Inappropriate Use Research Articles

Surgical Site Infections in Gastrointestinal Surgeries: Estimation of Prevalence, Risk Factors and Bacteriological Profile.

Surgical site infections (SSIs) are one of the leading causes of operation-related adverse effects.To create an effective hospital infection program, information about a local pattern is essential. The ever-changing pattern of infections and inappropriate use of antibiotics has predisposed to the development of drug-resistant strains and has made the management of SSIs arduous. The purpose of this study is to estimate prevalence and identify risk factors and commonest organisms associated with SSIs. In this analytical cross-sectional study, the relationship between various risk factors and the development of SSIswas evaluated in patients undergoing elective surgery and staying at least seven days postoperatively in the Department of Surgical Gastroenterology and Liver transplant for a study duration of two months. Diagnosis of SSIs was based on modified CDC criteria. Wound pus was followed by blood collection in suspected secondary septicemia. MacConkey and blood agar were used to culture pus; brain heart infusion broth was used for blood samples. Antimicrobial susceptibility testing was carried out using Mueller-Hinton agar by the Kirby-Bauermethod. Twelve out of 50 had developed postsurgical wound infections where Gram-negative organisms prevailed over Gram-positive ones. The associated risk factors identified in this study are age, BMI, wound class, American Society of Anesthesiologists (ASA) score, preprocedural WBC count >10,000, and the duration of surgery. Escherichia coli is the causative microbe for the majority of infections (35.7%). Gram-negative bacteria isolated in this study were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant organisms were predominant. Conclusion: The present study identified an SSI rate of 24% in gastrointestinal surgeries. The sensitivity and resistance pattern of the organisms isolated will help in measures to be taken to devise a proper and effective current hospital antibiotic prophylaxis policy.

Exploring the Influence of Family Attitudes and Individual Psychological Factors on Antibiotic Utilization: A Pilot Study.

The inappropriate use of antibiotics gives rise to detrimental consequences, both physical and emotional, with a decreased quality of life and higher levels of anxiety and depression. The current observational study aimed to investigate the association between awareness, beliefs, and behaviors toward antibiotics, highlighting the modulating role of individual and psychological factors in response to illness and medication. Through an online questionnaire, several psychological indexes, as well as knowledge of, attitude toward, and experiences with antibiotics, both individual and family-related, were assessed in a sample of 100 responders (74 females, mean age 33.37 ± 11.36). A positive association between intake behavior, awareness, and individual attitude emerged. Familial approach to antibiotics appears as a predictor of individual attitude and behavior toward these drugs, and awareness about antibiotic risks mediate the relationship between the tendency to be more compliant with prescriptions (R2 = 0.300; MSE = 1.541; F(2, 98) = 20.737; p < 0.0001). Moreover, individuals with a personality characterized by higher conscientiousness are more aware of antibiotic risks (p < 0.01), whereas individuals with a lower awareness are those with higher indexes of psychophysical discomfort (i.e., anxiety, perceived stress, somatization) and levels of emotional rebound (p < 0.05). Anxiety (F(3, 96) = 3.874; p = 0.012; R2 = 0.108) and somatization (F(2, 97) = 3.114; p = 0.030; R2 = 0.089) also significatively moderated the intake behavior, despite the family approach. Overall, the current study provides preliminary findings regarding the way in which family experiences and individual psychological aspects may be influencing factors in the behavior and attitude towards antibiotics and can be used to plan patient-centered therapeutic communication and education.

Automated surveillance of antimicrobial consumption in intensive care, northern Sweden: an observational case study

BackgroundThe digitalization of information systems allows automatic measurement of antimicrobial consumption (AMC), helping address antibiotic resistance from inappropriate drug use without compromising patient safety.ObjectivesDescribe and characterize a new automated AMC surveillance service for intensive care units (ICUs), with data stratified by referral clinic and linked with individual patient risk factors, disease severity, and mortality.MethodsAn automated service collecting data from the electronic medical record was developed, implemented, and validated in a healthcare region in northern Sweden. We performed an observational study from January 1, 2018, to December 31, 2021, encompassing general ICU care for all ≥18-years-olds in a catchment population of 270000 in secondary care and 900000 in tertiary care. We used descriptive analyses to associate ICU population characteristics with AMC outcomes over time, including days of therapy (DOT), length of therapy, defined daily doses, and mortality.ResultsThere were 5608 admissions among 5190 patients with a median age of 65 (IQR 48-75) years, 41.2% females. The 30-day mortality was 18.3%. Total AMC was 1177 DOTs in secondary and 1261 DOTs per 1000 patient days and tertiary care. AMC varied significantly among referral clinics, with the highest total among 810 general surgery admissions in tertiary care at 1486 DOTs per 1000 patient days. Case-mix effects on the AMC were apparent during COVID-19 waves highlighting the need to account for case-mix. Patients exposed to more than three antimicrobial drug classes (N = 242) had a 30-day mortality rate of 40.6%, with significant variability in their expected rates based on admission scores.ConclusionWe introduce a new service and instructions for automating local ICU-AMC data collection. The versatile long-term ICU-AMC metrics presented, covering patient factors, referral clinics and mortality outcomes, are expected to be beneficial in refining antimicrobial drug use.

The effectiveness of a protocol without routine radiographs for follow-up of adolescent idiopathic scoliosis patients (CURVE): a study protocol.

Current follow-up protocols for adolescent idiopathic scoliosis (AIS) are based on consensus and consist of regular full-spine radiographs to monitor curve progression and surgical complications. Consensus exists to avoid inappropriate use of radiographs in children. It is unknown whether a standard radiologic follow-up (S-FU) approach is necessary or if a patient-empowered follow-up (PE-FU) approach can reduce the number of radiographs without treatment consequences. A nationwide multicenter pragmatic randomized preference trial was designed for 3 follow-up subgroups (pre-treatment, post-brace, post-surgery) to compare PE-FU and S-FU. 812 patients with AIS (age 10-18 years) will be included in the randomized trial or preference cohorts. Primary outcome is the proportion of radiographs with a treatment consequence for each subgroup. Secondary outcomes consist of the proportion of patients with delayed initiation of treatment due to non-routine radiographic follow-up, radiation exposure, societal costs, positive predictive value, and interrelation of clinical assessment, quality of life, and parameters for initiation of treatment during follow-up. Outcomes will be analyzed using linear mixed-effects models, adjusted for relevant baseline covariates, and are based on intention-to-treat principle. Study summary: (i) a national, multicenter pragmatic randomized trial addressing the optimal frequency of radiographic follow-up in patients with AIS; (ii) first study that includes patient-empowered follow-up; (iii) an inclusive study with 3 follow-up subgroups and few exclusion criteria representative for clinical reality; (iv) preference cohorts alongside to amplify generalizability; (v) first study conducting an economic evaluation comparing both follow-up approaches.

Younger Children with Respiratory Tract Infections Are More Exposed to Off-Label Treatments: An Exploratory Retrospective Study in a Pediatric Emergency Setting.

We performed a retrospective data analysis. All patients aged 0-18 referred to PED from 1 September to 1 October 2022, were included. Further analysis was performed when respiratory tract infections were diagnosed. gender, age, triage group, chronic diseases, vital signs, and PED-prescribed treatment (medications, dosages, methods of administration). Statistical analysis used SPSS 28.0, with significance at p < 0.05. Data from 473 patients were analyzed, median age 3.5 years. Chronic diseases were present in 17.1% of children. 387 medications were prescribed, 47.5% being off-label. Off-label treatment was common for external otitis, acute laryngitis, and acute bronchitis (p < 0.001). There was incorrect administration of tobramycin with dexamethasone for otitis (n = 16, 100%) and inappropriate use of salbutamol inhalations by age (34.8%, n = 16). Some medications were given orally instead of injections (ondansetron n = 5, 62.5%; dexamethasone n = 82, 98.7%) or intranasally instead of intravenously (IV) (midazolam n = 7, 87.5%). IV adrenalin was prescribed for inhalations (n = 46). Younger children were more likely to receive off-label treatment (p < 0.001). Our study highlights the widespread issue of off-label and unlicensed drug prescribing in pediatric emergency care. Further research is necessary, because this reliance on off-label prescribing raises concerns about patient safety and compliance, especially given the limited clinical trials and therapeutic options available.

Incision and drainage as mainstay therapy in antibioma: A case report

Antibioma is a chronic sterile, tough fibrous abscess formed commonly due to prolonged and inappropriate use of antibiotics for infections, without facilitating proper drainage of the pus. It is a localized swelling which is painless, smooth, non-tender and firm on palpation. It is only after the abscess has been incised, the body defence mechanism and antibiotic can eradicate the infection by releasing pressure, increasing blood circulation and oxygen to the anaerobic environment. Here, a rare case of antibioma in the neck of an 8 year old male child who had undergone extraction of an offending tooth to eradicate the infection. However, inadequate drainage of the abscess and lack of proper postoperative follow-up led to persistence of residual infection.

The Limits of Analogy in Establishing the Legal Consequences of a Fictitious Divorce

In the Russian and foreign family legal reality, the practice of inappropriate use of divorces has become widespread. With the general attention of law to fictitious legally significant phenomena in the context of normative uncertainty of the concept, signs and consequences of fictitious divorce, it is necessary to check and take into account the possibilities of analogy as a traditional means of filling legal gaps in private law regulation in relation to the problem of the lack of legislative regulation of the legal consequences of fictitious divorces. At the same time, the method of analogy can and should act not only as one of the objects of study, but also as a means of achieving a scientific result. The study raises and rejects the scientific hypothesis about the similarity of the normatively undefined consequences of the depravity of the causa of a fictitious divorce and the regulated consequences of a fictitious marriage. At the same time, the author shows the positive role of the analogy of law as part of the means of settlement and family law disputes and methods of countering unfair behavior in marriage dissolution without the purpose of its termination. The significance of the work is manifested in its ability to doctrinally support the legislator’s abstinence from direct normative consolidation of the criteria of fictitious divorce and its invalidity. At the same time, the article indicates the way to situationally overcome the uncertainty of the concept under consideration using the analogy of law.

ASPECTS OF FOOD SAFETY ISSUES IN MODERN AGRICULTURE

Foodborne illnesses remain a persistent public health threat, with thousands of outbreaks each year caused by contaminated produce, meat, and dairy. The study analyzed food safety risks associated with traditional industrial farming practices, including concentrated animal feeding operations (CAFOs), large-scale produce production, and nationwide processing and distribution networks. Quantitative analysis of outbreak data reveals hot spots of contamination in commodities and the food system. Qualitative research and interviews contextualize the complex contamination pathways and challenges of preventing the spread of pathogens in modern agriculture. The main risks include inappropriate manure use, contaminated irrigation water, undersized buffer zones and inadequate sanitation at processing facilities. Policy improvements related to livestock density, water treatment, and implementation of protection plans may help reduce future threats. Ultimately, enhancing food safety in a way that does not compromise productivity and affordability requires a comprehensive, systems-level approach across the farm, processing facility, and regulatory agency. KEYWORDS: food safety, foodborne illness, industrial agriculture, commodities, contamination, pathogens, policy

Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers?

Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.

Management of potentially inappropriate medication use among older adult’s patients in primary care settings: description of an interventional prospective non-randomized study

BackgroundThe management of inappropriate medication use in older patients suffering from multimorbidity and polymedication is a major healthcare challenge. In a primary care setting, a medication review is an effective tool through which a pharmacist can collaborate with a practitioner to detect inappropriate drug use.AimThis project described the implementation of a systematic process for the management of potentially inappropriate medication use among Lebanese older adults. Its aim was to involve pharmacists in geriatric care and to suggest treatment optimization through the analysis of prescriptions using explicit and implicit criteria.MethodThis study evaluated the medications of patients over 65 years taking a minimum of five chronic medications a day in different regions of Lebanon. Descriptive statistics for all the included variables using mean and standard deviation (Mean (SD)) for continuous variables and frequency and percentage (n, (%)) for multinomial variables were then performed.ResultsA total of 850 patients (50.7% women, 28.6% frail, 75.7 (8.01) mean age (SD)) were included in this study. The mean number of drugs per prescription was 7.10 (2.45). Roughly 88% of patients (n = 748) had at least one potentially inappropriate drug prescription: 66.4% and 64.4% of the patients had at least 1 drug with an unfavorable benefit-to-risk ratio according to Beers and EU(7)-PIM respectively. Nearly 50.4% of patients took at least one medication with no indication. The pharmacists recommended discontinuing medication for 76.5% of the cases of drug related problems. 26.6% of the overall proposed interventions were implemented.DiscussionThe rate of potentially inappropriate drug prescribing (PIDP) (88%) was higher than the rates previously reported in Europe, US, and Canada. It was also higher than studies conducted in Lebanon where it varied from 22.4 to 80% depending on the explicit criteria used, the settings, and the medical conditions of the patients. We used both implicit and explicit criteria with five different lists to improve the detection of all types of inappropriate medication use since Lebanon obtains drugs from many different sources. Another potential source for variation is the lack of a standardized process for the assessment of outpatient medication use in the elderly.ConclusionThe prevalence PIDP detected in the sample was higher than the percentages reported in previous literature. Systematic review of prescriptions has the capacity to identify and resolve pharmaceutical care issues thus improving geriatric care.

Impact of narcotics information management system on inappropriate benzodiazepine receptor agonist prescriptions: A quasi-experimental analysis in South Korea.

The South Korean government implemented the narcotics information management system (NIMS) on 18 May 2018 to manage benzodiazepine receptor agonists (BzRAs) and narcotics effectively and establish a reporting mechanism for these drugs. This study assessed the effects of NIMS on inappropriate use of BzRAs. Using national patient sample data from 2016 to 2020, we analysed adult outpatients who were prescribed oral BzRAs. We conducted a time series and segmented regression analysis using selected indicators to analyse the monthly variations related to the inappropriate use of these medications. The study revealed no significant changes in the indicators of inappropriate BzRA use following the NIMS implementation. Contrary to expectations, there was a significant increase in the proportion of patients exceeding defined daily dose (DDD) and in those receiving concurrent prescriptions of multiple BzRAs, following the implementation of NIMS. The immediate impact of the COVID-19 pandemic was an increase in DDD exceedance; however, overall, this did not significantly affect BzRA use. The introduction of NIMS did not significantly enhance the management of BzRA misuse. Additional measures, including continuous monitoring, system improvements and comprehensive education for prescribers and patients, are recommended to ensure the appropriate use of psychotropic medications.

Enhancing Medication Safety through Implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults.

To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.

Estimating the Total and Regional Body Fat of Physically Active Men Is Not Appropriate for Sedentary Men

Objectives. The reliability of predictive body fat equations remains unclear due to their inappropriate use across different subject cohorts and conditions. The objective of this study was to validate and cross-validate equations to predict total and regional body fat in young physically active males. Material and methods. Three hundred and five young male participants were divided into the following groups: active validation (n=165), active cross-validation (n=70), or sedentary cross-validation ones (n=70). The study used a stratified random sampling based on weekly physical activity level. The total and regional body fat mass were measured using dual-energy X-ray absorptiometry (DEXA) after an overnight fast. Simultaneous measurements of height, body mass, skinfold thickness, body mass index, and body circumferences were taken. The total and regional body fat predictive equations were generated using multiple linear stepwise regression models. The coefficient of determination (R²) and standard error of estimation (SEE) were calculated to examine the accuracy of the predictive equations. Furthermore, cross-validation groups were analysed. Results. The percentage of total body fat, trunk fat, legs fat, arms fat, and body mass index of active cross-validation were found to be significantly lower than in the sedentary cross-validation groups. The total body fat percentage was highly associated with abdominal skinfold thickness (R=0.68-0.74, P&lt;0.001), body mass index (R=0.55, P&lt;0.001), and suprailiac skinfold thickness (R=0.67-0.71, P&lt;0.001) in the active validation group. The predictive total and regional body fat equations of physically active men showed adjusted R² values ranging from 0.35 to 0.66, with standard error of estimation values between 2.74 to 4.35%. The standard error of estimation for the predictive percentage of total and regional body fat in the active cross-validation group was lower than in the sedentary cross-validation group. Conclusions. The findings demonstrate that new predictive total and regional body fat equations can be used to accurately estimate body fat in healthy young active males under fast conditions.

Tumor misdiagnosis resulting in inappropriate use of biologics.

Unilateral or destructive sinonasal disease should raise suspicion for tumor. Patients receiving biologic therapy for CRSwNP should be carefully selected. Tissue diagnosis should be considered prior to starting biologics for nasal polyposis.

Resistance Analysis Of Several Antibiotics in Samples of Clinical Isolates With Salmonellosis

Typhus is a systemic infection caused by Salmonella typhi bacteria, which is usually transmitted through contaminated food or drink, usually treated with antibiotics. Inappropriate use of antibiotics causes various problems, one of which causes resistance. This resistance problem has become a global problem, including in Indonesia where there is an increase in bacterial resistance from 2013 which is 40%, 2016 as much as 60% and in 2019 reached 60.4%, due to irrational use of antibiotics so that bacteria become resistant to drugs. This study aims to determine the description of resistance to several antibiotics in clinical isolates of patients with Salmonellosis This study is a pre-experimental study, with a cross sectional approach. The samples used were pure isolates of Salmonella typhi bacteria obtained from blood samples of Salmonellosis patients, then tested for resistance with 5 different types of antibiotics (Ciprofloxacin, Amoxicillin, Levofloxacin, Cefotaxime and Sulfamethoxazolle-trimethopim) with the disk method (Kearby Beaure). The number of experimental units is 25 units, with the number of replications is 5 replications. The results showed that the five types of antibiotics were sensitive to Salmonella typhi bacteria with the highest antibiotic sensitivity being Ciprofloxacin while the antibiotic that had the lowest sensitivity was Amoxicillin. From the results, it can be concluded that the resistance test of the five antibiotics (Ciprofloxacin, Amoxicillin, Levofloxacin, Cefotaxime and Sulfamethoxazolle-trimethopim) is sensitive.

Unveiling the ecological landscape of bacterial β-lactam resistance in Delhi-national capital region, India: An emerging health concern

Inappropriate antibiotic use not only amplifies the threat of antimicrobial resistance (AMR), moreover exacerbates the spread of resistant bacterial strains and genes in the environment, underscoring the critical need for effective research and interventions. Our aim is to assess the prevalence and resistance characteristics of β-lactam resistant bacteria (BLRB) and β-lactamase resistant bacterial genes (BLRBGs) under various environmental conditions within Delhi NCR, India. Using a culture-dependent method, we isolated 130 BLRB from 75 different environmental samples, including lakes, ponds, the Yamuna River, agricultural soil, aquatic weeds, drains, dumping yards, STPs, and gaushalas. Tests for antibiotic susceptibility were conducted in addition to phenotypic and genotypic identification of BLs and integron genes. The water and sediment samples recorded an average bacterial abundance of 3.6 × 106 CFU/mL and an average ampicillin-resistant bacterial count of 2.2 × 106 CFU/mL, which can be considered a potent reservoir of BLRB and BLRBGs. The majority of the BLRB discovered are opportunistic pathogens from the Bacillus, Aeromonas, Pseudomonas, Enterobacter, Escherichia, and Klebsiella genera, with Multiple Antibiotic Resistance (MAR) index ≥0.2 against a wide variety of β-lactams and β-lactamase (BLs) inhibitor combinations. The antibiotic resistance pattern was similar in the case of bacteria isolated from STPs. Meanwhile, bacteria isolated from other sources were diverse in their antibiotic resistance profile. Interestingly, we discovered that 10 isolates of various origins produce both Extended Spectrum BLs and Metallo BLs, as well as found harboring blaTEM, blaCTX, blaOXA, blaSHV, int-1, and int-3 genes. Enterobacter cloacae (S50/A), a common nosocomial pathogen isolated from Yamuna River sediment samples at Nizamuddin point, possesses three BLRBGs (blaTEM, blaCTX, and blaOXA) and a MAR index of 1.0, which is a major cause for concern. Therefore, identifying the source, origin and dissemination of BLRB and BLRGs in the environment is of the utmost importance for designing effective mitigation approaches to reduce a load of antimicrobial resistance factors in the environmental settings.

Loop diuretic therapy with or without heart failure: impact on prognosis.

Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis. Glasgow regional health records (2009-16) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and comorbid disease (adjHR). Of 198 898 patients (median age 65 years; 55% women), 161 935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23 963 (12%) were taking loop diuretics but had no heart failure recorded, 7844 (4%) had heart failure recorded and took loop diuretics, and 5156 (3%) had heart failure recorded but were not receiving loop diuretics. Compared to the reference group, five-year mortality was only slightly higher for heart failure in the absence of loop diuretics [22%; adjHR 1.2 (95% CI 1.1-1.3)], substantially higher for those taking loop diuretics with no record of heart failure [40%; adjHR 1.8 (95% CI 1.7-1.8)], and highest for heart failure treated with loop diuretics [52%; adjHR 2.2 (95% CI 2.0-2.2)]. For patients with cardiovascular disease, many are prescribed loop diuretics without a recorded diagnosis of heart failure. Mortality is more strongly associated with loop diuretic use than with a record of heart failure. The diagnosis of heart failure may be often missed, or loop diuretic use is associated with other conditions with a prognosis similar to heart failure, or inappropriate loop diuretic use increases mortality; all might be true.

The Prevalence of Duplicate Prescription of Oral Antibiotic Drugs in Outpatient Care among People Insured by Corporate Health Insurance Societies in Japan.

Inappropriate antimicrobial use is a global problem, especially because the use of antimicrobials in excess of appropriate doses is associated with increased antimicrobial resistance. Duplicate prescriptions are an issue contributing to inappropriate antimicrobial use. This study aimed to analyse antibiotic prescriptions during a specific month to examine the frequency of outpatients receiving duplicate antibiotic prescriptions and the associated determinants. Utilizing the Japan Medical Data Centre health insurance claim database, we retrospectively identified 527,110 insured individuals with at least one medicine prescription in October 2014. Data regarding age, gender, antibiotic drug usage, and health insurance status were extracted. Duplicate prescriptions entailed a patient receiving two or more prescriptions of systemic antibiotics from multiple facilities within one month. The risk factors for duplicate antibiotic prescriptions were evaluated using logistic regression analysis. Of the total sample, 131,709 individuals (25.0%) received antibiotics, and 24,529 of these individuals (18.6%) had duplicate prescriptions. Third-generation cephalosporins accounted for the largest proportion of prescriptions (37.4%). Duplicate prescriptions were significantly associated with sex, age, medical facilities, and health insurance status. These findings could help to identify patients at risk of duplicate antibiotic prescriptions, highlighting the need to promote proper antimicrobial use in both patients and medical professionals.

Timely care for age-related macular degeneration: a qualitative study among retina specialists in Israel

BackgroundAge-related macular degeneration (AMD) affects quality of life and independence, and its incidence and prevalence are increasing due to ageing of the population. Access to effective timely treatment can improve vision and reduce incidence of blindness. This study aimed to explore the perspectives of ophthalmologists in the Israeli public healthcare system regarding timely treatment of AMD patients.MethodsQualitative semi-structured interviews were conducted in 2020-2021 with 22 senior ophthalmologists, from 10 general hospitals and from two HMOs, representing different geographic regions. All interviewees specialize in retinal diseases and work with AMD patients. Interviews discussed patient pathways involved in the diagnosis and treatment of AMD, access to care, and obstacles to timely care. Thematic analysis was conducted.ResultsBased on the interviews, we describe the usual referral and treatment pathways. Themes included regional disparities, long wait times in some areas, a lack of retina specialists, differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second-line treatment not fully covered by insurance, most affecting the weakest segments of the population.ConclusionsLoss of vision incurs high health and societal costs. In the context of insufficient medical manpower in Israel, the healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population. Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment. Awareness of AMD symptoms and the importance of early intervention could be highlighted by campaigns, particularly among high-risk groups.Highlights• Interviews with hospital-based and community ophthalmologists showed regional disparities in AMD treatment, with long wait times and a lack of retina specialists in some areas.• Differences in referral pathways, inappropriate use of emergency department to obtain timely treatment, and second line treatment not fully covered by insurance were highlighted.• The healthcare system will need to assess future resources to cope with accumulating burden of AMD cases over time in an ageing population• Precise referral information, and simultaneous referral to imaging and retinal clinics, may minimize delays in treatment.• Awareness of AMD symptoms and the importance of early intervention should be emphasized in high-risk groups.

Fenomena penyimpangan penggunaan kata serapan di Kota Kolaka

Inappropriate use of foreign words in the public sphere often occurs for several reasons, including ignorance of the original meaning of the word, influence from the surrounding environment, or unintentional use. In Indonesian, sometimes foreign words are used inappropriately or not in accordance with the rules. One of the foreign languages absorbed into Indonesian is Arabic. The research method uses qualitative research. Qualitative descriptive research to analyze data in the form of foreign language absorption words whose absorption is not in accordance with the standard language rules of Indonesian. The research was conducted during the month of Ramadan 1445 H/2024 M so that the phenomenon of deviation of absorption words that appeared in the public domain of Kolaka City focused on Arabic foreign absorption words. The data were collected by observing, interview, documenting, and document review the absorption vocabulary contained in the data sources in the form of notice boards, posters, banners, pamphlets, billboards, billboards, and others. The results showed that the most common mistakes found in the public domain of Kolaka City are the words ramadan, salat, prayer, musholah, ummat, muslimah, sholawat, dzuhur, and wudu which should use the words ramadan, prayer, musala, ummah, muslimat, salawat, zuhur, and wudu. The findings of this study are expected to have a good impact on society about the importance of paying attention to the context and original meaning of the absorbing words used in communication. A good understanding of the language of origin of an absorbed word in the appropriate context. Thus, errors in the use of absorbing words can be minimized and effective communication can be maintained. Keywords: Phenomenon, Deviation, Adapted Words, Public Space