Inappropriate Use Research Articles

Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications and mortality in a tertiary university hospital in Saudi Arabia.

Introduction. There are many multidrug-resistant isolates of the nosocomial pathogen, Acinetobacter baumannii, causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates. Aim. This study aims to retrospectively analyse A. baumannii bacteraemia (ABB) cases in Saudi Arabia, where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes and mortality associated with this infection. Methods. A retrospective chart review was conducted between 1 January 2015 and 31 December 2022 to identify all patients aged 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients' electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality. Results. Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson Comorbidity Index, Pitt bacteraemia score, quick Sequential Organ Failure Assessment score (P<0.001 for each), hospital ward (P<0.02), short duration of antibiotic treatment (P<0.01) and higher age (P<0.05). The most common source of infection was central line-associated bloodstream infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (P<0.02) and empirical use of colistin (P<0.05). In many patients, ABB was caused by carbapenem-resistant A. baumannii [(CRAB), 69.6%], and 74.4% of those patients died. Conclusion. To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia, especially in the critical care setting, and carries a very high risk of mortality.

Antibiotic Practices and The Rate of Surgical Site Infection Following Cesarean Section

Background: Cesarean section (CS) is the most performed operation globally. It’s a clean-contaminated surgery with higher surgical site infections (SSIs) risk. The mortality rate associated with cesarean section in Africa is 50 times greater than in high income settings, 11 women die per 1000 CS in sub-Saharan Africa and 14% of women suffer complication (SSIs). Proper antibiotic use can reduce this burden however effective antibiotics are running out due to inappropriate use. This study aimed to assess the pre-cesarean and post-cesarean antibiotic practices and the rate of SSIs following CS at Mbale regional referral hospital (MRRH)Methods: The study was a retrospective and descriptive cross-sectional on CS mothers between 1st January 2020 and 31st December 2022 at MRRH. Out of the 2432 patient files reviewed, an equal number (104) of women who developed SSIs and those that did not develop SSIs (104) were selected by simple random sampling, total sample size of 208.Result: More than half (n=148; 71.2 %.) received antibiotic prophylaxis. Majority received I.V ceftriaxone (38.0%) within 15minutes (mean duration) before skin incision. 35.1% of 208 that received antibiotic prophylaxis developed SSIs. I.V Metronidazole and Ceftriaxone were the most administered after CS and Oral metronidazole was the most prescribed upon discharge.Conclusion : The rate of SSIs at MRRH was 3% similar to that of Mbarara regional referral hospital at 3.5%. Lack of antibiotics prophylaxis and poor antibiotic prophylaxix timing could explain this rateu underscoring compliance to International, National and Hospital surgical bundles.

Patient awareness and practices regarding antimicrobial use and drug resistance.

Drug-resistant bacterial infections have become a substantial problem in various communities. Appropriate antimicrobial use is required because reducing antimicrobial use could reduce the number of resistant bacteria. The inappropriate use of antimicrobials can be prevented by improving the knowledge of patients, physicians, and other healthcare professionals; however, no antimicrobial awareness survey specifically aimed at patients has been conducted yet. Therefore, to promote proper antimicrobial use, mainly by patients, we conducted a survey on the attitudes of patients who brought their antimicrobial prescriptions from insurance pharmacies. The results were based on 858 responses. Awareness of the terms "bacteria, viruses, and antimicrobials" was > 80%, whereas that of "drug-resistant bacteria" was only 37.2%. Only 26.5% of respondents understood what the efficacy of antimicrobial drugs meant. Additionally, 31.5% of the respondents had experienced discontinuation antimicrobials, and approximately 70% of the reasons for discontinuation were self-judged symptom improvement. Furthermore, those who had experienced discontinuation were less aware of the various aspects of antimicrobial use than those who had not. In antimicrobial treatment, avoiding the emergence of drug-resistant bacteria is difficult, is detrimental to patients consuming treatment, and presents a major problem in society. Therefore, healthcare professionals should strive to optimize infectious disease treatment by providing appropriate guidance on the proper use of antimicrobials, significance of taking them, and harmful effects of their discontinuation to patients.

Potentially Inappropriate Medication Use in Older Adults With Multimorbidity in Taiwan.

Medication-related problem is a concerning issue in older adults with multimorbidity due to complexity of disease conditions and polypharmacy, and may lead to increase in risk for adverse health outcomes. This study aims to investigate the prevalence and associated factors of potentially inappropriate medication use among the growing population of older adults with multimorbidity in Taiwan. The study population was composed of patients who were aged 65 years or older with multimorbidity (two or more chronic diseases) and had at least one outpatient clinic visit with drug prescription in 2018 identified from the Taiwan National Health Insurance Research Database. Potentially inappropriate medication use was defined using the 2019 Beers criteria for drugs to be avoided for older adults. Multiple logistic regression model was conducted to examine patient-related and prescriber-related factors associated with PIM use. A total of 2 432 416 patients (69.7% of the entire older adult population) had multimorbidity and received at least one drug prescription at the outpatient clinic in Taiwan in 2018. The prevalence of having at least one PIM in this population was found to be 85.6%. Patient-related factors (age, sex, specific chronic diseases, frequency of outpatient visits) and prescriber-related factors (physician characteristics, healthcare setting, total number of medications, prior PIM use) were found to be associated with use of PIM. High prevalence of PIM use was found in older patients with multimorbidity in Taiwan. Both patient-related and prescriber-related factors had been found to be predictors of PIM use, and should be addressed when trying to improve the medication quality in this population.

Endosulfan as Potentiometric Sensor in a Kinetic Model of Molecularly Imprinted Polymer (MIP)

Indonesia is an agrarian country with abundant agricultural and plantation land, where farmers often face severe challenge of pests damaging crop yields. To address this challenge, chemical agents such as pesticides and herbicides are used for plant management and care. However, the inappropriate use of these chemical agents poses significant risks to the environment when the prevalence surpasses environmental and human tolerance limits. Pesticides and herbicides containing endosulfan components require proper management to prevent adverse effects on humans and the environment. Therefore, this research aimed to develop Molecularly Imprinted Polymer (MIP) endosulfan pollutant sensors to assess the kinetics of MIP adsorption to endosulfan analyte. Among the various models used for assessment, the Freundlich Isotherm showed optimal results, with an AT value of 1.79 × 107 L/mg, B (Constant related to heat of sorption) of 6 x 10-8 J/mol, and b (Freundlich Isotherm constant) of 4.13×1010. Furthermore, the obtained distribution coefficient (R2) at 0.9768 was more effective compared to other models.

Impact of ChatGPT on Academic Integrity and Assessment Effectiveness for E-learning in Higher Education: The Need for Redesigning Assessment Practices

In recent years, there has been a growing trend of integrating Artificial Intelligence (AI) into e-learning in higher education. ChatGPT has emerged as one of the most widely utilised AI tools in students' studies. However, the emergence of ChatGPT has contributed to the development of education while simultaneously impacting the integrity of education and the effectiveness of traditional assessment methods. Whether the teacher's teaching goals are achieved or not, whether the students' learning is authentic and effective, and how to ensure the effectiveness of the assessment pose significant challenges to the educator or education sector in the context of artificial intelligence. Therefore, this paper aims to clarify the negative impact of ChatGPT on educational integrity and assessment effectiveness through a systematic literature review. Through the meticulous synthesis and analysis of diverse existing research, this paper finds that several scholars have already clarified the pressing need for redesigning the assessment method within the context of e-learning. However, further research has found that there are several theoretical countermeasures and suggestions for the redesign of assessment methods, but a systematic system of assessment methods has not yet been formed. And there is no reflective analysis of the practice of the redesigned assessment methods. Therefore, this paper will, through a systematic literature review and reflective summarisation of educational assessment practices, aim to investigate effective and responsible assessment methods to mitigate the impact of the rapid development and inappropriate use of ChatGPT on education.

YELLOW RoUTIne prospective cohort study protocol: insight in the dynamics of bacteria in the elderly bladder

BackgroundAsymptomatic bacteriuria (ASB) – the presence of bacteria in urine without urinary tract infection (UTI) related signs & symptoms (S&S) – is common in the elderly bladder and is not considered pathogenic for UTI. We hypothesise that colonisation with non-uropathogenic bacteria could protect the bladder from invasion of more harmful bacteria. The exact role and dynamics of bacteriuria in the relation to the development of a UTI is still unknown. We aim to provide insight into the course of bacteriuria in the elderly bladder and its relation to UTI in frail older adults.Methods and analysisA prospective observational cohort study is being conducted in Dutch nursing homes (NHs) between February 2024 and December 2025. Urine samples and case report forms (CRF) on UTI-related S&S will be collected from each consenting NH resident every 3 months for a follow-up period of 18 months. Whenever a UTI-suspicion occurs in between the 3 monthly time points, additional data and a urine sample will be collected. Urine samples undergo several urinalyses (e.g. dipstick and bacterial culture). Additional molecular analysis will be conducted on a selection of cultured Escherichia coli (E. coli) for virulence genes.Primary analyses will be conducted between residents with and without ASB at each time point. The primary outcome is UTI incidence during follow-up. In secondary analyses we will also take into account the low versus high presence of virulence genes of the E. coli.DiscussionThe combination of high ASB prevalence and a reduced ability of frail older adults to express UTI-related S&S may lead to UTI misdiagnosis and inappropriate antibiotic use. To our knowledge, this is the first study to investigate the dynamics and role of bacteriuria in the elderly bladder and their potential protective effect on the development of UTI.The study findings with comprehensive analysis of epidemiological, clinical and molecular data could set the fundamental base for future guidelines and studies, and contribute to improving prevention, diagnosis and treatment of UTI in frail older adults, in addition to contributing to antibiotic stewardship in NHs.

The Use of Proton Pump Inhibitors in Patients with Liver Cirrhosis: Real Life Experience.

(1) Background: Proton pump inhibitors (PPIs) are commonly prescribed for gastric disorders. In patients with liver cirrhosis, PPI use is associated with an increased risk of spontaneous bacterial peritonitis and increased mortality rates; therefore, they should be used with caution. This study aims to evaluate the appropriateness of PPI prescriptions in hospitalized cirrhotic patients against current clinical guidelines to identify patterns of misuse and guide better prescribing practices. (2) Methods: A retrospective study was conducted on liver cirrhosis inpatients in an internal medicine department from January 2022 to May 2023. The primary measure was the proportion of PPI prescriptions aligned with clinical guidelines. Medical files were entirely reviewed by researchers to assess the appropriateness of PPI prescriptions using the current guidelines. Outcomes included the identification of common reasons for PPI prescription and the rate of inappropriate PPI use among the study population. (3) Results: The study included 189 cirrhotic patients, with PPIs prescribed to 95 (50.2%) patients during hospitalization and 75 (39.7%) patients at discharge. Among those, 47.4% of the inpatients and 34.7% at discharge had no valid indication for PPI administration. The most common reason for PPI prescription during hospital stays was gastritis, followed by antiplatelet use in high-risk patients, ulcers, and upper gastrointestinal bleeding. The most common inappropriate indication was portal hypertensive gastropathy (PHG), followed by treatment with corticosteroids and anticoagulants alone. We did not find an association between PPI administration during hospital stays and infections. Only in 4% of cases patients should have received PPIs and did not. (4) Conclusions: There is a concerning overprescription of PPIs in cirrhotic patients, often deviating from established guidelines. It subjects patients to unnecessary risks. There is an urgent need for increased awareness and adherence to clinical guidelines regarding PPI prescriptions in cirrhotic patients.

Nanoplasmonic Rapid Antimicrobial-Resistance Point-of-Care Identification Device: RAPIDx.

The emergence of antibiotic resistance has become a global health crisis, and everyone must arm themselves with wisdom to effectively combat the "silent tsunami" of infections that are no longer treatable with antibiotics. However, the overuse or inappropriate use of unnecessary antibiotics is still routine for administering them due to the unavailability of rapid, precise, and point-of-care assays. Here, a rapid antimicrobial-resistance point-of-care identification device (RAPIDx) is reported for the accurate and simultaneous identification of bacterial species (genotype) and target enzyme activity (phenotype). First, a contamination-free active target enzyme is extracted via the photothermal lysis of preconcentrated bacteria cells on a nanoplasmonic functional layer on-chip. Second, the rapid, precise identification of pathogens is achieved by the photonic rolling circle amplification of DNA on a chip. Third, the simultaneous identification of bacterial species (genotype) and target enzyme activity (phenotype) is demonstrated within a sample-to-answer 45min operation via the RAPIDx. It is believed that the RAPIDx will be a valuable method for solving the bottleneck of employing on-chip nanotechnology for antibiotic-resistant bioassay and other infectious diseases.

Use of antibiotics among small-scale cattle farmers in rural areas in Queretaro, Mexico

The inappropriate use of antibiotics in the livestock sector has been described as one of the causes of the emergence of antimicrobial resistance. Information on antibiotic use in small-scale farms is limited. Our objective was to identify patterns of antibiotic use in small-scale cattle farms in Queretaro, Mexico. Cross-sectional study with 50 small-scale cattle farmers from rural areas surveyed in the municipality of Tequisquiapan, Queretaro between May–October 2022. Convenience sampling, non-probabilistic, small-scale cattle farms were selected using respondent-driven sampling methodology. A face-to-face survey was applied, structured in five sections: i) small-scale cattle farmers´ profile, ii) characteristics of small-scale cattle farms, iii) antibiotic use, iv) antibiotic prescription, and v) inventory of stored antibiotics vials. The data collected were processed and analyzed. Ninety-two percent of the small-scale cattle farmers were male, with an age range of 23 to 88 years (median 58.5, IQR 49–64.5). Seventy-four percent of the small-scale cattle farmers had a basic level of schooling. The animal census consisted of 968 animals. A total of 142 stored antibacterial products from nine antibiotic classes were recorded: 34.5 % were penicillin, 19 % oxytetracycline, 13.4 % gentamicin, 9.8 % florfenicol, and 8.4 %enrofloxacin. About 50 % of the stored antibiotics have a "watch" classification in the WHO AWaRe tool. Seventy-eight percent of small-scale cattle farmers throw empty antibiotic vials in the trash. Our study showed that small-scale cattle farmers had an important use of third generation cephalosporins, tetracyclines, and fluoroquinolones; antibiotics considered “watch” by the WHO.

Referring wisely: knowing when and how to make subspecialty consultations in hospital medicine.

Subspecialty consultations are becoming highly prevalent in hospital medicine, due to an ageing population with multimorbid conditions and increasingly complex care needs, as well as medicolegal fears that lead to widespread defensive medical practices. Although timely subspecialty consultations in the appropriate clinical context have been found to improve clinical outcomes, there remains a significant proportion of specialty referrals in hospital medicine which are inappropriate, excessive, or do not add value to patient care. In this article, we sought to provide an overview of the common problems pertaining to excessive quantity and suboptimal quality of inpatient subspecialty consultations made in real-world practice and highlight their implications for healthcare financing and patient care. In addition, we discuss the underlying contributing factors that predispose to inappropriate use of the specialist referral system. Finally, we offer a practical, multitiered approach to help rationalize subspecialty consultations, through (i) a systematic model ('WISE' template) for individual referral-making, (ii) development of standardized healthcare institutional referral guidelines with routine clinical audits for quality control, (iii) adopting an integrated generalist care model, and (iv) incorporating training on effective referral-making in medical education.

Burden and Cost of Campylobacter Risk Factors in Australia.

Campylobacter is a globally important pathogen with well-studied risk factors, but the burden of risk factors has not been quantified. We quantified the cost of illness attributable to specific domestic risk factors for C. jejuni and C. coli in Australia. We used data from a 2018-2019 case-control study to estimate odds ratios and attributable fractions for risk factors. We used data on national incidence, hospitalization, and premature mortality to quantify burden. We then applied costs related to healthcare utilization, pain and suffering, premature mortality, and lost productivity to each risk factor. In Australia, C. jejuni caused 83.0% of campylobacteriosis infections and chicken consumption resulted in the highest attributable fraction (30.0%), costing approximately US$110 million annually. The excess burden of campylobacteriosis associated with the use of proton-pump inhibitors (PPIs) was US$45 million, with almost half these costs due to disease in adults over 65 years of age. Contact with young dogs (US$30 million) and chicken feces (US$10 million) also contributed to costs and burden. Campylobacteriosis is a significant cost to Australia, particularly because of lost productivity. Effective cross-sectoral interventions to improve chicken meat safety and reduce inappropriate use of PPIs might have substantial economic and human benefits.

Emergency care in Brazil: factors leading to clinically inappropriate use of emergency care among young adult users in the Brazilian context

BackgroundThis study aims to investigate the prevalence and associated risk factors of inappropriate use of emergency services among young adults in Vitória, Brazil.MethodsA cross-sectional study was conducted over 30 consecutive days in November and December 2019, involving systematic random sampling of young adults (aged 18–39) visiting the municipal emergency care unit. Data were collected through structured interviews, utilizing the Hospital Urgency Appropriateness Protocol (HUAP) to identify inappropriate use. Demographic characteristics, healthcare utilization patterns, and medical diagnoses were assessed. Poisson regression models were employed to explore associations between variables.ResultsAmong the 631 young adults surveyed, 30.6% exhibited inappropriate use of the emergency care unit. Factors associated with higher rates of inappropriate use included not seeking previous care in other healthcare services; having specific medical diagnoses like diseases of the respiratory system (PR: 2.03), diseases of the skin (PR: 4.13), and diseases of the ear and mastoid (PR: 3.74).ConclusionThe study underscores the significance of addressing inappropriate use of emergency services among young adults. Though the prevalence of inappropriate use was not significantly different from other age groups, the demographic characteristics and healthcare utilization patterns of young adults contribute to their unique challenges. To mitigate inappropriate use, efforts should focus on improving access to primary healthcare services, enhancing continuity of care, and raising awareness about appropriate healthcare-seeking behaviors among young adults. Ultimately, these interventions can foster a more effective and sustainable healthcare system that better serves the needs of the community.

Exploring Endophytic Fungi as Natural Antagonists against Fungal Pathogens of Food Crops.

The yield and quality of cultivated food crops are frequently compromised by the prevalent threat from fungal pathogens that can cause widespread damage in both the pre-harvest and post-harvest stages. This paper investigates the challenges posed by fungal pathogens to the sustainability and yield of essential food crops, leading to significant economic and food security repercussions. The paper critiques the long-standing reliance on synthetic fungicides, emphasizing the environmental and health concerns arising from their widespread and occasionally inappropriate use. In response, the paper explores the potential of biological control agents, specifically endophytic fungi in advancing sustainable agricultural practices. Through their diverse symbiotic relationships with host plants, these fungi exhibit strong antagonistic capabilities against phytopathogenic fungi by producing various bioactive compounds and promoting plant growth. The review elaborates on the direct and indirect mechanisms of endophytic antagonism, such as antibiosis, mycoparasitism, induction of host resistance, and competition for resources, which collectively contribute to inhibiting pathogenic fungal growth. This paper consolidates the crucial role of endophytic fungi, i.e., Acremonium, Alternaria, Arthrinium, Aspergillus, Botryosphaeria, Chaetomium, Cladosporium, Cevidencealdinia, Epicoccum, Fusarium, Gliocladium, Muscodor, Nigrospora, Paecilomyces, Penicillium, Phomopsis, Pichia, Pochonia, Pythium, Ramichloridium, Rosellinia, Talaromyces, Trichoderma, Verticillium, Wickerhamomyces, and Xylaria, in biological control, supported by the evidence drawn from more than 200 research publications. The paper pays particular attention to Muscodor, Penicillium, and Trichoderma as prominent antagonists. It also emphasizes the need for future genetic-level research to enhance the application of endophytes in biocontrol strategies aiming to highlight the importance of endophytic fungi in facilitating the transition towards more sustainable and environmentally friendly agricultural systems.

Analysis of longitudinal patterns and predictors of medicine use in residential aged care using group-based trajectory modelling: The MEDTRAC-Polypharmacy longitudinal cohort study.

Polypharmacy serves as a quality indicator in residential aged care facilities (RACFs) due to concerns about inappropriate medication use. However, aggregated polypharmacy rates at a single time offer limited value. Longitudinal analysis of polypharmacy patterns provides valuable insights into identifying potential overuse of medicines. We aimed to determine long-term trajectories of polypharmacy (≥9 medicines) and factors associated with each polypharmacy trajectory group. This was a longitudinal cohort study using electronic data from 30 RACFs in New South Wales, Australia. We conducted group-based trajectory modelling to identify and characterize polypharmacy trajectories over 3 years. We evaluated the model fitness using the Bayesian Information Criterion, entropy (with a value of ≥0.8 considered ideal) and several other metrics. The study included 2837 permanent residents (median age = 86 years, 61.7% female and 47.4% had dementia). We identified five polypharmacy trajectory groups: group 1 (no polypharmacy, 46.0%); group 2 (increasing polypharmacy, 9.4%); group 3 (decreasing polypharmacy, 9.2%); group 4 (increasing-then decreasing polypharmacy, 10.0%), and group 5 (persistent polypharmacy, 25.4%). The model showed excellent performance (e.g., entropy = 0.9). Multinomial logistic regressions revealed the profile of each trajectory group (e.g., group 5 residents had higher odds of chronic respiratory disease compared with group 1). Our study identified five polypharmacy trajectory groups, including one with over a quarter of residents following a persistently high trajectory, signalling concerning medication overuse. Quality indicator programs should adopt tailored metrics to monitor diverse polypharmacy trajectory groups, moving beyond the current one-size-fits-all approach and better capturing the evolving dynamics of residents' medication regimens.

Mixed effects models but not t-tests or linear regression detect progression of apathy in Parkinson’s disease over seven years in a cohort: a comparative analysis

IntroductionWhile there is an interest in defining longitudinal change in people with chronic illness like Parkinson’s disease (PD), statistical analysis of longitudinal data is not straightforward for clinical researchers. Here, we aim to demonstrate how the choice of statistical method may influence research outcomes, (e.g., progression in apathy), specifically the size of longitudinal effect estimates, in a cohort.MethodsIn this retrospective longitudinal analysis of 802 people with typical Parkinson’s disease in the Luxembourg Parkinson's study, we compared the mean apathy scores at visit 1 and visit 8 by means of the paired two-sided t-test. Additionally, we analysed the relationship between the visit numbers and the apathy score using linear regression and longitudinal two-level mixed effects models.ResultsMixed effects models were the only method able to detect progression of apathy over time. While the effects estimated for the group comparison and the linear regression were smaller with high p-values (+ 1.016/ 7 years, p = 0.107, -0.056/ 7 years, p = 0.897, respectively), effect estimates for the mixed effects models were positive with a very small p-value, indicating a significant increase in apathy symptoms by + 2.345/ 7 years (p < 0.001).ConclusionThe inappropriate use of paired t-tests and linear regression to analyse longitudinal data can lead to underpowered analyses and an underestimation of longitudinal change. While mixed effects models are not without limitations and need to be altered to model the time sequence between the exposure and the outcome, they are worth considering for longitudinal data analyses. In case this is not possible, limitations of the analytical approach need to be discussed and taken into account in the interpretation.

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.

Assessment In vitro and In silico of the Activity of Thiadiazines as NorA Efflux Pump Inhibitors.

Antimicrobials fight microorganisms, preventing and treating infectious diseases. However, antimicrobial resistance (AMR) is a growing concern due to the inappropriate and excessive use of these drugs. Several mechanisms can lead to resistance, including efflux pumps such as the NorA pump in Staphylococcus aureus, which reduces the effectiveness of fluoroquinolones. Thiadiazines are heterocyclic compounds whose chemical structure resembles that of cephalosporins. Therefore, these compounds and their derivatives have been studied for their potential in combating increased bacterial resistance. To analyze this hypothesis, direct activity assays, antibiotic action-modifying activity, fluorescence assays to evaluate the retention of ethidium bromide inside bacteria, and molecular docking were carried out. These experiments involved serial dilutions in microplates against Staphylococcus aureus strain 1199B under the influence of six thiadiazine derivatives (IJ10, IJ11, IJ21, IJ22, IJ23, and IJ25). The tests revealed that, despite not showing effective direct activity, some thiadiazine derivatives (IJ11, IJ21, and IJ22) inhibited the function of the bromide pump both in microdilution tests and in fluorescence and docking assays. Particularly, the IJ11 compound stood out for its activity similar to efflux inhibitors, as well as its inhibition of the norfloxacin pump of this bacterium. Among the results of this study, it deserves to be highlighted for anchoring future experiments, as it represents the first investigation of this group of thiadiazine derivatives against the NorA pump.

The frequency of potentially inappropriate medication usage in community-dwelling oldest-old people.

It is critically important to protect the health of the oldest-old people, as their hospitalization and death rates are high. The objective of this study was to analyze the prevalence of potentially inappropriate medication use among the community-dwelling oldest-old people and its association with their demographic characteristics. Data were collected from real-world settings using the observational method for this descriptive study. An older adult aged ≥ 85 years old was defined as the oldest-old. The participants were visited in their homes. The generic names of the medications used, and the age, sex, and province of residence were recorded. The medications were analyzed according to the 2019 Beers criteria, and their prevalence of use among the oldest-old people was determined. Data were collected from 549 of the oldest-old people. The median age of the participants was 88.0 years (88.8 ± 3.5; min = 85.0, max = 102), and 61.3% (n = 336) of them were female. The study findings showed that 65.0% of the community-dwelling oldest-old people used potentially inappropriate medications, with a median number of 1 (min = 0, max = 6). The prevalence of potentially inappropriate medication use increased linearly with the number of drugs used (p = 0.001). The median number of medications was significantly higher in the potentially inappropriate medication user group (5 vs. 2, p = 0.001). Diuretics, proton pump inhibitors, and nonsteroidal antiinflammatory drugs were the most frequently used potentially inappropriate medications. The prevalence of potentially inappropriate medication use was high among the oldest-old people in Turkiye. There were no differences in frequency of use according to age, sex, or geographical region. It is important to prevent the use of potentially inappropriate medications that should be avoided and to monitor the oldest-old group that uses potentially inappropriate medications that should be used with caution.

Assessing the Impact of a Designated Pharmacist Intervention on Drug Treatment Costs and Technical Efficiency in the Hemato-Oncology Outpatient Clinic

ObjectivesThis study aimed to investigate the impact of a designated pharmacist (DPha) intervention in a hemato-oncology unit, focusing on reducing drug treatment costs and improving technical efficiency (TE). MethodsData from an 8-month intervention in the Israeli Clalit Health Services hemato-oncology outpatient unit were analyzed. During the study, the DPha reviewed the drug therapies being administered. After the review, a recommendation letter was sent, if relevant, to the treating physician. Data on drug treatment costs and interventions were meticulously collected and analyzed from the perspective of the insurer. A simple design was used to assess the DPha intervention’s contribution to TE and cost reduction, which was used to generate credible and transparent estimates. Sensitivity analyses were conducted to assess the robustness of 2 major variables: drug prices and pharmacist salaries. ResultsOver 8 months, DPha interventions led to a $279 191 cost reduction for 91 patients, resulting in net savings of $269 420 ($2960 per patient). Noteworthy is the $411 savings for each hour worked by the pharmacist, with a major impact on medications not insurer approved for the patient’s condition ($101 151) and discontinuing inappropriate medications ($52 681). Biological drug optimization accounted for 81% of total savings. Sensitivity analyses demonstrated significant cost savings across various drug prices and pharmacist salary scenarios. ConclusionsThe study proposes a practical framework for optimizing pharmacist services and reducing the inappropriate use of costly oncology medications. Incorporating a DPha enhances TE and yields significant cost reductions, offering valuable insights for insurers, policy makers, and healthcare professionals.