Rational Use Of Medications Research Articles

Determining The Society's Knowledge and Practices on Rational Medication Use: Cankiri Province

Amaç: Bu çalışma, Çankırı İli’nde yaşayan bireylerin akılcı ilaç kullanımına ilişkin bilgi ve uygulamalarının belirlenmesi amacıyla yapılmıştır. Gereç ve Yöntem: Çalışma, tanımlayıcı özellikte olup, evrenini Çankırı İli’nde yaşayan bireyler oluşturmaktadır. Araştırmaya 18 yaş ve üzerindeki, bilişsel, duyuşsal ve iletişim problemi olmayan bireyler dahil edilmiştir. Araştırma 437 katılımcı ile tamamlanmıştır. Araştırma örneklemi tesadüfi olmayan örnekleme türlerinden olan kolayda örneklem metodu ile belirlenmiştir. Veriler, veri toplama formu ile Haziran- Ağustos 2021 tarihleri arasında, yüz yüze görüşme tekniği kullanılarak toplanmıştır. Bulgular: Katılımcıların akılcı ilaç kullanımına yönelik bilgi ve uygulamalarının dağılımı incelendiğinde, %29,7 ‘sinin gereksiz yere ilaç yazdırma eğiliminde olduğu, %27,4’ünün kendi kendine antibiyotik kullandığı, %40,5’inin ilacın kullanma talimatını okumadığı belirlenmiştir. Katılımcıların akılcı ilaç bilgi ve uygulamaları sosyodemgrafik özelliklerle karşılaştırıldığında; kendi kendine antibiyotik kullanmanın yaş, cinsiyet, medeni durum, eğitim düzeyi ve kronik hastalık varlığı ile ilişkili olduğu bulunmuştur (p<0,05). Sonuç: Çalışmamızda toplumun akılcı ilaç kullanımına yönelik bilgi ve uygulamalarının yetersiz olduğu, özellikle eğitim seviyesinin azalmasıyla birlikte akılcı ilaç kullanımının da azaldığı görülmüştür. Çalışmamızdan çıkan sonuçlara göre Çankırı İli’nde yaşayan bireylere, akılcı ilaç kullanımına ilişkin farkındalık eğitimlerinin düzenlenmesi önerilmektedir.

Rational Use of Medications: Eccentric or Non-existent?

Rational Use of Medications: Eccentric or Non-existent?

Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia

BackgroundPrescribing medications without potential drug-drug interactions (pDDIs) is one of the components of the rational use of medications. However, taking combined medications has resulted in life-threatening pDDIs, which are causing severe clinical outcomes for patients. This study was aimed at assessing the prevalence of pDDIs and associated factors in admitted patients with psychiatric disorders.MethodsAn institution-based multicenter cross-sectional study was conducted among patients with psychiatric disorders admitted to a selected hospital in Northwest Ethiopia. Samples were approached through a systematic sampling method. The Statistical Package for the Social Sciences (SPSS) version 26 was used to analyze the data. Logistic regression was applied to determine the association of variables with pDDIs. A p-value of < 0.05 was statistically significant.ResultsOut of 325 study participants, more than half (52.9%) were females, with a median age of 61 years. Overall, more than two-thirds (68.9%) were exposed to at least one clinically significant, either significant or serious level of pDDIs. Nearly one-fourth (23.2%) of participants had at least one serious level of pDDIs. Older patients were found more likely to have pDDIs compared to younger patients (p = 0.043). Similarly, patients with a higher number of prescribed medications (p = 0.035) and patients with longer hospital admissions (p = 0.004) were found more likely to be exposed to pDDIs than their counterparts.ConclusionIn this study, a significant number of admitted patients with psychiatric problems encountered clinically significant pDDIs. As a result, healthcare providers could assess and follow patients with a combination of medications that potentially have a drug-drug interaction outcome.

Investigation of Improvement Items Based on Students' Perspectives on Practical Training for Raising Pharmaceutical Problem-solving Capability at Pharmacies

Experience-based clinical training has been introduced in long-term practical training at pharmacies in Japan. Satisfaction and motivation of pharmacy students differs among pharmacies; however, the underlying causes of the differences are unclear. The purpose of this study was to investigate items for improvement for long-term practical training for raising pharmaceutical problem-solving capability at pharmacies based on students' perspectives. We performed a questionnaire survey to evaluate student satisfaction in clinical education and learning environments. The results were analyzed using customer satisfaction (CS) analysis. After long-term practical training at pharmacies, questionnaires were distributed to 126 pharmacy students at Fukuyama University between November 2021 and March 2022. Ninety-eight students responded. "The practice hours per prescription or pharmacotherapy screening and intervention (improvement factor: 14.954)", "the discussion hours for optimization of prescribing and rational medication use, or patient education with pharmacist (9.493)", and "the self-learning place (3.490)" were identified as items requiring improvement. Our findings suggest that the university should work together with pharmacies to improve the learning strategy and environments to increase direct and continuous interaction with pharmacists at pharmacies. Such interventions may result in improvement of students' satisfaction and a wide variety of practical pharmacy skills.

Development of a quality assessment tool for pharmacy and therapeutics committees and subsequent pilot testing

Pharmacy and therapeutics committees (PTCs) are multidisciplinary hospital teams responsible for rational medication use. We aimed at developing and piloting an assessment tool for their operating quality.We conducted a scoping...

Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association's (ADA) 2021 treatment guidelines among patients of type 2 diabetes mellitus: A cross-sectional study.

Glycemic control is the major therapeutic objective in diabetes. Poor glycemic control in diabetes mellitus can be prevented by using rational use of anti-diabetic medication, which needs to be evaluated for effectiveness by prescription pattern studies. The objective of this study was to assess the prescribing pattern and adherence to the American Diabetic Association's (ADA) treatment guidelines in type 2 diabetes mellitus patients in a tertiary care teaching hospital in Uttarakhand, India. This cross-sectional study was conducted on 206 type 2 diabetic patients who were prescribed anti-diabetic therapy. Patient's demographic details and drugs prescribed, with their dosage, were recorded to study the prescription pattern. Oral anti-diabetic drugs were most commonly prescribed in 149 (72.33%) type 2 diabetic mellitus patients. Five of these patients (3.35%) were on metformin monotherapy, whereas majority of patients (81, 54.36%) were on a fixed dose combination of Glimepiride (SU) + Metformin (MET). Forty-five patients (30.20%) were on MET + Dipeptidyl peptidase 4 inhibitors (DPP4I) combination; 5 (3.35%) were on MET + SU + alpha-glucosidase inhibitors (AGI) combination; 7 (4.69%) were on MET + SU + Pioglitazone (PIO) (Thiazolidinediones) combination; 6 (4.02%) were on sodium/glucose cotransporter-2 inhibitors (SGLT2I) and 57 (27.66%) were on insulin therapy. Out of 206 patients, the prescriptions of 185 patients (89.8%) were adherent and of 21 patients (10.19%) were not adhering to ADA 2021 treatment guidelines. Oral anti-diabetic agents predominate the prescribing pattern practices for type 2 DM but there was a shift in trend towards the use of fixed-dose combinations (FDC) in the management of type 2 DM, and majority of prescriptions were adherent to ADA treatment guidelines.

SKILL-BUILDING WORKSHOP ON THE RATIONAL USE OF PSYCHOTROPIC MEDICATIONS IN YOUTH

The program will define deprescribing as a systematic rational use of psychotropic medications that considers the indications, risks, benefits, shared decision making, and social context/disparities involved in treatment. This Workshop will prepare providers to identify specific environments and periods when deprescribing should be considered in youth and provide skills to safely conduct the process.

The outcomes of a national clinical review process for nonformulary medication requests in Saudi Arabia

AbstractBackgroundMedications often constitute a significant percentage of health care budgets; therefore ensuring rational medication use is essential. In December 2017, the Saudi Ministry of Health (MOH) introduced a national clinical review process for nonformulary medications (NFMs) requests across 284 MOH institutions to standardize review and approval process under the governance of Pharmacy and Therapeutics Committee (PTC).ObjectivesThis study aims to describe the effectiveness of implementing a national clinical review process for NFMs on the approval rate, decision turnaround time, and potential cost savings within MOH institutions.MethodsThis was a retrospective, observational cohort study undertaken over 36 months. All NFM requests were received through an electronic system, linking all the ministry's regions and departments with a single coding system. Quantitative descriptive statistics: frequency, percentage, median, and interquartile range were used to present the results of this study. A P value ≤.05 was considered statistically significant.ResultsThe approval rate among a total of 2388 NFM requests was 1733 (74%). The median submission turnaround time for NFM requests in 2018 to 2020 were 12.5 (interquartile range [IQR]: 5‐24), 7 (IQR: 3‐15), and 7 (IQR: 4‐14) working days, respectively (P ≤ .001). The median decision turnaround time for NFM requests in 2018 to 2020 were 7 (IQR: 4‐10), 5 (IQR: 3‐9), and 5 (IQR: 4‐8) working days, respectively (P = .019). Of the 615 disapproved requests, 514 (83.6%) were disapproved for a single reason. Moreover, disapproval of requests equated to a potential cost savings which exceeded 14.8 million United States dollars.ConclusionsThis initial study showed that implementing a structured, systematic review process for NFM requests resulted in potential cost savings and acceptable turnaround times for nonurgent requests. However, further studies are needed to examine the actual cost savings and clinical impact on patient outcomes.

Drugs utilization profile in England and Wales in the past 15 years: a secular trend analysis

BackgroundMedication use assessment has a critical role in promoting the effective and rational use of pharmaceutical medications. There are no studies that have explored the utilization of all medications in England and Wales in the past 15 years without restrictions in the age group being studied or class of medications.AimTo explore the medication utilization pattern of dispensed medications in England and Wales in the past 15 years.MethodA secular trend analysis study using publically available dispensing data on the population level in England and Wales for the duration between 2004 and 2019. Medication dispensing data was extracted from the Prescription Cost Analysis database.ResultsMedication prescriptions rate increased by 42.6% [from 1,345,095.75 (95% CI 1,345,004.25 – 1,345,187.26) in 2004 to 1,918,138.48 (95% CI 1,918,038.38 – 1,918,238.57) in 2019 per 100,000 persons, trend test, p < 0.001]. During the study period, the most common medication prescriptions were for the cardiovascular system, central nervous system, and endocrine system, which accounted for 30.2%, 18.8%, and 9.4%, respectively. The rate of medication prescriptions for skin, immunological products and vaccines, infections, and musculoskeletal and joint diseases decreased by 18.4%, 15.8%, 9.8%, and 5.7%, respectively.ConclusionThe last two decades have witnessed a remarkable rise in the quantity of medications dispensed in community settings. Utilization of chronic disease medications has increased in the past 15 years, specifically, dispensed medications for the cardiovascular system, central nervous system, and endocrine system. It is necessary to conduct additional cohort studies to investigate the clinical outcomes and prescribing safety of these medications.

Rational medication management mode and its implementation effect for the elderly with multimorbidity: A prospective cohort study in China.

BackgroundAs one of the countries with the most serious degree of aging, the incidence of potentially inappropriate drug use among the elderly is as high as 30. 4% in Chinese communities, and the lack of effective medication management and poor medication compliance at home are the main factors. Given these situations, we constructed a Rational Medication Management Mode based on family physician service, carried out an empirical research and evaluated the implementation effect.MethodsA prospective cohort study was conducted from September to December 2021 to analyze the implementation effect of the Rational Medication Management Mode by comparing the outcome indicators between the intervention group and control group. The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days. The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use.ResultsA total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. At 90 days, the number of medications was achieved by 3.88 (1.48), and patients with polypharmacy were reduced by 59.55% in the intervention group, having a significant difference compared with the control group (P < 0.001). Patients with medication reminders, intermittent medication and adverse drug reactions were achieved in 294 (95.15%), 47 (15.21%), and 51 (16.51%) respectively in the intervention group (P < 0.001). The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days (P < 0.0001).ConclusionThe Rational Medication Management Mode based family physician service, which provides the support of manuals and pillboxes, can decrease the elderly patients' number of drugs with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication usage behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China.

Assessment of prescribing pattern in chronic liver disease (CLD) patients and rational use of medication in a tertiary care teaching hospital

Background: Chronic liver disease (CLD) is a condition of liver damage that includes cirrhosis and fibrosis of liver. It is a progressive destruction of liver functions due to inflammation, exertion of bile and detoxification of harmful products of metabolism. Objective : To assess the prescribing pattern in chronic liver disease patients and to facilitate rational use of medication. Method : A uni-centric prospective (observational) study was conducted for a period of 6 months for analyzing the prescribing pattern used in treating Chronic Liver Disease (CLD) patients. All the patients (both male and female) diagnosed with CLD visited to gastroenterology department were included in the study. Patients with pregnancy, age below 18 year and above 80 year were not involved in the study. Result: It was observed that the number of males accounted for the 64% of the total patients and rest 36% were females. CLD affected the age group of 48 – 58 years and the common causes were hepatitis C virus (55.55%) and alcohol consumption (26.19%).

Self-medication Practices and Associated Factors among COVID-19 Recovered Patients to Prevent Future Infections: A Web-based Survey in Bangladesh

Background: Human health is largely affected by self-medication in both ways, adversely and favorably, as evidenced by the COVID-19 pandemic. The fear of spreading novel coronavirus disease (COVID-19) from health workers and hospital environments has led many Bangladeshi people to practice self-medicate for as the preventive strategy against this disease. Consequently, this practice entails an improper and injudicious use of medicine to cure self-recognized symptoms. To date, the COVID-19 has no effective treatment. The lack of a cure for COVID-19 and the continual progression of the diseases in educational settings induce a substantial population to practice self-medication. Therefore, a study of self-medication practices is necessary for the framework of the pandemic. This study aimed to estimate the prevalence and factors associated with selfmedication to prevent or manage future COVID-19 infections among recovered COVID-19 patients. Methods: This cross-sectional study was conducted since September 2020 to February 2021 using an e-survey along with 360 participants (&gt;18 years). Data were collected using a pre-tested self-reported questionnaire. Descriptive statistics and correlations analysis were performed in the study. Results: Among 360 (male 69.7% and female 30.3%) participants, the prevalence of selfmedication is 11%, and monthly family income, residence, education, occupation, and previous history of SM are the associated factors. Among the participants, 29.7% use antibiotics, and 30% use herbal products/drugs as medication. Conclusion: The present study found SMP is moderately prevalent among COVID-19 recovered patients. To minimize the rate of SMP, adequate health care– access systems and public education should be introduced, and media and community should be engaged in rational use of medication.

Prescribing Practices of Intravenous Immunoglobulin in Tertiary Care Hospitals in Malaysia: A Need for a National Guideline for Immunoglobulin Use.

Rational use of drug involves the use of medicine as per clinical guidelines. Given the steady increase in the clinical utility of intravenous immunoglobulin (IVIG) either as licensed or off-label use, concerns are being raised about the possibility of supply shortages that could significantly impact patient care. Therefore, there is a need to regulate and to promote the rational use of this valuable medication. This cross-sectional chart review study attempts to evaluate the prescribing patterns of IVIG at two tertiary hospitals in Malaysia. Patients’ medical files and dispensing records were examined and compared with current guidelines. A total of 348 prescriptions for IVIG were written during the 1-year study period. The highest usage of IVIG was for neurological (47.9%), immunological (27.5%), and hematological conditions (20%). The number of prescriptions with the US Food and Drug Administration (FDA) licensed indications and off-label indications was 148 (42.5%) and 200 (57.5%), respectively. Age (OR: 1.02, 95% CI: 1.01–1.03, p = 0.003) and those admitted to the critical care units (OR: 11.11, 95% CI: 5.60–22.05, p < 0.001) were significant factors for receiving IVIG for an off-label indication. Most prescriptions (79%) had appropriate dosing. Significant factors associated with receiving inappropriate dose of IVIG include age (OR: 0.93, 95% CI: 0.89–0.97, p = 0.001) and those admitted to the critical care units (OR: 10.15, 95% CI: 3.81–27.06, p < 0.001). This study advocates the development and implementation of evidence-based clinical guidelines with prioritization protocol to ensure rational use of IVIG.

Cardiovascular risks and primary interventions among treated rheumatoid arthritis patients: Experience from a tertiary care centre in Kuala Lumpur, Malaysia

Purpose: To investigate the cardiovascular risk among treated rheumatoid arthritis (RA) patients to predict the factors associated with high cardiovascular risk and to determine the presence of pharmacotherapy primary prevention among treated RA patients with high cardiovascular disease (CVD) risk.Methods: The study was a prospective cross-sectional study on adult patients diagnosed and treated for RA and without established heart disease/stroke. Cardiovascular risk scoring was based on Framingham Cardiovascular Disease 10-year risk prediction model (BMI model) x 1.5 factor while descriptive and inferential analyses were done using SPSS.Results: High CVD risk was defined as FRS-CVD cardiovascular risk categories (&gt;20%) and 55.9% of patients were at high CVD risk. Use of Hydroxychloroquine (OR: 0.44; 95 % CI: 0.21- 0.92; p= 0.028) and COX-2 inhibitors (OR: 0.31; 95% CI:0.10- 0.95; p = 0.039) were found to be significantly associated with high CVD risk among treated RA patients. Significant number of high CVD risk patients did receive pharmacotherapy primary prevention (p = 0.001).Conclusion: Hydroxychloroquine and COX-2 inhibitors are independent negative risk predictors associated with high CVD risk among treated RA patients. Baseline cardiovascular risk data may be useful in rational use of medications to treat RA, considering that cardiovascular related mortality is the leading cause of death in RA.

Use of Thiazide Diuretics and Risk of All Types of Skin Cancers: An Updated Systematic Review and Meta-Analysis.

Simple SummaryBy examining evidence from 30 non-randomized studies, we found that thiazide diuretic users have a higher risk of skin cancer than non-thiazide diuretic users. A small but consistent risk was identified across all types of skin cancers, including the more dangerous malignant melanoma (all subtypes, superficial spreading melanoma, nodular melanoma, and lentigo maligna melanoma) and non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma). The high cancer risk associated with thiazides, especially the risk of malignant melanoma, is concerning. Individual skin cancer risk assessment, monitoring, and consideration of suitable drug alternatives are needed before the long-term use of these agents. Our findings suggest that to promote the rational use of anti-hypertensive medication, the benefits of thiazide diuretics must be weighed against potential safety concerns in terms of skin cancer risks.Background: The use of thiazide diuretics is associated with skin cancer risk; however, whether this applies to all skin cancer types is unclear. Methods: In this meta-analysis, we searched multiple electronic databases and gray literature up to 10 April 2022, with no language restrictions, to identify relevant randomized controlled trials (RCTs) and non-randomized studies (cohort, case-control) that investigated the association between thiazide diuretics and skin cancer. The primary outcomes of interest were malignant melanoma and non-melanoma skin cancer (basal cell carcinoma [BCC], squamous cell carcinoma [SCC]). Secondary outcomes included other skin cancers (lip cancer, Merkel cell carcinoma, malignant adnexal skin tumors, oral cavity cancer, and precursors of skin cancer). We used a random-effects meta-analysis to estimate pooled adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Thirty non-randomized studies (17 case-control, 13 cohort, no RCTs) were included. Thiazide diuretic users had a higher risk of malignant melanoma (17 studies; n = 10,129,196; pooled adjusted OR, 1.10; 95% CI, 1.04–1.15; p < 0.001; strength of evidence, very low; very small harmful effect), BCC (14 studies; n = 19,780,476; pooled adjusted OR, 1.05; 95% CI, 1.02–1.09; p = 0.003; strength of evidence, very low; very small harmful effect), and SCC (16 studies; n = 16,387,862; pooled adjusted OR, 1.35; 95% CI, 1.22–1.48; p < 0.001; strength of evidence, very low; very small harmful effect) than non-users. Thiazide diuretic use was also associated with a higher risk of lip cancer (5 studies; n = 161,491; pooled adjusted OR, 1.92; 95% CI, 1.52–2.42; p < 0.001; strength of evidence, very low; small harmful effect), whereas other secondary outcomes were inconclusive. Conclusions: Thiazide diuretics are associated with the risk of all skin cancer types, including malignant melanoma; thus, they should be used with caution in clinical practice.

Assessment of Adverse Drug Events, Their Risk Factors, and Management Among Patients Treated for Multidrug-Resistant TB: A Prospective Cohort Study From Pakistan.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a growing public health problem. Treatment regimens used against MDR-TB are costly, prolonged, and associated with more side effects as compared with the drug-susceptible tuberculosis. This study was framed to determine the incidence of adverse drug events, risk factors, and their management in MDR-TB patients. Methods: This prospective follow-up cohort study was conducted at the site of programmatic management of drug-resistant TB located at the Pakistan Institute of Medical Sciences, Islamabad. All patients, irrespective of their age, gender, and ethnicity, were included in the study. Adverse drug events were observed in patients at different time points during the study. Patients enrolled for the treatment from January 2018 were prospectively followed till December 2020 up to their end treatment outcomes. Results: Out of 126 MDR-TB patients enrolled for treatment, 116 met the inclusion criteria and were included in the final analysis. Most patients (50.9%) were between 18 and 45 years of age. A minimum of one adverse event was experienced by (50.9%) patients. Of all the adverse events, gastrointestinal disorders were more frequent (47.4%), followed by arthralgia (28.4%) and psychiatric disturbance (20.6%). Furthermore, multivariate analysis showed a significant association with the incidence of adverse events in patients with age group above 60 years (odds ratio (OR) 4.50; 95% CI 1.05-19.2), active smokers (OR 4.20; 95% CI 1.31-13.4), delayed reporting to the TB center (OR 4.03; 95% CI 1.34-12.1), and treatment without bedaquiline regime (OR 3.54; 95% CI 1.23-10.1). Most of the patients (94.6%), counseled by the pharmacist, were found to be satisfied with the information provided and looked for more pharmacist counseling opportunities in the management of MDR-TB. Conclusion: Current findings recommend that ADEs might be well managed by timely identification and reporting. Bedaquiline coupled with other active medications lowered the chance of ADEs in MDR-TB patients. Elderly patients, active smoking behavior, and those who have a delay in the treatment initiation are more prone to ADEs. Clinical pharmacist’s contribution to TB control programs may help caregivers and patients concerning the rational use of medication, early detection, and management of ADEs.

Pharmaceutical services in public hospitals in Mexico: a cross-sectional study

To describe the provision of pharmaceutical services within Ministry of Health hospitals in Mexico and identify the main factors that affect their implementation. Between November 2018 and April 2019, we conducted telephone interviews with the heads of pharmacy departments of 413 state and federal Ministry of Health hospitals in Mexico. Responses were analyzed with descriptive and inferential statistics to determine the main factors influencing the implementation of pharmaceutical services within these public hospitals. Of the 413 hospitals, a total of 96 hospitals in 27 states reported the provision of at least one pharmaceutical service. The most frequently reported services were: patient education on the correct use of medications (23%), provision of information to other health professionals on the rational use of medications (21%), and participation in the hospital´s pharmacovigilance system (19%). The main factors associated with the implementation of HPS were the number of pharmacists (46%, n = 215, p=0.001) and the pharmaceutical- or health sciences-oriented education of the head of the pharmacy department of the hospital (46%, n = 215, P = 0.001). Hiring more pharmacists and ensuring the appropriate professional education of the head of the pharmacy department are key factors to expanding the implementation of pharmaceutical services in Mexico's public hospitals.

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

AbstractPediatric seizures are one of the most common neurological manifestations seen in pediatrics. Unravelling the etiology, timely and appropriate investigations followed by suitable therapies are essential for improving quality of life. During the pandemic, focused group discussions were conducted among 50 pediatric neurologists across five cities in India to gather insights on treatment practices in pediatric epilepsy and to optimize therapeutic strategies and alternative approaches for rational use of antiepileptic medications. These discussions were mainly aimed at reviewing current literature on prevalence, etiology, diagnosis, and management of epilepsy in children and subsequently rationalizing diagnostic and treatment approaches in routine clinical practice. Epileptic encephalopathies comprise of childhood epilepsy with progressive cerebral dysfunction. Genomics plays a vital role in identifying the underlying genetic associations, empowering precision therapy. Currently, the ketogenic diet has become a well-recognized modality for reducing severity of seizures. To overcome the high incidence of adverse effects due to older antiepileptic drugs, newer drugs are being developed to improve ease of use, diminish drug interactions, decrease adverse effects, and identify drugs with unique mechanisms of action. Common lacunae in practice include information gaps, educating parents, or caregivers about rational drug use and ensuring compliance to antiepileptic medications. This article discussed the consensus clinical viewpoint of expert clinicians, as well as insights on optimized treatment of pediatric epilepsies in both infancy and childhood. It also discusses aspects, like reducing drug burden, emerging therapies in the identification of the genetic basis of epilepsies, and targeted therapy alternatives, for pediatric populations in the Indian scenario.

Investigating the knowledge, perception, and practice of healthcare practitioners toward rational use of compounded medications and its contribution to antimicrobial resistance: a cross-sectional study

BackgroundPharmaceutical compounding ensures access of individuals with specific requirements to individualized therapy. However, there is an inconsistency of compounded medication quality. Therefore, advancing the rational use of compounded medication is essential for patient safety and medication effectiveness.ObjectiveThe presented study was aimed to investigate the healthcare practitioners’ knowledge, perception, and practice of extemporaneous compounding and its contribution to the prevalence of antimicrobial resistance.MethodA descriptive cross-sectional survey using a structured questionnaire was conducted. The study participants were 300 healthcare practitioners working in Jimma University Medical Center, hospital pharmacies, and community pharmacies in Jimma and Mettu Town, Southwest Ethiopia.ResultsMost respondents were pharmacists (62.7%) and first-degree holders (48.3%). The majority of them had experience in administering (57.7%), preparing (38%), prescribing (21%), and repackaging and labeling (14%) compounded medications. Commonly they request compounded medications when prepackaged products (77.7%) and needed dosage regimens (72.3%) were not available in the market. However, most of them believed that compounded medications might lack quality (49%) and had poor patient compliance (40.7%). Moreover, they fear that inappropriate preparation processes (75%) and under-dose administration (59%) of compounded medication might contribute to the development and prevalence of antimicrobial resistance.ConclusionMost healthcare practitioners practice rational use of compounded medications and strongly agree that inappropriate compounding of antimicrobials contributes to antimicrobial resistance development.

Epilepsy With Suicide: A Bibliometrics Study and Visualization Analysis via CiteSpace.

Objective:The purpose of this study was to analyze the research status of epilepsy with suicide and to determine the hotspots and frontiers via CiteSpace.Method:We searched the Web of Science Core Collection (WoSCC) for studies related to epilepsy and suicide from inception to September 30, 2021. We used CiteSpace to generate online maps of collaboration between countries, institutions, and authors, and revealed hot spots and frontiers in epilepsy with suicide.Results:A total of 631 publications related to epilepsy with suicide were retrieved from the WoSCC. Andres M. Kanner was the most published author (25 papers). The USA and Columbia University were the leading country and institution in this field, with 275 and 25 papers, respectively. There were active cooperation between institutions, countries, and authors. Hot topics focused on depression, antiseizure medications, pediatric epilepsy, and risk factors of suicide in patients with epilepsy (PWEs).Conclusions:Based on the CiteSpace findings, this study detected active collaboration among countries, institutions and authors. The main current research trends include suicide caused by depression, suicide caused by the use of antiseizure medications, suicide in children with epilepsy, and risk factors for suicide in PWEs. Thus, more attention should be paid to the psychiatric comorbidity of PWEs (especially pediatric epilepsy), the suicidal tendency of PWEs, and the rational use of antiseizure medications in the future.