 76% of children’s (aged 0–12 or unknown child) exposures were exploratory in nature, involving a variety of medicines. Youth (aged 13–19) had frequently engaged in intentional self-poisoning (61% of their exposures), and most commonly by exposure to paracetamol, antidepressants, and quetiapine. Adults (aged 20–64) and older adults (aged 65 and over) were frequently affected by therapeutic errors (50% and 86% of their exposures, respectively). Adults were most frequently exposed to paracetamol, codeine, tramadol, antidepressants, and hypnotics, while older adults were exposed to paracetamol and various cardiac medications. ConclusionsTypes of inappropriate medicine exposures vary in different age groups. Implications for public healthPoisons centre data add to pharmacovigilance monitoring of potential harm from medicines and inform medication safety policies and interventions.

Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals

IntroductionOlder adults are among the most vulnerable groups during the COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce the number of potentially inappropriate medications but these services were halted during COVID-19.AimTo assess the prevalence and factors associated with inappropriate medicine use among older populations with COVID-19.MethodsThis was a cross-sectional, retrospective analysis of medications among hospitalized older adults with COVID-19. Potentially inappropriate medication use was categorized using the Beer’s and STOPP criteria.ResultsCombining both criteria, 181 (32.7%) of the 553 patients were identified to have used at least one or more potentially inappropriate medication. A marginally higher number of inappropriate medications was documented using the Beers 2019 criteria (151 PIM in 124 patients) compared to STOPP criteria (133 PIMS in 104 patients). The long-term use of proton pump inhibitors (n = 68; 12.3%) and drugs which increases the risk of postural hypotension were the most commonly reported PIM (n = 41; 7.4%). Potentially inappropriate medication use was associated with previous history of hospital admission in the past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29–3.99) and higher number of discharge medications.ConclusionsNearly, one in three older adults with COVID-19 had been prescribed a PIM, and the proportion of older adults with polypharmacy increased after discharge. This highlights the importance of having clinical pharmacist conducting medication reviews to identify PIMs and ensure medication appropriateness.

Medicine use in children aged under 12 years-Population survey in Finland.

To study the prevalence of prescribed and over-the-counter (OTC) medicine use in children under 12 years of age in Finland and to examine factors associated with the medicine use. A nationwide population survey was carried out in Finland in spring 2018 with a random sample of children under 12 years (n= 8000). A response rate of 24% (n= 1921) was attained. The questionnaire was sent to the child's primary guardian. Current use of prescribed medicines and the use of OTC medicines in the preceding 2 days were the main outcome measures. Of all the children 19% had used prescribed medicines, 15% OTC medicines, and 31% either prescription or OTC medicines during the preceding 22 days. Children's health related factors were positively associated with prescribed medicine use including fairly good to poor health status, symptoms experienced, and illnesses diagnosed by a physician. The guardian's healthcare education and use of prescribed medicines were also associated with children's prescribed medicine use. Symptoms of illnesses and fairly good health status were found to be associated with childrens' use of OTC medicines. The use of medicines in children under 12 years of age is quite common in Finland. As expected, children's health-related factors were associated with medicine use. Also, guardians' healthcare education and the use of prescribed medicines were associated with children's prescription medicine use. Children's medicine use should be continuously monitored and investigated further to identify the reasons leading to appropriate and inappropriate medicine use in children.

Comparison of Two Diagnostic Techniques for the Apis mellifera Varroatosis: Strengths, Weaknesses and Impact on the Honeybee Health.

Simple SummaryVarroa destructor is the main parasite affecting the health of adult honey bees and their larval forms. This mite negatively influences beekeeping income, as it can cause a decrease in yields and the loss of entire colonies of an apiary. To control this parasite, it is essential to establish the level of infestation through a precise diagnosis. In this work, two techniques used for the diagnosis of V. destructor on a bee sample were compared: the sugar roll test and CO2 injection. Both techniques were evaluated with the Varroa EasyCheck tool. This device is particularly versatile because it allows you to choose between different diagnostic techniques. The results of a comparison show that the sugar roll technique is cheaper and results in greater diagnostic accuracy. Both methods do not have a major impact on the health and welfare of bees compared to the alcohol washing method, which results in the death of the test sample. This study is of particular practical value, as it guides beekeepers in choosing the technique to use in a crucial practice for breeding, which is diagnosis.Varroa destructor is the most dangerous pest that poses a threat to honey bee survival. In recent years, increasingly worrying phenomena of drug resistance have occurred to various active ingredients of pharmaceutical formulations used to control this parasitosis. Determining the level of infestation is essential to preventing the inappropriate use and abuse of veterinary medicines, and to choose the most appropriate time for treatment. This comparative study investigates the sensitivity and diagnostic accuracy of two field techniques for diagnosing V. destructor infestations in hives. The EasyCheck device (Véto-pharma) was used in two of its application modes, namely, the sugar roll test and carbon dioxide (CO2) injection. The experiments were conducted on 15 samples of 300 bees each taken from the same frame and checked for the presence of mites using standard and modified field techniques in both uncaged and caged queen hive conditions. The results demonstrate that the sugar roll technique is significantly more effective and safer than CO2 injection, allowing for a higher accuracy in diagnosing a V. destructor infestation. Furthermore, the evaluation of mites present on bees in brood block conditions has proven to be particularly reliable. Considering the number of mites on the filter of the device as an additional step helps to implement the diagnostic accuracy of the CO2 injection technique, however, not achieving the efficacy results of the sugar roll.

National survey on World Health Organization/International Network of Rational Use of Drugs core drug use indicators in the outpatient setting and availability of medicines in a developing South Asian country

Abstract Objectives To describe the availability of medicines and World Health Organization (WHO)/International Network of Rational Use of Drugs (INRUD) core drug use indicators in a nationally representative sample of outpatient department (OPD) pharmacies in government hospitals of Sri Lanka. Methods This descriptive-cross-sectional national survey was conducted in OPD pharmacies in government hospitals, representing all 25 districts of Sri Lanka. WHO/INRUD core prescribing indicators were evaluated, together with the identification of the most commonly prescribed medications. To measure the availability of medicines, a list of 103 medicines from the WHO Global Core List (GCL), WHO/South East Asia Regional Office (SEARO) Regional Core List (RCL) and a national ‘Supplementary List’ were surveyed. Key findings A total of 3055 prescriptions were evaluated. There were 88 different medications prescribed with the commonest being paracetamol (n = 578; 18.9%). The average number of medicines per encounter was 3.3 ± 1.4 (range 1–10). Overall, the percentage of encounters with an antibiotic was 43.4% (n = 1327). There were 178 prescriptions where more than one antibiotic (5.8%) has been prescribed. Overall, the percentage of encounters with an injection was only 0.5% (n = 14). The percentage of medicines prescribed by generic name and from the essential medicine list (EML) was 84.3% and 98.9%, respectively. The average availability of medicines overall was 71.8% (range 0–100%). On average, medicines from the WHO/Health Action International GCL, WHO-SEARO RCL and national supplementary list were available in 69.8%, 75.8% and 71.3% of hospital OPD pharmacies, respectively. Conclusions The major contributors to irrational prescribing and inappropriate use of medicines in this setting were polypharmacy and prescription of antibiotics. Prescribing by generic name, use of injectable preparations and use of medicines from the EML conformed to the WHO-recommended optimal levels to a great extent.

Errors and the inappropriate use of medicines in UK care homes

Medication errors can occur at any stage of the medication use cycle: prescribing, dispensing, administration or monitoring. Medication errors can have grave consequences, particularly in older and frail patients. These patients are often residents in care homes, which found themselves in the spotlight during the COVID-19 pandemic for failures in upholding the standards of […]