Pharmaceutical Prescription Research Articles

ЛЕКАРСТВЕННЫЕ ПОРАЖЕНИЯ ПЕЧЕНИ - СОВРЕМЕННЫЙ ВЗГЛЯД НА АКТУАЛЬНУЮ ПРОБЛЕМУ

Abstract. Introduction. The high prevalence, variability of clinical manifestations, limited knowledge about the mechanisms of toxicity, the complexity of diagnosis makes drug-induced liver injury one of the unsolved problems in clinical medicine. The expansion of the pharmaceutical market, the growth in the number of uncontrolled medications put forward drug-induced liver damage in a number of urgent problems not only for hepatologists, but also for doctors of other specialties. Aim. Review of current scientific publications devoted to the study of drug-induced liver damage. Material and methods. A search and subsequent analysis of scientific publications devoted to the study of the issue of diagnosis and treatment of drug-induced liver lesions, published on the databases: Unpaywall, PubMed, eLibrary, CyberLeninka, MedLine, was carried out. Results and discussion. The article presents up-to-date data on the pathogenesis of occurrence, classification features, principles of diagnosis and treatment of drug-induced liver lesions. Pharmaceuticals that most commonly cause drug-induced liver injury are listed. Conclusion. Drug-induced liver injury covers a wide range of clinical conditions, ranging from mild abnormalities in biochemical parameters to acute liver failure. The vast majority of adverse liver reactions occur from 5-90 days after the last dose of inducer drugs. Many scientific papers have been devoted to the study of drug-induced liver injury, but clinical practitioners still have many unresolved issues related to the correct diagnosis and treatment of drug-induced liver injury. This is facilitated primarily by the uncontrolled prescription and intake of pharmaceuticals, the «fashion» for biologically active additives, which in its outcome forms the development of polypharmacy and, accordingly, the potentiation of hepatotoxicity of drugs.

Comparison of US and EU Prices for Orphan Drugs in the Perspective of the Considered US Orphan Drugs Act Modifications and Discussed Price-Regulation Mechanisms Adjustments in US and European Union.

The 2019 worldwide sales of Orphan Drugs were estimated at $136 billion USD, which constituted 16% of the global pharmaceutical prescription market and is expected to grow by 12% in the next 5 years. A better understanding of Orphan Drug pricing may contribute to on-going discussions on Orphan Drug Act (ODA) corrections in US or modifications of price setting mechanisms in EU. The objective of the study was comparison and analysis of the prices of Orphan Drugs in US and EU. All drugs with Orphan Drug status were compared in the US and EU. For the US prices, the US Department of Veterans Affairs (VA) was sourced. The EU List Prices came from six EU countries: Denmark, France, Germany, Greece, Poland, Spain. We found US prices to be higher than the six selected EU countries. The average Price Ratio was 1.64. The prices across EU countries were more homogeneous, while the number of the reimbursed and therefore available to patient medicines varied and was correlated with GDP per capita r = 0.87. Considered implementation of the External Reference Price system in US may generate significant savings in the US but may result in upward pressure on pricing of Orphan Drugs in EU. Centralization of the Orphan Drugs pricing negotiations in EU may prevent such development and offer a win-win opportunity for all involved parties.

35185 Impact of telehealth on duration of tetracycline prescription during COVID-19

The impact of the COVID-19 pandemic caused more dermatology providers than ever before to turn to telemedicine and virtual visits to safely arrange clinic appointments during lockdowns. Doxycycline and minocycline are two commonly used tetracycline antibiotics that are frequently prescribed by dermatologists for their effective anti-inflammatory properties and good safety profile. This study aimed to evaluate whether virtual visits during COVID-19 impacted duration of doxycycline prescription and determine whether provider type (physician assistant, resident, fellow, or staff attending) affected duration of doxycycline prescription. A retrospective cohort was designed using all documented pharmaceutical prescriptions of doxycycline in 2019 and 2020 prescribed by dermatology providers at the University of Iowa Hospitals. Preliminary results show an overall increase in telemedicine visits from 13.73%, in 2019 compared with 38.13% in 2020 (P < .0001). Analysis also demonstrates that only 25.42% of total in-person dermatology visits resulted in a doxycycline prescription of less than 31 days vs. 47.49% of total virtual visits (P < .0001). However, despite demonstrated increase in virtual visits in 2020, year did not seem to play a factor in the duration of antibiotic prescription with instances of duration being almost equal between 2019 and 2020 (P < .0001). In this era of increasing telehealth, the demonstrated decrease in duration of doxycycline prescription in virtual visits is perhaps indicative of increased accessibility afforded by teledermatology. Future studies might explore factors related to provider decision-making in virtual visits compared with in-person visits and holds implications for how televisits may play an increasingly greater role in acne management.

Towards Creative Public Health: The Contribution of the Medical and Health Humanities

In this keynote address, Professor Paul Crawford introduces the distinctive fields of medical and health humanities, and the way that the arts and humanities can bring new capacities and possibilities for healthcare, health and wellbeing. He will discuss terminology and concepts of the medicalization of the illness experience and the rise of more critical, creative and democratising approaches. He will underline the substantial evidence for how the arts and humanities can improve medical outcomes and increase understanding of the public/patient experience of illness. In so doing, he addresses the potential for what he has called ‘creative public health’ that fully addresses the use of social and cultural assets to enhance the health of nations. In particular, he will provide insight into how this can be mobilised in practice through reference to major programs of research. First, he presents an overview of a major project to support and critically address the value of social and cultural assets for the public and a more medicalized initiative to provide patients with a social rather than pharmaceutical prescription. Second, he describes an innovative creative approach to ‘mutual recovery’ that seeks to enhance well-being within and between practitioners, family carers and patients as part of a whole community/ organisation approach to health. Third, he presents findings from his highly successful ‘What’s Up With Everyone’ research-embedded campaign to advance young people’s mental health literacy in association with Academy-award winning Aardman (Shaun the Sheep, Wallace &amp; Gromit, etc). Finally, he discusses: a. the potential for creative industries to work more closely with governments and health organisations as part of a ‘shadow health service’, complementing centralised health services through the extensive resources of the creative arts; b. the importance of advancing creative clinical environments in a STEM-dominated healthcare culture.

Can Redesign SOP Oriented Time Standardization and Authorization According to Job Description to Waiting Time be a Solution?

Pharmacy installation is part of the service system that influences hospital quality standards, one of which is waiting time for pharmaceutical service. The waiting time at the Outpatient Pharmacy Installation of Hospital X exceeds the Hospital Minimum Service Standard and Hospital Quality Indicators, which is 50 minutes. This study aims to determine the root of the problem and the solution to the long waiting time for prescription drug services at Outpatient Pharmacy installations. This research is a case study with a search method for identifying the root of the problem, determining alternative solutions, and prioritizing the main solution. The long waiting time for finished drug services is caused by the lack of shifts of workers when poly peak times, the absence of flow information and appropriate SOPs when pharmaceutical prescription services run concurrently, and non-compliance by pharmacists with SOPs for pharmaceutical services. The main solution was to create flow information and a new SOP for outpatient prescription services.

Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany

BackgroundIn settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients.MethodsOur set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients.ResultsThe process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure.ConclusionOur set of indicators provides useful information on patients’ health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care.

386 Impact of telehealth appointments on pharmaceutical management of dermatological conditions

The impact of the COVID-19 pandemic caused dermatology providers to use telemedicine to safely arrange clinic appointments during lockdowns. This study aimed to evaluate the impact of telehealth on antibiotic prescription length. Specifically, we sought to compare antibiotic length prescription for virtual vs. in-person visits before, during, and after COVID-19 shutdowns. A retrospective cohort study was performed using all documented pharmaceutical prescriptions of tetracycline in 2019-2021 prescribed by dermatology providers at a large academic tertiary referral center.

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

BackgroundThe dual COVID-19 and overdose emergencies amplified strain on healthcare systems tasked with responding to both. One downstream consequence of the pandemic in the USA and Canada was a surge in drug overdoses resulting from public health-restricted access to services and an increasingly toxic unregulated drug supply. This study aimed to describe changes implemented by programs prescribing pharmaceutical alternatives to the drug supply during the early stages of the COVID-19 pandemic.MethodsAn environmental scan used surveys and qualitative interviews with service providers across Canada to examine pharmaceutical alternative prescribing practices and programs before and during the pandemic. This study summarized the nature, frequency, and reasons for pandemic-driven service delivery changes using directed content analysis, counts, and thematic analysis.ResultsEighty-two of the 103 participating sites reported 1193 unique changes in physical space (368), client protocols (347), program operations (342), ancillary services (127), and staffing (90). Four qualitative themes describing the reasons for these changes emerged, namely (1) decreasing risk of COVID-19 infection; (2) decreasing risk of overdose; (3) prioritizing acute care of COVID-19 patients; and (4) improving client access to treatment.ConclusionsWhile most changes were aimed at decreasing risk of COVID-19 infection, some were found to be at odds with the measures needed to combat the overdose crisis; others met dual objectives of decreased risk of both overdose and infection. Further research should examine which changes should be kept or reversed once COVID-19-related public health measures are lifted.

Economic burden of pneumococcal disease in children in Liguria, Italy

ABSTRACT Vaccinations against Streptococcus pneumoniae are included in infant immunization programs globally. However, a substantial burden due to pneumococcal disease (PD) remains. This study aimed to estimate the cost of emergency department (ED) visits and hospitalizations associated with invasive pneumococcal disease, all-cause pneumonia, and acute otitis media in children <15 years of age in the Liguria region of Italy between 2012 and 2018. The retrospective cohort study used data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse, which contain information on hospital stays, outpatient visits, laboratory/imaging techniques, surgical procedures, and pharmaceutical prescriptions. Patients with one or more ED or inpatient claim for PD (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes) were included. Cost of ED visits and hospitalizations were estimated from the diagnosis-related group system and procedures performed in the ED. In Ligurian children <15 years of age during 2012–2018, the median annual number of hospitalizations plus ED visits due to PD was 4,009, and the median estimated annual cost was €3.6 million. All-cause pneumonia accounted for the majority of hospitalization costs during the study period. Number and costs of ED visits and hospitalizations increased from 2012 to 2018. Despite widespread infant immunization in Liguria, economic costs due to PD-associated ED visits and hospitalizations remained high in children 0–14 years of age.

Randomized clinical trial (RCT) of a clinical pharmacist intervention to reduce drug misuse and improve inappropriate prescribing in hospitalized patients in province of Al Basra

Objective: To determine if a multimodal pharmacist intervention based on medication review, patient interview, and follow-up can minimize the incidence of pharmaceutical prescribing errors between patients receiving clinical pharmacist intervention and patients receiving just usual care. Method: A randomized, controlled trial of 626 patients aged 62 and older with polypharmacy (five chronic drugs) from a general hospital was conducted. During all scheduled appointments, a clinical pharmacist meets with intervention group patients to assess their drug regimens and provide recommendations to them and their doctors. Prescription appropriateness, drug interaction, adverse drug events, medication compliance and knowledge, number of drugs, patient satisfaction, and physician receptivity were the outcome measures. Result: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group (P = 0.0036) There was no difference between groups at condition of life (P = 0.68). Doctors were more receptive to the intervention and followed clinical pharmacist’s recommendations more frequently than they were for control patients (50.63% versus 49.37%). Conclusion: According to this study, involving clinical pharmacists in discovering and discussing prescription discrepancies reduced medication inconsistencies in the medical record.

Unintentional drug-related deaths in people with mental illness in NSW Australia, 2012–2016: a retrospective cohort study

PurposePeople with mental illness are a vulnerable and stigmatised group with poor health outcomes including greater premature mortality. This study aimed to investigate trends and rates of change in unintentional drug-related deaths for people with mental illness, describe types of medicines involved, and identify populations at risk in a cohort from New South Wales, Australia.MethodsFeatures of unintentional drug-related deaths for people with mental illness between 2012 and 2016 were identified in a retrospective review of data from the National Coronial Information System.ResultsA total of 495 unintentional drug-related deaths were identified (1.6 deaths/100,000 population), showing an upward trend (p < 0.01). The most common substance involved was diazepam in both genders (males 135/319, 42%, female 76/176, 43%) and more than one contributory drug was included in 80% of cases. Between 2012 and 2016, amphetamine-related deaths showed the highest increase (3.2-fold), followed by codeine (2.5-fold) and quetiapine (2.5-fold). Males (RR 1.8, 95% CI 1.5–2.2) and people aged 35–44 (RR 1.7, CI 1.3–2.2) were more likely to die from unintentional drug-related deaths compared with the reference (females and people aged 25–34).ConclusionThis study found that the drugs commonly involved in deaths are also the drugs commonly used by and prescribed to people with mental illness. There were also significant differences between gender, age group, and marital status in the trend and rate of unintentional drug-related deaths for people with mental illness. A multifaceted approach encompassing both pharmaceutical prescribing and targeted public health messaging is required to inform intervention and prevention strategies.

Uso degli antibiotici in età pediatrica

The pharmaceutical prescription allows a quantitatively but not qualitative evaluation of a drug as it does not report the reason. The software used by family paediatricians is designed to receive the diagnosis, but the field is not usually filled in. The Pharmaceutical Service of the Piedmont Region has undertaken an experimental study to assess the feasibility of modifying the systems to expand the possibilities of evaluating the use of antibiotic. The work involved 15 paediatricians in the ASL CN1 district and 15 in Verbano-Cusio-Ossola one. In compliance with the available regulations and for about 24 months, the paediatricians voluntarily agreed to include the diagnosis along with an antibiotic prescription. At the end of the observation, more than 70 thousand prescriptions were made, with a slight non-significant increase between 2018 and 2019, in both districts. Prescriptions were compared with the previous year’s data. Information on diagnosis, before the project started, was present in about 40% of prescriptions and increased to 100%. The most diagnosed pathologies were acute bronchitis, acute tonsillitis and otitis media, without differences between CN1 and VCO. The most used antibiotic is amoxicillin in combination with clavulanic acid, which alone accounts for almost half of the prescriptions. At the end of the study, it is possible to affirm that the inclusion of the diagnosis does not seem to have created individual difficulties and/or to have modified the clinical/prescription behaviour. The presence of the data on the diagnosis, however, makes it possible to broaden the system’s ability to read the critical areas present in the prescriptive behaviour and to monitor any trend in relation to its appropriateness and available guidelines. Through a sustainable and minimal intervention, it is possible to expand the capacity of the prescriptive system to evaluate behaviours and to eventually plan targeted actions, consistently with the needs to counteract antibiotic resistance.

Availability of drugs for the treatment of cats with ocular diseases in Germany - Discrepancy between theory and reality

Only a few ophthalmologics specifically approved for cats are available on the market leading to frequent use of drugs approved for humans. In Germany, the administration, dispense or prescription of pharmaceuticals is regulated by the pharmaceuticals law ('Arzneimittelgesetz' (AMG)) as well as the regulation concerning pharmacies in veterinary practice ('Verordnung über tierärztliche Hausapotheken' (TÄHAV)). The aim of this study was to collect data concerning the occurrence and frequency of feline eye diseases and to evaluate the frequency of the necessity for extra-label drug use. Evidence-based, optimal treatment schemes were generated and reviewed with regard to their feasibility in Germany. Data from 876 cats with ocular problems of the "Small Animal Clinic", Freie Universität Berlin as well as a small animal practice in Southern Germany were evaluated (01.01.2015-31.12.2018). Subsequently, the theoretical accessibility for approved agents and/or extra-label drug use in Germany was analyzed. 1198 diagnoses were based on 925 ophthalmic examinations. The most common diseases include conjunctivitis, keratitis, uveitis, hypertensive retinopathy and glaucoma. 885/1198 (73.9 %) of these diseases required treatment, which equates to 722/925 (78.1 %) cases. For all patients, treatment would have been possible according to evidence-based data. In 225/722 (31.2 %) cases, treatment with the pertaining, specifically approved agents would have been possible. Extra-label drug use would have been necessary in 497/722 cases (68.8 %). Of the 497 cases necessitating extra-label use, pharmaceuticals approved for humans would have been available for 481 cases (96.8 %), extra-label use of other veterinary pharmaceuticals would have been possible in 28 cases (5.6 %) and in 60 cases (12.2 %) especially manufactured drugs could have been employed. In a total of 36/722 cases (5 %), optimal care would not have been possible in the context of the current regulatory framework. Based on regulations concerning therapeutic necessity, the ophthalmologic therapy of cats in Germany is possible within the regulatory framework. In the present study, 5 % of the patients could not receive optimal medical care. The closure of this gap demands additional approval of veterinary ophthalmic drugs as well as the research and development of novel active agents and veterinary pharmaceuticals.

CensusADHD Study: An Australian-wide medication-based recruitment study for Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder affects over 5% of children and is characterised by a persistent pattern of problems with focussing or maintaining attention and/or hyperactivity-impulsivity. The censusADHD Study is a richly phenotyped nationwide cohort of Australian children with attention-deficit/hyperactivity disorder. The overarching aims of the study are to examine attention-deficit/hyperactivity disorder medication utilisation patterns and treatment response, the impact of children's attention and behavioural problems on caregivers, and costs related to attention-deficit/hyperactivity disorder. Families of potential attention-deficit/hyperactivity disorder cases aged between 6 and 11 years were identified using Pharmaceutical Benefits Scheme prescription records for attention-deficit/hyperactivity disorder medications held by Services Australia and sent a study information letter. Data were collected from 1574 primary caregivers via online survey in 2015, including the behavioural profile of the child, the child's medication use and experiences with side effects and the impact of the child's behaviour on the caregiver. Approximately 81% of caregivers also consented to record linkage of the child's Pharmaceutical Benefits Scheme and Medicare Benefits Schedule claims to directly assess prescription dispensing history and health service usage to estimate costs to the family and Medicare health system. Boys were diagnosed with attention-deficit/hyperactivity disorder earlier (p = 0.021), more likely to present as the combined and predominantly hyperactive subtypes (p = 0.001) and at higher risk of experiencing a school suspension (p < 0.001) or expulsion (p = 0.043). Overall, children presenting as the combined subtype had higher rates of psychiatric comorbidities (p < 0.001). Finally, prescription costs for each family and the Pharmaceutical Benefits Scheme significantly increased in the year following attention-deficit/hyperactivity disorder diagnosis (p < 0.001). Research examining the psychosocial and financial impact of attention-deficit/hyperactivity disorder on Australian children and their families is needed. Our findings demonstrate the importance of examining both gender and attention-deficit/hyperactivity disorder subtype presentation in future studies.

Together we can begin fixing public health globally

It is irrefutable that most convenience and favored foods and beverages are the leading cause of morbidity and mortality worldwide. Government and private health agencies and organizations and cardiologists specifically, and clinicians in general, have failed and should be held liable for malpractice for pushing procedures and pills above longevity-lifestyle redirection for Maillard, alcohol, nicotine, and other drug abuse disorders. Particular lifestyle transitioning training for specific Maillard, alcohol, nicotine, fentanyl, and other drug misuse lifestyle transitioning programs have proven the most successful. And medical publishers and medical school deans to front-line medical clinicians and technicians are either unwilling or unable to conceptualize the basics of how lifestyle transitioning for substance misuse works. A must when trying to sell a joyous longevity lifestyle to themselves, their students, and their overweight residential and ambulatory guests. A detailed understanding of recovery lifestyle training programs is privy to a small number of experts globally, RL DuPont, NS Miller, and JA Cocores, for example. Specifics surrounding why Maillard foods are powerful opiate and dopaminergic agonists are clear to the author. Falsely arrested and silenced by the Florida Board of Medicine in February 2013 for putting lifestyle changes above the pharmaceutical industry and prescription cardiology and other pill-pushing by Hillary Clinton's Florida-based Drug Czar Dave Aronberg. The purpose of this article is to supply clinicians and healers with information surrounding why and how Maillard-coated favorite foods and beverages within each country behave like fentanyl and methamphetamine. And how to sell the unwanted proposition of helping unhappy browned-food compelled people slowly begin moving towards a joyous longevity lifestyle. These steps and much more should have been worldwide headlines over the past few decades. Instead, the world was distracted away from vital, joyous longevity lifestyle information by corporatocracies and autocratic governments posing as democracies that feed off their wealth and power. The world is perpetually distracted from what the average person is most concerned about by the so-called elite with a self-serving agenda. The elite-funded news of February 23, 2022, is no exception. Healers and everyday people need to begin fending for their joyous longevity lifestyle. These are the first baby steps and formulas to outlive the elites to once again form governments by and for the people.

Medication Use and Costs Among Older Adults Aged 90Years and Older in Italy.

Older adults are often affected by multiple chronic conditions and experience geriatric syndromes that may affect the risk/benefit profile of medications. Little is known about the use of such medications in the older population. This article describes medication use and costs in Italian adults aged ≥90 years. Data from the 2019 Pharmaceutical Prescriptions database, concerning data on medications reimbursed by the Italian National Health Service, were analyzed in terms of prevalence and amount of use expressed as defined daily dose/1,000 users (DDD/1,000 users/day), accounting for different age-groups and sex. All individuals aged ≥90 years used at least one medication, with a mean number of 3128 DDD/1,000 users/day corresponding to an annual cost of 683 euros per user. Both use and costs linearly decreased with increasing age, with men accounting for a higher amount of DDD/1,000 users and costs than women across all age-groups. Antihypertensives (1330 DDD/1,000 inhabitants), antiplatelet agents (337 DDD/1,000 inhabitants), medications for peptic ulcer and gastroesophageal reflux (328 DDD/1,000 inhabitants), and lipid-lowering agents (166 DDD/1,000 inhabitants) were the most frequently used medications. We observed a progressive decrease in the usage of the majority of medications with increasing age, with the exception of antibiotics and antipsychotics. Individuals aged ≥90 years used a lower DDD/1,000 users, with an associated decrease in annual costs. The persistent use of preventive medications highlights the potential lack of awareness regarding medication rationalization and guidance for optimizing prescriptions. Our findings highlight the need for further initiatives to improve medications’ appropriateness in these older age-groups.

Spectrofluorimetric first derivative synchronous approach for determination of olanzapine and samidorphan used for treatment of schizophrenia in pharmaceutical formulations and human plasma

The combination of olanzapine and samidorphan has just been authorised for the treatment of schizophrenia. The current study created a very accurate, sensitive and selective spectroscopic technique based on the first derivative of synchronous fluorescence for determining olanzapine and samidorphan in their pharmaceutical prescriptions without prior separation. For the quantitative analysis of samidorphan and olanzapine, the adopted approach is focused on measuring the synchronised fluorescence intensity of the examined medicines at fixed wavelength range (Δλ) = 50 nm and the first derivative's peak magnitudes were observed at 300 and 350 nm, respectively. The effects of various factors on the synchronised fluorescence intensity of the referenced medications were researched and adjusted. Both medications' calibrating charts were shown to be linear throughout a range of concentrations of 0.1–1.1 µg mL−1. LOD for SAM and OLA were 0.02 and 0.01, respectively. In addition, LOQ was determined for SAM and OLA as follow, 0.07 and 0.06, respectively. The devised approach was effectively used to the quantitative measurement of the two medicines in Lybalvi® tablets with various samidorphan and olanzapine ratios, in addition to spiked human plasma. A variance ratio F-test and student t-test were needed to be able to compare the results to another published analytical technique and found no significant differences.

Somatropin therapy in italian adults with growth hormone deficiency

BackgroundIn adult population, Growth Hormone Deficiency (GHD) is a complex clinical condition with heterogeneity of causes and duration. Growth Hormone (GH) replacement therapy has beneficial effects entailing a chronic and expensive use. Therefore, entity, appropriateness and standardization of GHD treatment need to be accurately analysed.In Italy, the epidemiological surveillance on somatropin therapy is entrusted to the National Register of Growth Hormone Therapy (Registro Nazionale degli Assuntori dell’Ormone della Crescita-RNAOC) by the Italian Regulation, in accordance of which the RNAOC-database is collecting the notifications of somatropin prescriptions.MethodsAim of this study is to analyse data on somatropin-treated adult population communicated to the RNAOC by the specialist centres of 15 Italian regions and 2 autonomous provinces.ResultsFrom 2011 to 2019, the somatropin-treated adults were 970 with 4061 examinations (1.21 ± 0.33 visits/year).The diagnoses were: hypopituitarism (n = 579); hypophysectomy (n = 383); and congenital GHD (n = 3). Five subjects were addressed with diagnoses not included in the regulation.The starting posology of somatropin was 0.320 (± 0.212) mg/day, 0.292 (± 0.167) mg/day in male and 0.360 (± 0.258) in female patients, with 7 administrations/week in 70.31% of the prescriptions. The differences in posology by gender persisted at 10th year of the follow-up. Starting dosage was higher in patients diagnosed with adult GHD before the age of 30 (0.420 ± 0.225 mg/day), with a progressive decrease of the dosage during the follow-up.ConclusionsThis is the first report on adult GH treatment, describing numbers, diagnoses, and pharmaceutical prescriptions associated to somatropin therapy in a large cohort of Italian GHD-adults.

Using electronic medical record data to assess chronic kidney disease, type 2 diabetes and cardiovascular disease testing, recognition and management as documented in Australian general practice: a cross-sectional analysis

ObjectivesTo evaluate the capacity of general practice (GP) electronic medical record (EMR) data to assess risk factor detection, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular...

Extended Prescribing Roles for Pharmacists in Poland-A Survey Study.

Background: In recent years, a systematic increase in the role and powers of pharmacists has been observed. The COVID-19 pandemic has shown that this is a professional group that is extremely necessary for the smooth functioning of the health care system. One of the important powers of pharmacists is the possibility of issuing prescriptions for both patients in the pharmacy and for themselves and their family members. Polish pharmacists obtained extended entitlements in this field in March 2020. Due to the extension of pharmacists’ prescribing rights in Poland, it was decided in this study to determine the current practice of pharmaceutical prescribing, and pharmacists’ views on their new duties. Methods: The study used the method of a questionnaire, which was distributed to all pharmacists actively working in Poland. During the study, 309 completed questionnaires were obtained that gathered information about prescriptions written by pharmacists, as well as their opinions related to this entitlement. The results of the survey were analyzed using descriptive statistics. Results: Out of all authorized pharmacists, 75.62% use the new, extended authorization to issue pharmaceutical prescriptions. About half of them believe their prescriptions should be refundable. Only 11.52% of respondents do not use the entitlement to issue prescriptions for themselves or their family members. In addition, it was noticed that those who write such prescriptions most often use the fully paid version. Conclusions: Polish pharmacists use the new entitlements willingly but carefully. The legal provisions governing electronic prescription should be clearer. In addition, the idea of continued prescription should be developed as this is the most common reason that pharmacists issue prescriptions.