Proper Use Of Drugs Research Articles

JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection

Colorectal endoscopic submucosal dissection (ESD) has become common in recent years. Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also many types of precarcinomatous adenomas. It is important to establish practical guidelines in which the preoperative diagnosis of colorectal neoplasia and the selection of endoscopic treatment procedures are properly outlined, and to ensure that the actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with the guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society has recently compiled a set of colorectal ESD/endoscopic mucosal resection (EMR) guidelines using evidence-based methods. The guidelines focus on the diagnostic and therapeutic strategies and caveat before, during, and after ESD/EMR and, in this regard, exclude the specific procedures, types and proper use of instruments, devices, and drugs. Although eight areas, ranging from indication to pathology, were originally planned for inclusion in these guidelines, evidence was scarce in each area. Therefore, grades of recommendation were determined largely through expert consensus in these areas.

AVALIAÇÃO DOS INDICADORES DE QUALIDADE DAS PRESCRIÇÕES DE MEDICAMENTOS DISPENSADOS EM UM CENTRO DE SAÚDE DO MUNICÍPIO DE VITÓRIA DA CONQUISTA, BAHIA, BRASIL

A prescrição apropriada é um dos fatores mais importantes para a adequada utilização do medicamento e sua qualidade pode ser avaliada por indicadores. Estes são medidas qualitativas ou quantitativas que avaliam desempenhos, detectam problemas e orientam a solução. Este trabalho buscou avaliar a qualidade da prescrição de um Centro de Saúde no município de Vitória da Conquista, BA. Para tal, foram recolhidas 1064 cópias de prescrições médicas a partir das quais foram calculados os indicadores de prescrição propostos pela Organização Mundial da Saúde (OMS), complementados pelos indicadores propostos por Frohlich e Mengue. Os medicamentos prescritos foram classificados obedecendo à classificação da Anatomical Therapeutic Chemical, também da OMS. No Centro de Saúde avaliado, são prescritos, em média, 2,2 medicamentos por receita médica. Do total de medicamentos prescritos, 98,7% são prescritos por seus nomes genéricos. Em 40,3% das prescrições foi encontrada a indicação de antibióticos. Houve prescrição de injetáveis em 5,4% das receitas médicas. Em relação à lista municipal de medicamentos, 50,6% dos medicamentos fazem parte desta lista. Tais resultados demonstram que as prescrições do Centro de Saúde avaliadas não atenderam à totalidade dos parâmetros de qualidade propostos, indicando que alguns hábitos de prescrição devem ser modificados em busca da melhoria da qualidade da prescrição.

Social Pharmacology: A Further Step in Public Health

Social Pharmacology is a field of health science which generates knowledge about marketed drugs in actual use; it focuses on evaluation of the consequences of an individual's exposure to any marketed drug and factors related to its utilization.. The goal of this discipline is to gain knowledge still needed after a drug is marketed. The dossier of a new medicine following regulatory approval contains only the beginning of information needed to be gathered. The postmarketing period represents the most extensive opportunity to study medications in their social life cycle The post- approval environment is complex: strict drug development process controls are no longer in place and operational and management actions by industrial sponsors, health delivery agencies and regulators are unpredictable. We review the impact of pharmacology on public health in its broadest scope. Social pharmacology is proposed as a strategic means to obtain essential data about marketed drugs by engaging the expertise of heterogeneous groups of health-related disciplines., By assessing the wide scope of potential interactions between vectors linked to the actual use of marketed drugs, population-based conclusions may be reached about risk-benefit factors, need for alert responses, proposed actions for decision-making, importance of negative drug effects, and promotion of proper and efficient use of drugs .

Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus.

In order to improve patient care, OMEDIT (Observatory of drugs, medical devices and therapeutic innovation) Alsace, conducted a study to develop a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes. The study conducted from December 2011 to June 2012 was organized in 4 phases: 1) creation of a preliminary list of drugs from those currently used in nursing homes in Alsace, 2) application of a two-round Delphi process to evaluate the preliminary list involving mobilization of experts from different backgrounds (geriatricians, general practitioners, pharmacists …), 3) identification of molecules considered in literature as potentially inappropriate, 4) generation of a final PDE list, including information concerning proper use of drugs for prescription and administration. 53 experts participated in the study. In the first round, 338 drugs were on the preliminary list, 246 were considered as appropriate by experts and 28 as inappropriate. 64 drugs without consensus were submitted to a second round. 32 of them were considered as inappropriate and 32 others remained on the list with no consensus. These last 32 were evaluated by OMEDIT and 3 were considered as appropriate drugs for the elderly. Totally, 252 drugs constitute the final PDE list from our study. The PDE list constitutes a new guide for optimization of both prescription and administration of drugs in nursing homes and could help reduce misuses and poly-medication, which are constant preoccupations to avoid adverse drug reactions in elderly.Key points● The study was carried out with the aim to create a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes using a modified Delphi method.● The PDE list constitutes a new guideline to harmonize practices in nursing homes and to help physicians and nurses to achieve best possible care management.

AB0347 Barriers to Achieving Controlled Rheumatoid Arthritis in the Uae

BackgroundAchieving a low DAS28 (disease activity score) of less than 3.2, is a common treatment goal for Rheumatoid Arthritis (RA). In clinics however, despite efforts, some patients still fail to...

Outcome evaluation of an intervention to improve the effective and safe use of meropenem.

Pharmacists have been involved in promoting the proper and safe use of antimicrobial drugs in our institution since 2010. Setting Kochi Medical School Hospital, Japan. To design and evaluate a plan of administration of meropenem (MEPM) based on its pharmacokinetics and pharmacodynamics, drug sensitivity, bacterial cultures, patient condition and renal function. A total of 547 patients admitted between April 2010 and March 2013 with serious infections who were successfully treated with MEPM for three or more days were analysed. Patients were initially divided into two groups according to renal function: group A consisted of patients with mild renal dysfunction [creatinine clearance (CLcr) > 50 mL/min] while group B consisted of patients with moderate to severe renal dysfunction (CLcr ≤ 50 mL/min). These groups were then subdivided into two groups according to the implementation of pharmacist intervention. Daily dose, frequency of administration, dose interval, duration of therapy, adverse events and cost reduction. In the non-intervention subgroup within group A, the daily dose was 1,000 mg/day, the frequency of administration was 1.8 ± 0.6 times/day, and the duration of therapy was 9.4 ± 5.4 days. In the intervention subgroup within group A, the daily dose was 1,500 mg/day, the administration frequency was 2.5 ± 0.6 times/day, and the duration of therapy was 7.4 ± 3.7 days. Although the dose was higher (P < 0.05) and the duration of therapy was an average of 2 days shorter (P < 0.05) in the intervention subgroup, there was no significant difference in the rate of adverse events between the two subgroups. In group B, there were no significant differences between the two subgroups in the daily dose, administration frequency, or duration of therapy. However, liver dysfunction was significantly more common in the non-intervention subgroup than in the intervention subgroup (P < 0.05). The total reduction in drug cost in the intervention groups was estimated to be US$17,490 over 3 years. Pharmacist intervention was associated with a shorter duration of therapy, lower drug costs, and decreased adverse effect. We believe that our intervention is beneficial in terms of effectiveness and safety, and supports proper antimicrobial use.

Chronic inactive pulmonary tuberculosis and treatment sequelae: chest radiographic features [Perspective

The chest radiograph (CXR) is a key initial tool in the diagnosis of many lung conditions, including pulmonary tuberculosis (TB). With proper use of anti-tuberculosis drugs, TB can be treated effectively and many CXR changes are limited. However, anti-tuberculosis drugs have not always been available, and in some cases they have not been started early in the disease process. The infection has then been able to take hold and cause significant radiologically visible damage, such as calcification and fibrosis. Before the use of anti-tuberculosis drugs, a variety of surgical techniques were employed to control pulmonary infection, including plombage, oleothorax, phrenic nerve crush and thoracoplasty. Each of these led to distinctive CXR features. This article sets out to describe the CXR features of chronic disease and surgical treatments, as their increasing rarity with the passage of time has meant that they can be misinterpreted. However, with increasing life expectancy and the revival of surgery due to the development of anti-tuberculosis drug resistance, the correct interpretation of these CXR changes is still of importance.

Influence of obstructive jaundice on neuromuscular blocking effect and drug metabolism of rocuronium

Objective To observe the effect of obstructive jaundice on the neuromuscular blocking effect and drug metabolism of rocuronium,so as to guide proper use of rocuronium during anesthesia for patients undergoing hepatobiliary surgeries.Methods Thirty patients(with normal renal function and without muscle or nerves diseases,ASAⅠ-Ⅱ)receiving elective surgery were divided into 2groups:obstructive jaundice group(group Ⅰ,n=15)and control group(group Ⅱ,n=15).All patients received continuous peridural anesthesia and general anesthesia.Neuromuscular blockade was evaluated with train-of-four(TOF)stimuli of the ulnsar nerve using TOF Watch SX nerve stimulators.The onset time,clinical duration of rocuronium,the time of TOFR from 0 to 70% and recovery index(T1 from 25%-75%) were observed. Liquid chromatography-tandem mass spectrometry(LC/MS/MS)was used to determine the concentration of rocuronium in the plasma at 30,60,90,120,and 180 min after administration of 0.9 mg/kg rocuronium.Results The age,body mass index,and prothrombin time were matched between the two groups.The total bilirubin,direct bilirubin and indirect bilirubin in groupⅠ were significantly higher than that in group Ⅱ(P<0.01).The onset time was similar between the two groups;the clinical duration of rocuronium,the time of TOFR from 0to 70%,and the recovery index(to 10%,25%,50%,and 75% of T1)in groupⅠ were significantly longer than those in groupⅡ(P<0.01).The plasma concentrations of rocuronium in groupⅠ were significantly higher than those in group Ⅱat 60,90,120 min after administration of rocuronium(P<0.01 or P<0.05).Conclusion Obstructive jaundice may prolong the duration of rocuronium action and recovery time,and slows down themetabolism of rocuronium.So patients with obstructive jaundice should have a longer interval for drug addition.Peri-and postoperative monitoring of neuromuscular function is suggested for proper drug use and anesthesia extubation.

Pharmaceuticals companies' promotional brochures: do they display reliable and useful medications' information?

Background: The main objective of this study which was the first of its kind in Sudan was the evaluation of the medication informational contents (section headings) of pharmaceutical companies’ promotional brochures, their possible benefits, reliability and usefulness in the proper and rational use of drugs. Methods: Three hundred and fifty-one (n=351) brochures were collected from randomly selected doctors’ clinics in Khartoum, Sudan. Ninety-two of those brochures were excluded for being either duplicates, reminder brochures, promoting medical devices or cosmetics. The remaining (259), were then screened to match their macro-informational contents (section headings) against same advised in world health organization ethical criteria for medicinal drug promotion. Results: Almost all the screened brochures displayed unbalanced and poorly evidence supported (48.2%) medication information messages, which minimized the risks of the promoted drugs (45.4%), while displaying section headings encouraging more use of the promoted products, in higher frequencies (93.66%).There was significant difference between the frequencies of display of medication information section headings of eight out of nine tested section headings, of a multinational and branded generic brochures (p. value ranged between 0.01 and 0.000). Conclusions: Screened brochures were found to display poorly reliable and unbalanced medication information. Healthcare providers shall, accordingly, seek independent medication information sources, and not solely depend on commercial sources of medication information. Official regulators shall strictly define and mandate medication information contents in printed pharmaceutical promotional materials. Healthcare providers should, also, master the skills of appraising such promotional printed materials if rational medication use is to be achieved.

Analysis of Bone Repair Tissue after Implantation of Biomaterials and Application of Vibratory Waves

Bone tissue in ideal conditions morphofunctional remodeling properly. The bone can be affected by fractures, tumors, hormonal dysfunction, senescence, genetic modifications, among others. In such circumstances, the proper diet, drug use, exercise and other factors are important to the prevention of bone mineral loss. The effect of kinesiotherapy obtained through the application of vibratory waves administered through the vibrating platform, Juvent1000 ® already been established in the prevention of bone mineral density, muscular trophism, among other systems in humans. The response by analyzing bone tissue of bone repair in critical defect is not known in experimental animals and in human clinical. This research evaluated the osteogenic potential critical defect in the calvaria of rats subjected to the application of vibratory waves obtained by vibrating platform and implant in the critical defect of rat calvaria. The bone tissue response was evaluated showed satisfactory results obtained in biological points 15, 45 and 120 days.

Education Effect of the Simple Suspension Method Training for Fifth-year Medical Students

The clinical training curriculum for fifth-year students of a school of medicine (Department of Medicine) includes training in clinical pharmacy, which is conducted by the Department of Pharmacy. Following training involving the simple suspension method, a survey was conducted to examine its effects to improve medical students' knowledge on the proper use of drugs. Forty-eight 5th-year students of Ehime University School of Medicine, Department of Medicine, underwent training that employed the simple suspension method, and examinations were conducted prior to and following it to assess its effects. Following the training, the questionnaire results were analyzed using Quantification Theory Class II to examine whether knowledge acquired from it had motivated the students to use the simple suspension method. A correspondence structural analysis was also conducted to identify improvements in the training. The correct answer rate increased from 55.2±2.4% before to 83.8±1.7% after training, which supports its learning effects. The presence or absence of changes in disposition and the efficacy of the method for patients with dysphagia strongly motivated the medical students to use the method. As a future improvement, it is necessary to describe differences between the crushing and simple suspension methods during training. The results of a survey on training involving medical students conducted based on the simple suspension method suggested its learning effects and knowledge that motivated them to use the method.

Biomarker Exploration and Its Clinical Use

Biomarkers are useful tools as indicators/predictors of disease severity and drug responsiveness, and thus, are expected to make drug development more efficient and to accelerate proper use of approved drugs. Many academic achievements on biomarkers have been reported, but only several biomarkers are used in drug development and clinical settings. We first show our results on the pharmacogenomic analysis of the anti-cancer drug irinotecan and of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). UGT1A1*6 and *28 were significantly associated with altered pharmacokinetics of an irinotecan metabolite, SN-38, and with increased frequency of severe neutropenia. HLA* 58:01 and HLA-B*15:11/HLA-A*31:01 were associated with SJS/TEN by allopurinol and carbamazepine, respectively. Our papers have been cited in the package inserts of irinotecan and allopurinol. In addition to these genomic biomarkers, metabolomic biomarkers, which can reflect the disease phenotype and drug responsiveness, have been exploring for 12 major diseases in Japan, as a part of a multi-omics team with multi-national centers. In animal models of dilated cardiomyopathy and Alzheimer's disease, we found several changes in lipid metabolite levels in the diseased tissues. Moreover, two oxidized fatty acids were correlatively changed in the brain and plasma from Alzheimer's model mice before its onset, and thus, could be candidates for predictive biomarkers. Finally, we propose/discuss several key issues for academic researches on biomarker discovery and development, especially for newly coming researchers in the field of pharmaceutical sciences. We hope that this review would help novel biomarker identification and qualification in Japan.

Analysis of patients' narratives posted on social media websites on benfluorex's (Mediator® ) withdrawal in France

Websites and discussion lists on health issues are among the most popular resources on the Web. Use experience reported on social media websites may provide useful information on drugs and their adverse reactions (ADRs). Clear communication on the benefit/harm balance of drugs is important to inform proper use of drugs. Some data have shown that communication (advisories or warnings) is difficult. This study aimed to explore the Internet as a source of data on patients' perception of risk associated with benfluorex and the impact of wider media coverage. Three French websites were selected: Doctissimo, Atoute.org considered the best-known and visited website in France for health questions and Vivelesrondes (Long live the Tubbies) for overweight people. Three periods were chosen: (1) before November 2009 (i.e. before benfluorex withdrawal), (2) between November 2009 and November 2010 (when the risk of valvulopathy with benfluorex appeared in social media) and (3) after November 2010. Two hundred twenty initial postings were analysed. These lead to 660 secondary postings which were analysed separately. In period 1, 114 initial postings were analysed, mostly concerning efficacy of the drug (72%). In period 2, 42 initial postings were analysed involving mainly ADRs or warnings (73%). In period 3, 64 initial postings were analysed; most frequent expressing anger directed at the healthcare system (58%) and anxiety about cardiovascular ADRs (30%). Online consumer postings showed that there were drastic changes in consumers' perceptions following media coverage. This study suggests that analysis of website data can inform on drug ADRs. Social media are important for communicating information on drug ADRs and for assessing consumer behaviour and their risk perception.

Development of Internet-based System to Collect and Provide Drug Information for Patients/Consumers

For drug fostering and evolution, it is important to collect information directly from patients on the efficacy and safety of drugs as well as patient needs. At present, however, information gathered by healthcare professionals, pharmaceutical companies, or governments is not sufficient. There is concern that patients may fail to recognize the importance of providing information voluntarily. The present study was conducted to provide drug information to patients/consumers, to enlighten them on the importance of providing drug information by themselves, and to develop an Internet website, called "Minkusu," for collecting drug information from patients. This website is based on a registration system (free of charge). It is designed to provide information on proper drug use, and to collect opinions about drugs. As of May 31, 2012, a total of 1149 people had been registered. The male/female ratio of registered members was approximately 1:1, and patients/consumers accounted for 23%. According to the results of a questionnaire survey, several patient/consumer members appreciated the usefulness of the information service, and they took an opportunity to know of the concepts of drug development and evolution (Ikuyaku, in Japanese) through the information services provided by this site. In conclusion, the developed information system would contribute to the proper use of drugs by patients/consumers and to the promotion of drug development and evolution.

Les médicaments d’exception : spécificité et rôle dans le cadre du bon usage des médicaments

BackgroundIn 1994, the French health care system established a special status for certain costly drugs reimbursed for ambulatory use: exception drugs. Drugs with this status are reimbursed only when prescribed for specified indications. The purpose of this study was to identify the specific characteristics of drugs with the exception status, and to understand the role of this status in proper use of drugs. MethodsDrugs included in the study were analyzed using three types of data: administrative, clinical and economic. ResultsFor most of the drugs, prescription was restrictive. For five of them, the sickness fund accepted reimbursements for fewer indications than mentioned in the marketing authorisation. For the majority, reimbursement was 100%. The exception drugs were indicated for the treatment of 15 diseases. Eighty percent of expenditures for exception drugs concerned ten drugs. ConclusionThe characteristics considered in the study did not enable a specific description of the inherent features of exception drugs. This special status was established for the purpose of economic efficiency. Currently, its role in ensuring proper use of drugs is questionable.

The past, present and perhaps future of pharmacovigilance: homage to Folke Sjoqvist

Over the years since 1961 and the identification of thalidomide as the common link in thousands of birth defects, daily pharmacovigilance activities and signal generation have evolved from the analysis of individual case reports and imputology, to case series and underreporting, to spontaneous report databases and disproportionality analyses, to data mining in population databases. Regulatory requirements have also changed from purely passive monitoring and reacting to alerts to a proactive approach that includes risk management plans and risk minimization, and from reporting only by healthcare professionals to patient reporting and exploration of social media. The emphasis only on risk assessment is changing towards assessment of the risk/benefit ratio and the exploration of real-life efficacy studies to complement the measure of real-life risk. The interactions between industry and regulators have been amplified and strengthened. However, most adverse reactions, including severe ones, are related to well-known and often pharmacological effects of the older drugs, possibly with genetic predispositions. Prevention is the next frontier for pharmacovigilance, beyond simply generating alerts, and it involves not only the removal of drugs from the market, but also promotion of proper drug prescribing by better trained physicians and the proper use of drugs by better informed patients.

Multi drug and extensively drug-resistant TB (M/XDR-TB) management: Current issues

Abstract Multi Drug and Extensive Drug Resistant Tuberculosis (M/XDR-TB) has been an area of growing concern among clinicians, epidemiologists and public health workers worldwide. Lack of controlled trials in M/XDR-TB patients retard the optimal management of such patients, and guidelines that have been developed largely on expert opinion are crowed with controversies. Lack of effective drugs, improper regimens prescribed by poorly trained doctors and unreliable Drug Susceptibility Test (DST) reports add to the magnimity of the situation. Quality-assured culture and DST are indispensable for the diagnosis of M/XDR-TB. M/XDT-TB must be managed very effectively with careful use of Second-Line Drugs (SLDs) to reduce the morbidity and mortality and transmission of M/XDR-TB. M/XDR-TB is a man made problem and its emergence can be prevented by prompt diagnosis and effective use of first-line drugs in every new patient. The Programmatic Management of Drug Resistance Tuberculosis (PMDT-TB) proposed by the WHO has highlighted the comprehensive management strategy to control MDR-TB. Laboratory services for adequate and timely diagnosis of M/XDR-TB must be strengthened and programmatic management of M.XDR-TB must be scaled up as per target set by global plan. The proper use of second-line drugs must be ensured to cure existing MDR-TB, to reduce its transmission and to prevent XDR-TB. Sound infection control measures to avoid further transmission of M/XDR-TB and research towards the development of new diagnostics, drugs and vaccines should be promoted for proper control of M/XDR-TB.

DGI-007 Analysis of the Prescriptions of Antibiotics as Last Resort

Background The composite index on proper use of antibiotics (ICATB) includes surveillance of the ATBs used, evaluation of ATB prescriptions and the existence of an ATB list associated with checking...

Plasma and Serum from Nonfasting Men and Women Differ in Their Lipidomic Profiles

Biomarkers will play important roles in disease diagnosis, drug development, and the proper use of drugs. Blood is considered the best biofluid for biomarker research because it is easy to access and a wealth of data are available. However, previous studies revealed that several ionic metabolites showed different levels (including presence or absence) in plasma and serum. Thus, attention should be paid to selecting the best biofluid for biomarker exploration. Many lipid molecules have biological significance and thus would be candidate biomarkers. However, no comprehensive study revealing differences in lipid metabolite levels between plasma and serum has been undertaken. Furthermore, gender differences have not been reported. To clarify the difference in the levels of lipid metabolites between human plasma and serum from both genders, we performed lipid metabolomic analysis using liquid chromatography-mass spectrometry-based systems for phospholipids (PLs), lysoPLs, sphingomyelins, ceramides and oxidative fatty acids. Our results revealed that most of the lipid metabolites were present at similar levels in plasma and serum and in males and females. However, several oxidative fatty acid metabolites showed differences. Of the metabolites related to clotting processes, three showed higher levels in serum than in plasma, and three were detected only in serum. Furthermore, four metabolites were present at different levels between males and females, and two were detected only in males. Thus, attention should be paid to the selection of plasma or serum when utilizing these lipid metabolites as biomarkers.

宮崎県北部山間地域住民の医療アクセスと医薬品適正使用状況

宮崎県北部山間地域住民の医療アクセスと医薬品適正使用状況