Prescription Patterns In Patients Research Articles

Prescription Patterns in Patients with Chronic Obstructive Pulmonary Disease and Osteoporosis

ObjectivePatients with chronic obstructive pulmonary disease (COPD) have a higher risk of osteoporosis. Few studies have addressed the prescription patterns in osteoporosis patients with COPD. The purpose of this study was to conduct a retrospective study of the prescription patterns in patients with COPD and osteoporosis in Taiwan.MethodsThe study was conducted with data from the Taiwan National Health Insurance Research Database from January 1, 2003, to December 31, 2016. We selected the COPD population in Taiwan older than 40 years with at least one prescription for a bronchodilator. We excluded patients who had osteoporosis, fracture, asthma, or cancer before the diagnosis of COPD. After the diagnosis of COPD, patients who did not have osteoporosis were also excluded. We followed this COPD and osteoporosis cohort until they had been prescribed medication for osteoporosis.ResultsThere were 13,407 patients with COPD and osteoporosis who received osteoporosis treatment. Among the patients who received treatment, the majority were female (n = 9136), accounting for 68.14% of all treated patients. A total of 53.4% of the patients had been prescribed steroids least once within the last year before receiving a diagnosis of osteoporosis. A total of 34.61% of the patients received systemic corticosteroids with a daily dose equivalent to 5 mg of prednisolone within the 3 months prior to the diagnosis of osteoporosis. The older the patient was, the higher the probability of the prescription of medication for osteoporosis. Patients with depression had a high probability of receiving medication for osteoporosis with adjusted hazard ratio of 1.141 (95% confidence interval, 1.072–1.214).ConclusionThe rate of prescriptions for the treatment of osteoporosis in patients with COPD was low. Physicians need to be aware of this issue and treat osteoporosis more aggressively in patients with COPD.

Perioperative Opioid and Nonopioid Prescribing Patterns in AVF/AVG Creation

To evaluate postoperative opioid prescribing patterns in patients undergoing hemodialysis access creation. Operative logs were reviewed to identify patients undergoing creation of arteriovenous fistula (AVF) or graft (AVG) from September 2016 to January 2018. Immediate postoperative opioid prescriptions were compared for ambulatory patients versus inpatients. Opioid prescriptions at the time of discharge for inpatients were recorded. Rates of opioid prescribing were standardized by conversion to morphine milligram equivalents (MMEs). Opioid use postoperatively and at the time of discharge based on anesthetic technique, general anesthesia versus regional or local anesthesia with sedation were compared. Alternative pain medications administered and pain scores were recorded. Comparisons were made between the percentage of opioid use and doses administered between AVF and AVG patient groups, ambulatory and inpatients, and type of anesthetic technique used. Statistical analysis was performed with chi-square and t-tests. We identified 164 patients undergoing AV access creation but not receiving chronic opioid therapy. A significantly higher percentage of inpatients received opioids in the immediate postoperative period than ambulatory patients (AVF: 72% vs. 19%, P<0.001; AVG: 62% vs. 25%, P=0.001). Overall, all AVG patients were more likely to be discharged with an opioid prescription than all AVF patients (37% vs. 8%, P<0.001). Of AVG patients managed in the ambulatory setting, 48% were discharged with an opioid prescription. The mean total opioid postoperative dose prescribed to inpatients was significantly higher than that prescribed to ambulatory patients for both fistulas (28.73 MMEs vs. 1.27 MMEs, P<0.001) and grafts (22.11 MMEs vs. 2.16 MMEs, P=0.005). General anesthesia patient groups were more likely to receive opioids postoperatively than local anesthesia with sedation patients for both AVF (54% vs. 24%, P=0.027) and AVG creation (61% vs. 17% P<0.001). Postoperative alternative medication use in the hospital was low with 18% acetaminophen and 1% nonsteroidal anti-inflammatory drug use for AVF patient groups and 24% acetaminophen and 0% nonsteroidal anti-inflammatory drug use for AVG patient groups. The percentage of patients reporting postoperative pain in the recovery room and on the inpatient units was comparable between ambulatory and inpatient settings (AVF: 21% vs. 28%, P=0.534; AVG: 23% vs. 44%, P=0.061). A higher percentage of inpatients undergoing hemodialysis access received opioids when compared with ambulatory patients in the immediate postoperative period. Inpatients were prescribed higher mean doses than ambulatory patients. AVG patient groups were prescribed more opioids than AVF patient groups. Alternative analgesic agent use was low, suggesting an opportunity for improved pain control and opioid reduction. Dialysis access creation represents an opportunity to improve on opioid prescribing patterns.

Assessing the Prescription Pattern of Antimicrobial Agents in Intensive Care Unit at Tertiary Care Hospital

Antibiotic resistance is the major concern in developing countries especially in India, and the prime reason behind it is the irrational prescription of antibiotics. Therefore, assessment of the prescribing pattern of antibiotics in the intensive care unit (ICU) would help to ascertain the rational use of antibiotics in ICU. In a prospective observational study, prescription pattern of patients on antimicrobial agents for any infectious diseases was reviewed and assessed in ICU at a tertiary care hospital for 6 months. All the patients receiving at least one antibiotic except paediatric, pregnant, and lactating patients were included in the study. The prescriptions were also analysed in accordance with the indicators provided by WHO AWARE list. A total of 227 patients were enrolled in the study after obtaining their informed consent form. The majority of patients were in the age group 51 to 65 (33.48%) and males (54.18%). The most common pathological conditions for which patients admitted to ICU were acute gastroenteritis (21.68%), urinary tract infection (13.98), and viral fever (11.19%). Amongst all antimicrobial agents prescribed, cefoperazone along with sulbactam (20.29%) and ceftriaxone (18.84%) was most frequently prescribed followed by metronidazole (9.90%) and levofloxacin (6.76%). Broad-spectrum antibiotics were prescribed in 66% of the total enrolled patients, whereas only 9% of patients underwent a culture sensitivity test. As per the WHO AWARE list, 50% of antimicrobial agents were from the watch category followed by 20% and 17% from the access and reserve category, respectively. The high use of broad-spectrum antibiotics suggests that there is a need for more awareness amongst the health care professionals and communities about the emerging antibiotic resistance problem which is mainly due to over and inappropriate use of antibiotics.

Drug prescribing pattern in patients of myocardial infarction in a tertiary care teaching hospital of North India

Background: The term acute myocardial infarction (MI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia. Aims of this study were to assess drug prescribing pattern in patients of myocardial infarction and to compare prevalence of MI according to age, gender, diet, smoker or non-smoker, alcoholic or non-alcoholic, family history of cardiovascular disease.Methods: This observational study was conducted at department of pharmacology, in association with department of cardiology and included all patients of myocardial infarction visiting cardiology outpatient department or indoor patients and proforma was used to evaluate drug prescribing pattern.Results: Total 200 patients of acute myocardial infarction were analysed. Incidence of MI was more common in males (76%); age group 51-60 years (28.5%); non-vegetarians (68.5%); smokers (52.5%) and reduced physical activity (70.5%). 59.5% of patients had family history of cardiovascular disease. Commonly prescribed drugs were antiplatelets (100%) followed by hypolipidemic (99.5%), proton pump inhibitors (92%), antianginal (90.5%), anticoagulants (68.5%), thrombolytics (24.5%).Conclusions: This study provides insight towards drug prescribing pattern in MI patients. Most frequently prescribed drugs were antiplatelets followed by hypolipidemic and proton pump inhibitors. Patients had multiple risk factors and these can be reduced by lifestyle modifications.

Heart failure signs and symptoms, hospital referrals, and prescription patterns in patients receiving sacubitril/valsartan in primary care and cardiologist settings in Germany.

AimsThe aim of this paper was to analyse heart failure (HF) signs and symptoms, hospital referrals, and prescription patterns in patients receiving sacubitril/valsartan (sac/val) in primary care and cardiology settings in Germany.Methods and resultsA retrospective cohort study of electronic medical records identified 1263 adults (aged ≥18 years) in the German IMS® Disease Analyzer database who were prescribed sac/val during 2016 and had at least 6 months of data following sac/val initiation. Clinical characteristics were collected during the 12 months before the first recorded sac/val prescription (index date) and 6 months post‐index. Details of sac/val dose and prescription patterns were also recorded in the 6 months post‐index. HF signs, symptoms, and all‐cause hospital referrals were evaluated for 90 days pre‐index and 30–120 days post‐index. Most patients (62%) were prescribed the lowest sac/val dose of 24/26 mg twice daily (b.i.d.) at index; only 14% of patients initiated on 24/26 mg or 49/51 mg b.i.d. were up‐titrated to the 97/103 mg b.i.d. target dose during the 6 months post‐index, while 6% of patients initiated on either 49/51 mg or 97/103 mg b.i.d. were stably down‐titrated. Evaluation of prescription patterns in relation to clinical characteristics did not clearly explain the reluctance to up‐titrate in the majority of patients. More patients experienced HF signs or symptoms or all‐cause referrals to hospital during the 90 days pre‐index than during the 30–120 days post‐index.ConclusionsThe majority of patients receiving sac/val are not up‐titrated, contrary to recommendations of the EU summary of product characteristics; this is not fully explained by patients' clinical characteristics. Further research is required to understand the reasons for clinician inertia.

Initial cardiovascular treatment patterns during the first 90 days following an incident cardiovascular event.

The aim of this study was to investigate the initial cardiovascular prescription patterns in patients after their first cardiovascular events, and to identify factors associated with cardiovascular polypharmacy. This was a cross-sectional study including patients aged ≥ 45 years with the first record of coronary heart disease (CHD) or stroke between 2007 and 2016 using The Health Improvement Network database. This study investigated the patterns of cardiovascular drugs prescribed during the first 90 days after the first cardiovascular events. Logistic regression was used to examine the association between patients' baseline characteristics and cardiovascular polypharmacy (≥5 cardiovascular drugs). A total of 121,600 (59,843 CHD and 61,757 stroke) patients were included in the study. The mean age was 69.5 ± 11.9 years. The proportion of patients who were prescribed 0-1, 2-3, 4-5 drugs and ≥6 drugs were 11.0%, 29.8%, 38.6% and 20.5%, respectively. Factors associated with cardiovascular polypharmacy were sex (female: OR 0.74, 95% CI 0.72-0.76 vs male), age (75-84 years old: OR 0.50, 0.47-0.53 vs 45-54 years old), smoking status (current smoking: OR 1.29, 1.15-1.24 vs never), body mass index (obesity: OR 1.38, 1.34-1.43 vs normal), deprivation status (most deprived: OR 1.09, 1.04-1.14 vs least deprived) and Charlson comorbidity index (index ≥5: OR 1.25, 1.16-1.35 vs index 0). Multiple cardiovascular drugs treatment was common in patients with CVD in the UK. High-risk factors of CVD were also associated with cardiovascular polypharmacy. Further studies are warranted to assess the impact of cardiovascular polypharmacy and its interaction on CVD recurrence and mortality.

Analysis of prescription pattern in patients on maintenance hemodialysis

Chronic kidney disease (CKD) is a world-wide public health problem associated with various complications. CKD patients undergoing hemodialysis have associated comorbidities and prescribing drugs rationally in these patients is a difficult task. To evaluate the prescribing patterns of medicines in CKD patients on maintenance hemodialysis.A Cross-sectional, hospital-based observational study was conducted in King Khalid General Hospital, Al Majmaah for a period of one year. The records of patients in the given period were examined and data pertaining to prescriptions was analyzed.A total of 41 prescriptions of patients were analyzed. The most common associated co-morbidity was hypertension in 82.9% of the patients, followed by anemia in 73.1% of patients and secondary hyperparathyroidism in 63.4% of the patients. 85.4% of the patients had more than one comorbidity. The total number of drugs prescribed was 504 and the average number of prescriptions per patient was 12.3. The percentage of drugs prescribed using generic name was 71.4 and 65.3% drugs prescribed were from the WHO essential drugs list. Total number of Fixed dose combinations used was only 1.2%. The study has generated a profile of drugs prescribed in CKD patients on maintenance hemodialysis in a secondary care hospital in Saudi Arabia. High number of medications were used per prescription in this study thus increasing the possibility of drug interactions and Adverse events. Further studies with special consideration for drug-drug interactions, adverse events and adherence need to be conducted.

Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism

Introduction: Anticoagulation remains the mainstay pharmacotherapy for acute pulmonary embolism (PE), but multiple treatment options exist. The Pulmonary Embolism Response Team (PERT) is a multidisciplinary group that evaluates patients, formulates evidence-based treatment plans, and mobilizes resources. The objective of this study was to characterize the anticoagulation prescribing patterns made by PERT and to determine the clinical impact of anticoagulant selection. Materials and Methods: This was a retrospective analysis of patients evaluated by PERT from 2016 to 2018. Multivariable linear regression was conducted to determine predictors of length of stay (LOS). Results: A total of 209 patients were evaluated by PERT and received anticoagulation on discharge. Of those, 47% received a non-vitamin K oral anticoagulant (NOAC), 29% received warfarin, and 23% received low-molecular-weight heparin. Patient preferences and comorbidities were the most common reasons for NOAC omission. Patients who received NOACs had a shorter median LOS than warfarin (6.1 [4.6-7.6] days vs 10.9 [8.4-13.4] days; P < .05). Selection of NOAC upon discharge was the only factor independently associated with reduced LOS (β coefficient: −0.6; 95% CI: −1.01 to −0.18; P < .01). Conclusion: The most common recommendation made by PERT was to initiate a NOAC upon discharge, resulting in shorter hospital LOS compared to patients who received warfarin.

Administrative prevalence and incidence, characteristics and prescription patterns of patients with migraine in Germany: a retrospective claims data analysis

BackgroundMigraine is a frequent headache disorder with high disease burden. The aims of this study were to determine the administrative prevalence and incidence of migraine in Germany; and to elucidate disease characteristics, prescription patterns and the patient journey through the German healthcare system.MethodsIn this retrospective, observational study, adult patients with migraine (International Classification of Diseases, 10th revision, German modification G43) were identified in the anonymised German Company Sickness Fund database (CSFD) from 2008 through 2016. The administrative prevalence and incidence of migraine were calculated for the total CSFD study population and extrapolated to the German Statutory Health Insurance (SHI) population. Migraine subtypes, concurrent diagnoses, prescription patterns and visited healthcare professional groups were analysed.ResultsA total of 243,471 patients with migraine were identified in the CSFD (2008–2016); 78.0% were female and 45.3% were aged 35–54 years. The administrative prevalence of migraine, extrapolated to the SHI population, ranged between 2.89% in 2008 and 3.98% in 2016; administrative incidence ranged from 0.587% in 2009 to 0.267% in 2016, and varied between 0.399% and 0.442% during 2011 to 2015. Overall, 29.1% of patients received at least one prescription for any preventive medication listed in the German guideline. Only 7.9% received the same preventive medication for more than 1 year, with 82.9% of these patients discontinuing the medication before study end. Regarding acute medications, 74.2% of prescriptions were for analgesics/non-steroidal anti-inflammatory drugs and 21.2% were for triptans. General practitioners most commonly diagnosed and treated migraine in the CSFD population. Patients with prescriptions for two or more different preventive therapy classes had higher use of acute and emergency medications, and visited healthcare professionals and hospitals more frequently than patients with no prescriptions or prescriptions for only one preventive therapy class.ConclusionsThe administrative prevalence of migraine in this claims database suggests many patients with migraine did not seek medical care. Of those who did, fewer than one-third received preventive medication, with most patients having been prescribed only one such medication and few having continued treatment beyond 1 year. These outcomes suggest there is scope for improvement in migraine management in Germany.

Prescription patterns in patients with schizophrenia in Japan: First-quality indicator data from the survey of "Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)" project.

BackgroundGuideline for Pharmacological Therapy for Schizophrenia was published by the Japanese Society of Neuropsychopharmacology in 2015. “Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)” project aimed to standardize medical practice using quality indicators (QIs) as indices to evaluate the quality of medical practice. In this study, we have reported the quality indicator values of prescription before the beginning of the guideline lectures in the EGUIDE project to ascertain the baseline status of treating patients with schizophrenia.MethodsA cross‐sectional, retrospective case record survey was conducted, involving 1164 patients with schizophrenia at the time of discharge. We checked all types and dosage of psychotropic drugs.ResultsForty‐three percent of patients had antipsychotic polypharmacy, and substantial concomitant medication was observed (antidepressants; 8%, mood stabilizers: 37%, anxiolytics or hypnotics: 68%).ConclusionsIn the results obtained in this study, we plant to report changes in the effectiveness of education in the EGUIDE project near the future.

Hormone Replacement Therapy Prescription after Premature Surgical Menopause

To assess hormone replacement therapy (HRT) prescription pattern in patients undergoing premature surgical menopause on the basis of surgical indication. Retrospective cohort study. Academic tertiary care center. Surgically menopausal patients aged ≤45 years who underwent a minimally invasive hysterectomy with salpingo-oophorectomy. HRT prescription in the 6-week postoperative period. A total of 63 patients met inclusion criteria. Of these, 52% (n = 33) were prescribed HRT in the 6-week postoperative period. Indications for surgical menopause included pelvic pain or endometriosis (31.7%), gynecologic malignancy (20.6%), BRCA gene mutation (17.4%), breast cancer (9.5%), Lynch syndrome (4.8%), and other (15.8%). In total, 80% of patients with pelvic pain, 25% with gynecologic malignancies, 45% with BRCA gene mutations, 33.3% with breast cancer, and 66.6% with Lynch syndrome used HRT postoperatively. In patients who used HRT postoperatively, 76% were offered preoperative HRT counseling. This is in contrast with those patients who did not use HRT postoperatively, of whom only 33% were offered HRT counseling (p <.001). Perioperative complications were not predictive of HRT use postoperatively. In patients who did not use HRT postoperatively, 13.3% used alternative nonhormonal therapy. In patients who underwent premature surgical menopause, 52% used HRT postoperatively. Patients with pelvic pain and Lynch syndrome were more likely to use HRT, whereas those with gynecologic or breast malignancies and BRCA gene mutations were less likely to use HRT. Preoperative HRT counseling was associated with postoperative HRT use.

UNDER-PRESCRIPTION OF SGLT2 INHIBITORS IN PATIENTS WITH DIABETES AND CARDIOVASCULAR DISEASE IN THE UNITED STATES

Diabetes is associated with increased risk of cardiovascular disease (CVD). Sodium-Glucose Transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular outcomes in patients with diabetes. We sought to describe SGLT2i prescription patterns in patients with diabetes and CVD in the United

Sociodemographic and drug prescription pattern in patients with rheumatoid arthritis in a tertiary care teaching hospital

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affects mainly the small joints of the hands and feet. RA is widely prevalent throughout the world.Methods: A prospective and observational study was carried out on 44 patients for 6 months. Patients of either sex, aged between 18 to 70 years diagnosed with rheumatoid arthritis were screened and recruited in the study. Patients were diagnosed on the basis of clinical assessment and the lab parameters assessed were rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide antibody). Prescriptions were analyzed for socio-demographic details and drug prescribing pattern.Results: Out of 44 patients, 36 (81.82%) were females, 8 (18.18%) were males. Maximum occurred 19 (43.18) between 31 to 40 years of age. Out of 19 (43.18%), females were 16 (36.36%), males were 3 (6.83%). 39 (88.63%) were from rural and 5 (11.37%) from urban area, 21 (47.73%) illiterate, 15 (34.09%) primary educated, 7 (15.91%) secondary educated, 1 (2.27%) educated above higher secondary, 4 (9.08%) unemployed, 2 (4.55%) students, 19 (43.18%) housewives, 7 (15.91%) agricultural workers, 7 (15.91%) non-agricultural outdoor workers and 5 (11.37%) non-agricultural indoor workers. Most common co-morbidity was hypertension 28 (63.63%). Anti-CCP was positive in 38 (86.36%). All of the patients 44 (100%) received disease-modifying anti-rheumatic drugs (DMARDs). Majority of the patients were prescribed with triple DMARDs combination 30 (68.18%).Conclusions: We observed that female were dominant over the male with male: female ratio of 1: 4.5. Prescriptions pattern was primarily based on DMARDs.

P.097 Prescription patterns in patients with schizophrenia discontinuing long-acting injectable antipsychotics: A chart-review

P.097 Prescription patterns in patients with schizophrenia discontinuing long-acting injectable antipsychotics: A chart-review

Appropriateness of using granulocyte colony-stimulating factor (G-CSF) for primary prophylaxis of febrile neutropenia in solid tumors.

Febrile neutropenia (FN) is one of the dose-limiting adverse effects of chemotherapy. Granulocyte-Colony Stimulating Factors (G-CSFs) minimize the incidence of FN and reduce the risk of neutropenia complications. This study was conducted to address the prescription pattern of G-CSF for primary prophylaxis of FN during the first cycle of chemotherapy in solid tumors. This prospective observational study was done to investigate the G-CSF prescription pattern in patients receiving the first cycle of chemotherapy for solid tumors and compare it with the NCCN guideline recommendations. Based on the guideline, prophylactic G-CSF administration was indicated in 26 of the 96 patients (27.1%) and all of them received G-CSF. On the other hand, 70 patients (72.9%) did not meet the guideline criteria for prophylaxis, but 60 (62.5%) of them received G-CSF. Seven doses of pegfilgrastim and 165 doses of filgrastim were used inappropriately in the study population, which was associated with an economic burden of about 224.7 million IRR (5350 USD). Taken together, inconsistencies with the guideline were observed in this prospective evaluation, suggesting that submitting rationalized policies to decrease G-CSF prescription, especially in patients with a lower or intermediate FN risk, yields substantial cost savings.

1954 Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Surgical Outcomes and Opioid Prescription Patterns in Patients Undergoing Minimally Invasive Hysterectomy: A Safety-Net Teaching Hospital Experience

Study Objective To evaluate the effect of ERAS bundle implementation on surgical duration, blood loss, length of stay (LOS), 30-day readmission, complication rates as well as opiates prescribing pattern at discharge in patients undergoing hysterectomy. Design Retrospective chart review including all hysterectomies performed one year before and one year after the implementation of the ERAS bundle. Setting Teaching county hospital in Texas. Patients or Participants All patients undergoing hysterectomy from 1/1/17-12/31/18. Interventions ERAS components included: 1- Preoperative carbohydrate loading, Preemptive anesthesia, 2- Intraoperative fluid and narcotic restriction and regional anesthesia, 3- Postoperative early feeding and ambulation. Measurements and Main Results 474 patients were included in the study, 51% before and 49% after ERAS. Route of surgery included 36% vaginal, 33 % laparoscopic and 30% open hysterectomy. Patient characteristics were similar between groups. Surgical outcomes as well as opioid prescription at discharge measured in Morphine Milli-Equivalents (MME) were recorded and compared before and after the intervention. After ERAS implementation, more regional blocks were performed in open hysterectomies: 6% vs 20%, p Conclusion ERAS implementation in a safety net teaching hospital was associated with decreased LOS with no increase in complications, ER visits or readmissions in hysterectomy cases while decreasing opioid prescription at the time of discharge.

TP2 COSTS AND PRESCRIPTION PATTERN OF PATIENTS WITH PSORIATIC ARTHRITIS AND ITS ASSOCIATED COSTS

TP2 COSTS AND PRESCRIPTION PATTERN OF PATIENTS WITH PSORIATIC ARTHRITIS AND ITS ASSOCIATED COSTS

Women Hospitalized for Acute on Chronic Decompensated Systolic Heart Failure Receive Less Furosemide Compared to Men.

The cumulative incidence of systolic heart failure is similar in men and women. However, major prognostic differences exist between genders. We sought to measure gender differences in furosemide prescribing patterns for patients with preexisting heart failure with reduced ejection fraction (HFrEF) admitted with Stage C acute decompensation, regardless of the underlying cause. We conducted a single-center retrospective analysis of patients admitted between 2015 and 2018 for acute on chronic decompensated HFrEF. Primary outcomes were differences in initial furosemide dose, total dose over the first 24 hours of hospitalization, and total dose during the entire hospitalization between women and men. Secondary outcomes included acute kidney injury (AKI), intubation, noninvasive ventilation (NIV), and in-hospital 30-day and 1-year mortality. We studied 434 patients (31% female) with similar baseline characteristics. Females received significantly less furosemide compared to men for the initial dose, over the first 24 hours, and throughout their hospitalization. However, AKI was more prevalent in women versus men (p=0.008). Females admitted for acute on chronic decompensated HFrEF receive significantly less furosemide when compared to men, but developed more AKI prior to discharge.

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study

ObjectiveThis study describes medication prescribing patterns in patients with motor functional neurological disorder (mFND) treated in South London and Maudsley NHS Foundation Trust (SLaM), comparing outcomes to a control group of psychiatric patients from the same hospital trust. MethodThis is a retrospective case-control study using a psychiatric case register. Cross-sectional data were obtained from 322 mFND patients and 644 psychiatry controls who had had contact with SLaM between 1st January 2006 and 31st December 2016. ResultsA slightly lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, OR: 0.59, CI: 0.39–0.89, p < 0.05). Of medication recipients, mFND patients were prescribed a higher number of agents (mean: 4.7 v 2.9, p = 0.001) and had higher prescription rates of antidepressants, anti-epileptics, analgesics, and certain non-psychotropic medications. Higher numbers of prescriptions were associated with co-morbid physical conditions, and previous psychiatric admissions. ConclusionsThis is the first study to describe medication prescriptions in a large cohort of mFND patients. Patients were prescribed a wide range of psychiatric and physical health medications, with higher rates of polypharmacy than controls. Psychotropic medication prescription is not necessarily the first line treatment for mFND, where physiotherapy and psychotherapy may be offered initially. There is limited, early-phase evidence for pharmacological therapies for mFND, and as such, the benefit-to-risk ratio of prescribing in this complex and poorly understood disorder should be carefully assessed.

Cardiovascular risks in type 2 diabetes and the interpretation of cardiovascular outcome trials.

BackgroundPatients with type 2 diabetes (T2D) are at increased cardiovascular (CV) risk compared to subjects without diabetes, with some data estimating that CV disease (CVD) risk is doubled in these individuals. Additionally, CVD remains the leading cause of death in patients with T2D, so it is paramount to determine the relationship between these two diseases.PurposeOlder diabetes treatments have limited CV safety data. In 2008, the US Food and Drug Administration published guidance for manufacturers on antihyperglycemic agents, requiring studies to ensure CV safety of new therapies. Since then, manufacturers of many newer agents have conducted and published results from CV outcomes trials (CVOTs), with more trials due to publish soon. This review discusses the relationship between CVD and T2D and explores findings from the latest CVOTs of glucose-lowering agents to guide nurse practitioners in their prescribing patterns for patients with T2D.ConclusionPatients with T2D are at high risk of CVD, so CV risk should be carefully considered when managing these patients, and CV risks and benefits of antidiabetic drugs should be included in prescribing decisions.