Amount Of Prescriptions Research Articles

Species Distribution of Candidemia and Their Susceptibility in a Single Japanese University Hospital: Prior Micafungin Use Affects the Appearance of Candida parapsilosis and Elevation of Micafungin MICs in Non-parapsilosis Candida Species.

Introduction: Micafungin is a recommended echinocandin antifungal agent for candidemia treatment and prophylaxis. However, overuse of echinocandin antifungals may cause resistance. There is currently no information available regarding the low susceptibility associated with using micafungin. This study investigated the effect of micafungin use on changes in the detected Candida species and low susceptibility. Methods: We conducted a retrospective survey and included records of Candida spp. detected in blood cultures from January 2010 to December 2018 in our hospital. Survey items included clinical outcomes at 30 days after positive cultures, patient characteristics, and drug prescription status. Patient background information included gender, previous hospitalization, stay in the intensive care unit, comorbidities, and history of surgery (within 90 days before candidemia onset) and drug exposure. Species detected and their minimum inhibitory concentrations (MICs) and amount of antifungal prescriptions by department were investigated. Risk factors for detecting C. parapsilosis and for low susceptibility to micafungin were evaluated using multivariate analysis. Results: A total of 153 Candida clinical blood isolates were collected and C. albicans was the most prevalent species, followed by C. parapsilosis and C. glabrata. In the analysis by department, antifungal use and non-albicans Candida species were most frequently detected in the hematology department. Multivariate analysis showed that prior micafungin use increased the risk of C. parapsilosis (odds ratio (OR) 4.22; 95% confidence interval (CI) 1.39–12.79; p = 0.011). MIC90 of micafungin on C. glabrata and C. parapsilosis was 1.0 μg/mL. Prior micafungin use was clarified as a risk factor resulting in MIC > 0.06 μg/mL for micafungin in non-parapsilosis Candida species (OR 13.2; 95% CI 3.23–54.2; p < 0.01). Conclusion: Prior micafungin use increased the risk of C. parapsilosis and the MIC > 0.06 μg/mL of micafungin in non-parapsilosis Candida species. Since there are only a few antifungal options, further antifungal stewardship considering azole antifungal agents use is required.

Opiate use in dermatology: A population-based study using the National Ambulatory Medical Care Survey in the United States

Opiate use in dermatology: A population-based study using the National Ambulatory Medical Care Survey in the United States

Opioid prescription-use after cesarean delivery: an observational cohort study.

To evaluate current opioid prescription practices following a cesarean delivery. Women were asked to participate in a prospective observational cohort study following a cesarean delivery. Participants were asked about their opioid use after discharge, amount leftover, subjective pain score, and satisfaction. A total of 344 women had cesarean deliveries during the study period, 242 were approached, 171 met eligibility criteria, and 109 were included in the analysis. Women in our study were predominantly African American (66.1%), high school graduates (32.1%), publicly insured (65.1%), single (55%) working mothers (68.8%). Most had been previously prescribed opioids (70.6%), of which 58.4% had a prior cesarean delivery. Only 78.8% of study participants took their opioid prescriptions, and 89.6% had an average of 17 pills leftover. The number of pills taken correlated with those prescribed in the study. Improved satisfaction in pain control with opioid and non-opioid alternatives was associated with a decrease in opioids used. Similarly, the participants' perception of their abundant prescription quantity was associated with a decrease in prescription taken. Women were prescribed excess opioids. Excess opioids accounted for 63.3% of all pills filled, a total of 1670 pills leftover, most of which were stored in an unlocked location (75.6%). Our data showed a discrepancy of pills prescribed (24) compared to those used (10), which was also perceived as enough or too many by our participants. Our study demonstrates that women would benefit from fewer opioid pills and a discussion based on their pain perception.

Apples to Oranges

Background: Over- prescription of opioids after surgery contributes to the national opioid epidemic. Differences may exist with procedure type, but these are understudied. Objective: This study aims to evaluate opioid consumption patterns following hemorrhoidectomy vs. other anorectal operations, as hemorrhoidectomy recovery is reportedly more painful. Design: Retrospective cohort study with prospective telephone survey. Setting: Single safety net hospital. Patients: Group of 27 and 73 patients undergoing outpatient hemorrhoidectomy and anorectal surgery other than hemorrhoidectomy, respectively, between July 2019 and March 2020. Main Outcome Measures: We measured the prescription and consumption quantities of morphine milligram equivalents (MME) after surgery for hemorrhoids vs. other anorectal procedures. Results: MME prescribed at discharge was higher for the hemorrhoid cohort vs. for other anorectal surgery (86.1 ± 17.5 vs. 76.0 ± 6.3, P &lt; 0.001). The hemorrhoid group utilized higher quantities of MME during recovery: 30 (IQR 75 MME) vs. 6.25 (IQR 30 MME), P = 0.017), and also expressed lower satisfaction with their post-operative pain control regimen (33.3% vs. 88.3%, P &lt; 0.001). No differences were seen in patients continuing on opioids on postoperative day seven (p = 0.348), and patients with complete compliance with their non-opioid multimodal pain control regimen (p = 1.0). Return trips to the emergency department for pain and patients requiring additional opioid medication after discharge were higher in the hemorrhoidectomy group (33.3% vs. 1.3%, P &lt; 0.001 and 14.8% vs. 1.3% P = 0.016, respectively). The 50th, 75th, and 90th percentile for total MME consumed by the hemorrhoidectomy (vs. other anorectal surgery) cohort were 75 (vs. 30), 75 (vs. 54), and 97.5 (vs. 75) MME, respectively. Conclusions: Hemorrhoidectomy surgery requires up to five times the amount of opioids for postoperative pain control compared to other anorectal surgeries. Prescribed opioids still exceed the amount used, although dissatisfaction with pain control remains high after hemorrhoid surgery. Further study is required to better understand this unique entity. Limitations: Retrospective single-center design, patient-reported outcomes, male majority in the non-hemorrhoidectomy group. Conflict of Interest: None.

A Dental School Survey Assessing Dental Student Knowledge, Attitudes and Prescribing Behavior Regarding Opioid Use and Abuse

Purpose/Objectives: While improvements have been made in the amount of opioid prescriptions written by dentists, studies continue to show wide variability in opioid prescribing practices among dentists, suggesting additional education in this area is needed. The purpose of this study was to evaluate opioid knowledge, attitudes and prescribing behaviors among dental school students. Methods: The authors conducted a web-based survey of dental students at the University of Minnesota School of Dentistry from 2016 through 2018. The survey was comprised of demographic information, student knowledge of clinical and regulatory interventions to reduce prescription opioid abuse, student attitudes and knowledge regarding the magnitude and causes of opioid misuse and abuse, and student opioid prescribing patterns. Statistical analysis was conducted to determine whether calendar time or progression in the dental program were associated with differences in survey responses. Results: The response rate was 43.67% for a total of 586 dental student participants over the course of this study. The knowledge, attitudes, and behaviors regarding opioid use and abuse among dental students was influenced by both the dental school program curriculum as well as the passage of time during which the evolution of students views and awareness about opioids impacted their responses. Conclusions: Misperceptions and a lack of knowledge influence dental student attitudes and behaviors related to prescription opioids. Understanding the influence of the dental school curriculum and the passage of time on dental students’ knowledge, attitudes, and prescribing behavior may assist in guiding the development of dental curriculum to improve best practices in pain management and prevent the misuse, abuse, and diversion of prescription opioids. Academic dentistry plays a significant role in targeting gaps in student knowledge and understanding that will lead to the development and consistent implementation of best practices for pain management and safe opioid prescribing in dentistry

Prospective Evaluation of a Tiered Opioid Prescribing Guideline for Inpatient Colorectal Operations.

This study sought to prospectively validate an institutional prescribing guideline based on previously defined opioid consumption patterns following inpatient colorectal operations. In light of the opioid epidemic, reducing excess prescription quantities is key while still tailoring to patient needs. This is a cohort study of elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center. Opioid prescribing and consumption patterns [quantified as Equianalgesic 5 mg Oxycodone Pills (EOP)] were compared before and after adoption of a tiered opioid prescribing guideline. Tiers were divided based on opioid consumption in the 24 hours before discharge: Tier 1 (0 EOP), Tier 2 (0.1-3 EOP), and Tier 3 (>3 EOP). Our guideline recommended maximum prescriptions of 0 EOP for Tier 1, 12 EOP for Tier 2, and 30 EOP for Tier 3. Results: The study included 100 patients before and 101 after guideline adoption. Demographic and operative characteristics were similar between cohorts. Guideline adherence was 85%. Overall, there was a 41%reduction in mean prescription quantity and 53% reduction in excess pills per prescription. No change in opioid consumption or refill rates was observed. Adoption of a tiered opioid prescribing guideline significantly reduced opioid prescription quantity with no change in consumption or refill rates. Standardization of discharge prescriptions based on patient consumption in the 24 hours before discharge may be an important step toward minimizing excess prescribing.

Regional Distribution of Cardiologists and Prescription Patterns of Sodium-Glucose Transporter-2 Inhibitors in Japan.

The clinical evidence is accumulating since 2015 that anti-diabetic sodium-glucose cotransporter 2 (SGLT2) inhibitors have the beneficial effect of cardiovascular and, recently, renal protection. Although it is not well analyzed how the transfer of this new evidence into daily practice has expedited, we hypothesize that the recent usage of the drugs is positively associated with several certified cardiologists in each region.The 2016 annual and 2016-2017 increased number of SGLT2 inhibitor tablets, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan, were divided by the estimated number of patients with type 2 diabetes mellitus for each of the 47 prefectures. Then, regression analyses were performed to investigate the potential association of the number of certified cardiologists with the drug prescription.The 2016 prescription of ipragliflozin, dapagliflozin, luseogliflozin, canagliflozin, and empagliflozin was 2.7- to 4.4-fold different between prefectures. The 2016-2017 increased prescription volume also varied among prefectures by as large as 7.3-fold for ipragliflozin. Regression analysis revealed that the annual and increased prescription volume of all the SGLT2 inhibitors except luseogliflozin were higher in regions with more certified cardiologists (P < 0.05), even after adjusting for regional parameters.In conclusion, the regional number of certified cardiologists was positively associated with a 2016 annual of and 2016-2017 increase in SGLT2 inhibitor prescription amount, implying an early adopter role of clinical experts in healthcare delivery.

Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients.

Opioids are a mainstay of therapy for patients in the intensive care unit (ICU) as part of the analgesia-first approach to sedation. Despite knowledge of acute consequences of opioid based analgosedation, less is known about the potential long-term consequences, including the effect of opioid administration in the ICU on subsequent opioid use in opioid-naïve patients. To evaluate the relationship between ICU opioid administration to opioid-naïve patients and subsequent opioid use following discharge. A query of the electronic medical record was performed to identify opioid-naïve adult patients admitted directly to an ICU. Patients who received continuous intravenous infusion of fentanyl, hydromorphone, or morphine were screened for inclusion into the analysis. Of the 342 patients included for analysis, 164 (47.1%) received an opioid at hospital discharge. In total, 17 of the 342 patients (5.0%) became long-term users, noted to be more common in patients who received an opioid prescription at discharge (8.7% vs 1.6%; P = 0.006). Neither total ICU morphine milligram equivalent (MME) nor average daily ICU MME administration were found to correlate with daily MME prescription quantity at discharge (R2 = 0.008 and R2 = 0.03, respectively). Following control for potentially confounding variables, total ICU MME administration remained an insignificant predictor of subsequent receipt of an opioid prescription at discharge and long-term opioid use. This study failed to find a significant relationship between ICU opioid use in opioid-naïve patients and subsequent opioid use. These findings highlight the need to focus on transitions points between the ICU and discharge as potential opportunities to reduce inappropriate opioid continuation.

Application of the microwave field in jelly products technology

The object of research is the agar-based chocolate-jelly cake technology. Due to the annual decrease in the production of natural jelly-forming agents and their high price, the possibilities of improving the qualitative change in their functional properties are being studied. In this connection, various methods of modification by gelling agents, both chemical and physical, are proposed. It is proposed to use the field of ultra-high frequencies (UHF) during the preparation of agar-sugar-treacle syrup in the "Chocolate-jelly" cake technology, as a result of which the consumption of gelling agents is reduced to 40 %. Microwave processing of the swollen gelling substance allows to reduce its consumption without introducing other components into the product formulation and without significant changes in the production process. It is shown that microwave treatment of a 1 % agar solution leads to an increase in the strength of the formed jellies by 40 %. It was found that microwave treatment leads to an increase in the melting temperature of the jelly in comparison with the untreated sample. It was revealed that hysteresis is observed at solidification and melting temperatures, the value of which ranges from 10 to 30 °C. Microwave treatment of a polysaccharide solution in a microwave field reduces the critical concentration of the transition of the molecular structure of the gel to the supramolecular one. Comparison of the enthalpies of melting of agar jelly after microwave treatment and jelly without finishing indicates that a larger number of hydrogen bonds are involved in the formation of a single node of the structure network. The improved technology of the "Chocolate-jelly" cake based on agar differs from the traditional one in that the dissolution by gelling agents is carried out under the action of a microwave field, which makes it possible to reduce the prescription amount of agar. The proposed method of processing a 1 % agar solution with an ultrahigh frequency field leads to the strengthening of the jelly structure, and due to this, the costs of gelling agents in the production of jelly products are reduced and leads to a decrease in its cost. The implementation of the plan will expand the range of jelly products and create competitive products in the confectionery market.

Opioid use following a total shoulder arthroplasty: who requires refills and for how long?

IntroductionPain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this original opioid prescription is sufficient for the majority of patients, some go on to require prolonged opioid use. Our study investigated patient risk factors associated with opioid refill postsurgery.MethodsThe Truven Marketscan® database was queried for all patients who underwent either a primary anatomic TSA or primary reverse TSA from 2010 to 2017. Opioid data were collected using National Drug Codes (NDC) from outpatient pharmacy claims. Only opioid-naïve patients were included. Patients were then grouped into 1 of 3 cohorts based on postoperative opioid use: 1) Patients with no additional refills, 2) patients with a minimum of one additional refill up through 6 months postoperatively, and 3) patients with additional refills and continued opioid use past 6 months.ResultsOf the total of 17,706 opioid-naïve patients that underwent a TSA, 10,882 (61.5%) did not have any additional refills, 4473 (25.3%) required an additional prescription within 6 months after surgery, and 2351 (13.3%) had prolonged opioid use beyond 6 months postoperatively. A dose-dependent relationship was identified between initial opioid prescription quantity and risk for refill and prolonged use. The prolonged use group was prescribed an equivalent of 20.0 more 5 mg oxycodone pills than the no refill group and 12.7 more than the refill group (P < .001). On multivariate analysis, younger age, female gender, and tobacco use, along with the comorbidities of coronary artery disease, clinical depression, diabetes, and rheumatic disease were all found to be predictive factors of prolonged opioid use.DiscussionThe dose-dependent relationship observed between original opioid prescription data and number of additional refills needed, suggests that initially overprescribing opioids may lead to prolonged dependency. This study also identified several independent risk factors for prolonged opioid use, including younger age, depression, and tobacco use. This study will hopefully help recognize high-risk patient populations and serve as the foundation for future studies into opioid prescription standardization and preoperative opioid education.

Reducing opioid use in post-operative otolaryngology patients: A quality improvement project

PurposeIn opioid-naive patients, many low-risk surgical procedures are associated with an increased risk of chronic opioid use. The goal of this quality improvement project was to reduce the amount of opioid prescriptions after commonly performed surgeries in otolaryngology. Materials and methodsPre-intervention opioid prescribing state was measured using anonymous provider and patient surveys, as well as pharmacy provider prescription data. Next, this information was used to develop an opioid prescription protocol that both standardized opioid prescribing practices and encouraged multimodal analgesia following routine surgery. Finally, post-intervention data were gathered and compared to pre-intervention data to assess changes in prescribing patterns. ResultsBy patient survey, the worst pain and average pain after surgery (scale of 1–10) were unchanged after the intervention (5.1 to 4.8, p = 0.52; 4.1 to 3.6, p = 0.35, respectively). Post-intervention, 41% of patients reported receiving no opiates, whereas pre-intervention 100% of patients surveyed received opiates. The amount of ibuprofen and acetaminophen prescribed post-intervention increased 113% and 71%, respectively. By survey, the average number of opioid doses decreased from 24.0 ± 7.0 to 18.4 ± 6.6 (p = 0.018). ConclusionsThe implementation of a standardized physician opioid prescription protocol did not affect patient pain perceptions, resulted in an increase in multimodal analgesia prescription, and increased provider awareness of opioid over prescription.

How the prescription charge system works ‘Down Under’

In the second of three articles, Angus Thompson continues his reflections on the differences in prescribing and medicines management between the UK and Australia, this time looking at prescription costs, quantities and generics.

Impact of air temperature and drug concentration on liquid emission from elastomeric pumps

BackgroundElastomeric pumps (EPs) are devices that allow quantitative and continuous drug administration without the need for electronic control, and they are used by being filled with anticancer agents. Although the package inserts of several manufacturers that provide EPs describe the relationship between the flow rate per unit time and temperature, the solution is only saline solution or 5% glucose solution, and data on anticancer drugs have not been published. In this study, we focused on 5-fluorouracil (5-FU), a drug frequently used in cancer chemotherapy, and examined the effect of changes in standard of EPs and temperature on drug emission.MethodsWe evaluated the EP data of patients treated with Baxter Infusor® LV5 and SV2.5 in terms of emission rate, relationship between 5-FU prescription amount and emission rate, and relationship between emission rate and monthly air temperature in LV5 and SV2.5. The number of EPs sampled in the study was N = 5708 (n = 2988 for LV5 and n = 2720 for SV2.5).ResultsIn LV5, the emission rate varied from 88 to 97% (median 94.0%), whereas in SV2.5, the emission rate was observed as 97 to 98% (median 97.4%). The 5-FU prescription amount and the emission rate were not correlated in LV5 and SV2.5, respectively (LV5; y = − 0.0015x + 97.305, R2 = 0.0226, SV2.5; y = − 0.001x + 100.25, R2 = 0.0466). LV5 showed a higher emission rate in the months with higher air temperature and a lower emission rate in the month with lower air temperature. In addition, LV5 showed a significant reduction in emission rate compared with SV2.5 in all months (P < 0.001).ConclusionsIn this study, we clarified that air temperature is an important factor that affects the drug emission of EPs. Therefore, it is necessary to examine the conditions for total fluid volume suitable for the air temperature in each region and to provide sufficient information to patients.

Short-term prediction of opioid prescribing patterns for orthopaedic surgical procedures: a machine learning framework

ABSTRACT Overprescribing of opioids after surgical procedures can increase the risk of addiction in patients, and under prescribing can lead to poor quality of care. In this study, we propose a machine learning-based predictive framework to identify the varying effects of factors that are related to the opioid prescription amount after orthopaedic surgery. To predict the prescription classes, we train multiple classifiers combined with random and SMOTE over-sampling and weight-balancing techniques to cope with the imbalance state of the dataset. Our results show that the gradient boosting machines (XGB) with SMOTE achieve the highest classification accuracy. Our proposed analytical framework can be employed to assist and therefore, enable the surgeons to determine the timely changing effects of these variables.

Evaluation of Herbal Medicine Administration by Physicians in the Prescriptions of Yazd State Pharmacy

Introduction: Herbal medicines are one of the most widely used complementary therapies in the world. Therefore, it is necessary to perform exact studies on the status of herbal medicines in communities. The aim of this study was surveying the prescription amount of herbal medicines prescribed by physicians and the effect of variables such as gender, degree of education, age, type of specialization of physicians, different seasons, source of drug production, price and the rate of insurance coverage on it. Methods: The current study was a descriptive-analytical and cross-sectional one. This research was conducted in the period of April 1 to March 20, 2016 in a public pharmacy in Yazd. 1824 prescriptions were obtained using Cochran's statistical formula and the amount of prescription containing herbal medicines was evaluated using the prepared lists. The collected data in three general categories, including physicians' demographic characteristics, prescriptions and their containing drugs specification were analyzed using SPSS (version 16) software and using the Chi-square statistical test. Results: Among the 1824 prescription examined, only 120 prescriptions contained herbal medicines with the average number of 1.05 ± 0.22 herbal medicine items in each prescription. 114 prescriptions (95%) and 6 prescriptions (5%) included one and two herbal items, respectively. There was a significant relationship between the amount of herbal medicine and the degree (P=0.041), type of specialization (P=0.04) and gender of the doctors (P=0.009), however, there was no significant relationship between the amount of prescription containing herbal medicines, the seasons of prescription (P=0.866) and the age of the physicians (P=0.089). Conclusion: Considering the results of this study, the amount of herbal medicines prescribed by physician in Yazd city is low.

Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

Understanding whether statewide legislation, such as the Michigan Opioid Laws, is associated with reduction in postoperative opioid prescriptions is informative in guiding future legislation. To identify changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018. This cross-sectional study included 3781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 1, 2016, and November 30, 2019, at a tertiary care institution. From 2017 to 2018, Michigan enacted a series of laws to address the state's worsening opioid epidemic. Two major components of this legislation enacted on June 1, 2018, required prescribers to review a report of patients' opioid use history and obtain signed consent after educating patients on the use and disposal of opioids prior to prescribing. Demographic information, type of surgery, type and amount of opioid prescriptions, and morphine milligram equivalent (MME) were analyzed. MME was calculated as the product of dose, quantity, and opioid-specific conversion factor for each prescription. Linear interpolation spline regression was used to evaluate the association of prescription MME with time. Of 3781 patients, 1614 (42.7%) were male. The mean (SD) age at the time of surgery was 63.3 (16.6) years. Of 2026 patients undergoing surgery before June 1, 2018, 1782 (88.0%) were prescribed postoperative opioids; of 1755 patients undergoing surgery after June 1, 2018, 878 (50.0%) were prescribed postoperative opioids (P < .001). There was no difference in age, sex, race/ethnicity, surgery type, or opioids prescribed between these 2 cohorts. Linear interpolation spline regression showed a decrease of 26.025 MMEs (equivalent to a 36.2% reduction of mean MME) between June 1, 2017, and September 30, 2018 (β, -1.735; 95% CI, -0.088 to -0.024; P < .001), stabilizing at a persistently reduced rate of MME prescribed through the end of the study period (October 1, 2018, to November 30, 2019; β, -0.005; 95% CI, -0.039 to 0.016; P = .42). Changes in MME in the 12 months before or 12 months after the period of legislation enactment were not identified. In this cross-sectional study, reduction in opioid prescriptions for oculoplastic and orbital procedures was observed during the enactment period of the Michigan Opioid Laws and appeared to be sustained through the end of the study period. Similar statewide or national legislations aimed at increasing prescriber awareness and patient education on opioid use may help curtail the prescription opioid epidemic.

PIN147 Geography Variations in Antibiotic Use RATE: Evidence from 8,026 Primary Clinics in Taiwan

This study aims to explore whether the utilization rate of antibiotics in primary clinics is affected by medical department and geographical location. We also analyzed the correlation between medical-level factors, county-level factors, and antibiotic use rates. This study used a retrospective study design. We collected antibiotics utilization data (in the third quarter of 2017) from a total of 8,026 Western medicine primary clinics across Taiwan from the Taiwan National Health Insurance Medical Quality Information Open Network. The number of clinics, clinics and hospitals in each administrative area are also collected. We also collected data on the population of various administrative regions in Taiwan to calculate the degree of urbanization and aging population in each administrative region. This study used the 2-way analysis of variance (ANOVA) method to analyze whether there is a significant difference in antibiotic usage among different medical departments and different administrative regions. We also used Hierarchical Linear Modeling to analyze the correlation between medical-level factors, county-level factors and antibiotic use rate. This study found that the antibiotic use rate was significantly different between different medical departments and different administrative regions, and the interaction between the medical department and the administrative region and the antibiotic usage rate was significantly correlated. There was a significant positive correlation between the total amount of prescriptions in the clinic and the rate of antibiotic use. Regarding the administrative region where the clinic is located, the degree of urbanization and antibiotic utilization rate showed a significant positive correlation, while other factors were not significantly related to the antibiotic use rate. Antibiotic use rate has significant differences in geography. The higher the total prescription amount of the clinic, the higher the degree of urbanization in the administrative area where the clinic is located, and the higher the antibiotic use rate.

Big data analysis of Korea health insurance review and assessment service for prescription quantity and cost of drugs on types of dementia from 2017 to 2019

AbstractBackgroundRecently, the Republic of Korea has entered the aging society, and the diagnosis rate for dementia is increasing, and the number of prescription drugs is increasing accordingly. Therefore, this study intends to study the number of prescriptions and the cost of prescription according to the detailed type of dementia by using big data of Korea Insurance Review &amp; Assessment Service.MethodAuthors visited the Big Data Hub at Korea Health Insurance Review &amp; Assessment Service homepage. After extracting data on the prescription quantity and cost of drugs for 3 years from 2017 to 2019 for dementia subtypes(F00, F01, F02, F03) in Big Data Homepage, the data were analyzed and statistically verified using Microsoft Excel and IBM SPSS version 23.0. Jonckheere‐Terpstra test for hypothesis evaluation applicated. The currency exchange rate was 1170.24 Korean won per 1 US dollar as of January 25, 2020 ICD‐100(WHO 2007 version) Diagnostic criteria including F00 Dementia in Alzheimer`s disease(G30), F01 Vascular dementia, F02 Dementia in other diseases classified elsewhere, F03 Unspecified dementia were applicated.ResultPrescription Quantity from 2017 to 2019: 2017 F00 3,498,000,000 F01 302,024,085 F02 16,392,196 F03 109,765,584 2018 F00 40,602,837 F01 4,206,130 F02 3,009,702 F03 1,795,276 2019 F00 51,654,756 F01 3,229,505 F02 281,612 F03 1750040. Cost of Drugs from 2017 to 2019: 2017 F00 19,810,000,000won F01 1,985,000,000won F02 102,331,031won F03 713,251,799won 2018 F00 23,000,000,000won F01 2,340,000,000won F02 116,000,000won F03 771,000,000won 2019 F00 27,868,782,161won F01 1,709,269,727won F02 113,159,188won. Average Prescription Quantity Number for 3 years(p=0.602): F00 : 1,196,752,531 F01 : 103,153,240 F02 : 6,561,170 F03 : 37,770,300. Average Cost of Drugs for 3 years(p=0.602) : F00 : 23,559,594,054 Korean won(20,132,275.48 US dollar), F01 : 2,011,423,242 Korean won(1,718,812.59 US dollar), F02 : 110,496,740 Korean won(94,422.29 US dollar), F03 : 740,454,665 Korean won(632,737.44 US dollar).ConclusionFrom 2017 to 2019, drug prescriptions and medication costs are on the rise. Prescription and cost of dementia by type of dementia were highest in F00 Dementia in Alzheimer's disease (G30), followed by F01 Vascular dementia, F03 Unspecified dementia, and F02 Dementia in other diseases classified elsewhere.

Characteristic spectrum and decoction process of classical prescription Qingwei San

In this experiment, by determination of the HPLC characteristic spectrum of the classical prescription Qingwei San decoction, the contents of isoferulic acid, palmatine and paeonol in Qingwei San decoction and the extraction rate were investigated. The factors such as the crushing degree of decoction pieces, the amount of decocting water, the decocting time, the filter material and the decocting container involved in Qingwei San decoction process were examined to make a detailed comparison of Qingwei San's decoction processes during the development.HPLC characteristic spectrum method of Qingwei San was established, and then the decoction process parameters of Qingwei San were optimized, with the similarity of characteristic spectrum, the concentration of the index components and the extraction rate as indexes. The decoction process of Qingwei San was determined as follows: Qingwei San decoction pieces were weighed according to the prescription amount and pulverized into the most coarse powder; the powder was put in a ceramic pot, added with 225 mL water, heated to boiling, cooked for 50 minutes with gentle heat(100 W), and filtered with a layer of 300 mesh nylon cloth.The similarity of Qingwei San's characteristics pectrum of different decoction methods was all above 0.9, and the concentration of isoferulic acid, palmatine and paeonol in Qingwei San under determined decoction process was 40.74, 26.73, 65.73 μg·mL~(-1), respectively, with an extraction rate of 33.80%.The characteristic spectrum determined in this experiment can better express the information and index components of Qingwei San, and if combined with the extraction rate information, it can provide the general information, index component content and extraction information. The decoction process after detailed investigation can better reflect the quality of Qingwei San decoction, with easier control and operation. It can provide a basis for the subsequent research and development of Qingwei San decoction standard, and can also provide experimental basis and reference for the decoction process research of other classical prescriptions.

Opioid Consumption After Knee Arthroscopy

To prospectively observe opioid consumption in patients undergoing knee arthroscopy and to create an evidence-based guideline for opioid prescription. This prospective multicenter observational study enrolled patients undergoing outpatient knee arthroscopy for meniscal repair, meniscectomy, or chondroplasty. Patients were provided with a pain journal to record postoperative opioid consumption, Numeric Pain Rating Scale (NPRS) pain scores, and Likert scale satisfaction scores for 1 week postoperatively. State databases were reviewed for additional opioid prescriptions. One hundred patients were included in this study. Patients were prescribed a median of 5 pills (37.5 oral morphine equivalent [OME]). Median postoperative opioid consumption was 0 pills, with a mean of 0.6 pills (4.4 OME), and 74% of patients did not consume any opioid medication postoperatively. All patients consumed ≤5 pills (37.5 OME), and no patient required a refill. Patients reported a mean daily NPRS value of 1.9 out of 10 and a mean Likert score of 4.4 out of5. We found that current opioid prescribing habits exceed the need for postoperative pain management. Overall, all patients consumed ≤5 opioid pills, and 92% of patients discontinued opioids by the second postoperative day. In spite of the low prescription quantity, patients reported high satisfaction rates and low NPRS pain scores and required no refills. Therefore, we recommend that patients undergoing knee arthroscopy are prescribed no more than 5 oxycodone 5-mg pills. II, prospective prognostic cohort investigation.